Comorbidity in the context of medical rehabilitation in patients after large joint replacement of the lower extremities

  • Authors: Kustova O.V.1,2, Khoziainova S.3, Ponomarenko G.N.4, Makhotkina N.N.5
  • Affiliations:
    1. Federal state budget institution Federal scientific and educational center of medical-social expertise and rehabilitation by him. G. A. Albrecht of the Ministry of Labour and Social Protection of the Russian Federation
    2. Federal state budget educational institution for higher education Northwestern State Medical University. . I. Mechnikova of the Ministry of Health of the Russian Federation
    3. ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России, ФГБУ ФНОЦ МСЭ и Р им. Г.А. Альбрехта Минтруда России
    4. ФГБУ ФНОЦ МСЭ и Р им. Г.А. Альбрехта Минтруда России, ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России
    5. ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России
  • Section: Original study articles
  • Submitted: 11.02.2025
  • Accepted: 30.07.2025
  • Published: 30.07.2025
  • URL: https://journals.eco-vector.com/0869-8678/article/view/655530
  • DOI: https://doi.org/10.17816/vto655530
  • ID: 655530


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Abstract

BACKGROUND: The effectiveness of restoring motor activity after total arthroplasty of large joints of the lower extremities (TALJLE) is determined by the initial level of physical activity, demographic characteristics, body mass index, comorbidities, and the presence of chronic pain.

AIM: To assess the impact of comorbid pathology on the effectiveness of medical rehabilitation in patients after TALJLE and to substantiate optimal approaches to restorative treatment.

MATERIALS AND METHODS: A cohort study was conducted involving 120 patients aged 55–70 years. Four groups were formed: control (no comorbidities), with arterial hypertension (AH), diabetes mellitus (DM), and overweight (OW). Rehabilitation included individualized therapeutic exercise sessions, mechanotherapy, physiotherapy, and locomotor correction using the HP cosmos robotic complex. Effectiveness was assessed using the Visual Analogue Scale (VAS), WOMAC scale, Lequesne Index, Harris Hip Score, goniometry, and biomechanical gait analysis.

RESULTS: All groups demonstrated positive dynamics; however, the degree of improvement depended on the presence and type of comorbidity. The most pronounced results were observed in the control group: VAS decreased from 5.56±0.82 to 1.21±0.07 points; flexion angle — from 122.06±3.39° to 95.58±1.27°; Lequesne Index — from 14.42±0.33 to 7.24±0.16; Harris Hip Score — from 47.90±1.55 to 79.92±0.75; WOMAC — from 48.36±1.54 to 13.42±1.04. In patients with AH, DM, and OW, the dynamics were less pronounced: pain reduction was from 5.62±0.95 to 1.45±0.09; from 5.89±0.98 to 1.68±0.11; and from 5.93±1.01 to 1.89±0.12 points, respectively. The lowest functional gain was observed in the OW group (WOMAC — from 48.33±1.53 to 24.74±3.47).

CONCLUSIONS: The presence of comorbid conditions slows the rate of functional recovery after TALJLE. The introduction of robotic mechanotherapy into early postoperative rehabilitation increases its effectiveness.

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About the authors

Oksana Vyacheslavovna Kustova

Federal state budget institution Federal scientific and educational center of medical-social expertise and rehabilitation by him. G. A. Albrecht of the Ministry of Labour and Social Protection of the Russian Federation; Federal state budget educational institution for higher education Northwestern State Medical University. . I. Mechnikova of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: o.v.kustova.med@mail.ru
ORCID iD: 0009-0007-1408-7492
SPIN-code: 8912-4449

Deputy chief rehabilitation physician - head of the FGBU Physical and Rehabilitation Medicine Center FNOC ITU and P II.  G.A. Albrechta of the Ministry of Labour of Russia; Associate Professor of Physical and Rehabilitation Medicine of the FGVU.  I.I. Mesnikova Ministry of Health of Russia, candidate of medical sciences

Russian Federation

Stella Khoziainova

ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России,
ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России,
ФГБУ ФНОЦ МСЭ и Р им. Г.А. Альбрехта Минтруда России

Email: stella.khozyainova@gmail.com
ORCID iD: 0000-0002-7231-6018
SPIN-code: 4950-2424

преподаватель кафедры физической и реабилитационной медицины ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России,

ассистент кафедры физической и реабилитационной медицины ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России, 

ассистент кафедры физической и реабилитационной медицины ФГБУ ФНОЦ МСЭ и Р им. Г.А. Альбрехта Минтруда России

ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России, ул. Академика Лебедева, д. 6, Санкт-Петербург, 194044, Российская Федерация; ассистент кафедры физической и реабилитационной медицины ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России, ул. Кирочная, д.41, Санкт-Петербург, 191015, Российская Федерация; ассистент кафедры физической и реабилитационной медицины ФГБУ ФНОЦ МСЭ и Р им. Г.А. Альбрехта Минтруда России, Бестужевская ул., д. 50, Санкт-Петербург, 195067, Российская Федерация

Gennady Nikolaevich Ponomarenko

ФГБУ ФНОЦ МСЭ и Р им. Г.А. Альбрехта Минтруда России,
ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России

Email: ponomarenko_g@mail.ru
ORCID iD: 0000-0001-7853-4473
SPIN-code: 8234-7005

Генеральный директор ФГБУ ФНОЦ МСЭ и Р им. Г.А. Альбрехта Минтруда России,

заведующий кафедрой физической и реабилитационной медицины ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России

ФГБУ ФНОЦ МСЭ и Р им. Г.А. Альбрехта Минтруда России, Бестужевская ул., д.50, Санкт-Петербург, 195067, Российская Федерация; ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России, ул. Кирочная, д.41, Санкт-Петербург, 191015, Российская Федерация

Nina Nugzarovna Makhotkina

ФГБОУ ВО СЗГМУ им. И.И. Мечникова Минздрава России

Email: mahotkinanina1@rambler.ru
ORCID iD: 0000-0003-4479-3295
SPIN-code: 7805-2703

доцент кафедры физической и реабилитационной медицины 

ул. Кирочная, д.41, Санкт-Петербург

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