About the monograph by N.S. Nikolaev and R.V. Petrova “Physical rehabilitation of patients after arthroplasty of large joints of the lower extremities”

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Abstract


The article presents the experience of implementing a systematic approach to medical rehabilitation of patients after hip and knee arthroplasty using the example of the Federal Center for Traumatology, Orthopedics and Arthroplasty in Cheboksary. The monograph of the authors — direct participants in the process — contains practical recommendations, author’s techniques, recommended complexes of physiotherapy after arthroplasty of large joints of the lower extremities.


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Introduction. With the development of high-tech medical care in Russia in the field of traumatology and orthopedics, joint replacement is the first priority, and most often patients turn to this type of surgical treatment for coxarthrosis and gonarthrosis with a pronounced violation of the functional (stato-dynamic) state of the joints, accompanied by pain.

In Russia, a huge number of people suffer from osteoarthritis - the total incidence is 3646.3 per 100 thousand adults. According to an epidemiological study conducted in the Russian Federation, the frequency of osteoarthritis of the knee and / or hip joints among a population older than 18 is 13%.

Over the past 20 years, the number of patients with osteoarthritis has more than doubled, due primarily to an increase in the life expectancy of the population and the number of overweight people. All this determines the high medical and social importance of the problem of osteoarthritis and dictates the need to provide high-quality medical care and supervision at all stages of treatment and rehabilitation of such patients.Since the experience of the wide spreading of this type of operations in our country has a little more than 10 years, not all Russian orthopedic traumatologists own these methods. Moreover, few of them have sufficient knowledge and experience of outpatient "management" of such patients after discharge from the hospital. The growth of surgical skill is only one of the components of a good surgical outcome.The role of postoperative medical rehabilitation at its 2nd and 3rd stages is repeatedly increasing as an equally important link in patient recovery. Here we also have “bottlenecks” in terms of the readiness of physiotherapists, exercise therapy doctors, exercise therapy instructors to fully recover this category of patients in the outpatient unit, since medical rehabilitation after endoprosthetics began to develop only in the last 5-7 years.

The authors of the work presented to readers are experienced practitioners, an operating orthopedic traumatologist, doctor of medical sciences, professor N.S. Nikolaev and a physiotherapist with experience in medical rehabilitation for more than 30 years R.V. Petrova - they represent 10 years of experience working in a single-discipline clinic of federal significance in the new conditions for the provision of high-tech medical care in the field of «Traumatology and Orthopedics». This monograph is the first experience in summarizing modern approaches to the restoration of the motor functions of patients after knee and hip arthroplasty, which has been used in 2009 at one of the nine federal Russian centers for traumatology, orthopedics and endoprosthetics - Federal State Budgetary Institution FTSTOE of the Russian Ministry of Health (Cheboksary). More than 70% of patients of the Cheboksary Center receive surgical treatment in the volume of endoprosthetics of large joints of the lower extremities. Over the years, more than 50 thousand endoprosthetics of the knee and hip joints have been performed here (5-6 thousand operations annually). Not every trauma-orthopedic clinic (even in Europe) has such a great clinical practice of performing such operations. Accordingly, the experience of rehabilitation of these patients at the Center is enormous. It is enough to say that over the past years the average length of hospitalization of this category of patients has been reduced by almost half - from 10.6 to 6.3 days, mainly due to the use of modern methods of comprehensive rehabilitation in the early postoperative period. Speaking about the leading role of medical rehabilitation after joint replacement, it is necessary to note that the Center was one of the first in the country to formulate approaches and introduce the II and III stages of postoperative rehabilitation. Not the last role in this process was played by the institution's active and successful participation in the Russian pilot project «Development of a medical rehabilitation system in the Russian Federation» in the provision of rehabilitation assistance after hip joint replacement in 2015-2016.  The task of doctors during joint arthroplasty is not only to replace the joint itself and return the patient to motor activity, but also to minimize possible complications. Prevention of postoperative complications in the present is an important component of the effectiveness of the operation in the future. The authors of the monograph aimed not only to tell readers in detail about arthroplasty, but mainly to show how to avoid complications with the help of well-conducted rehabilitation and the use of preventive measures for postoperative complications. The importance of a multimodal approach to pain management during knee replacement is emphasized. An important role of ultrasound diagnostics in the process of early detection of postoperative hematomas was noted. The material on the basic principles of patients' routing at the stages of rehabilitation is accompanied by a detailed description of a whole arsenal of rehabilitation methods and tools. In the monograph you can not only find the basic methods, but also take into account the evaluation tools (scales) and criteria for evaluating the effectiveness of the rehabilitation. The authors did not forget to tell readers about the specifics of selecting patients for endoprosthetics, drawing their attention to the assessment of the comorbid background and perioperative risk factors, which is also often difficult for practicing trauma surgeons of the outpatient department.  The publication is competently structured, equipped with a glossary and a chapter with a description of terminology on this issue. Here, the history of the development of joint arthroplasty in the world and in the Russian Federation is phased in, links to almost 40 relevant literature on the topic and a list of current regulatory documents governing the provision of trauma and orthopedic care in Russia today are included. Authors generously share with readers their own developments and proprietary techniques that help to systematize information about the patient and the rehabilitation measures he is conducting. First of all, these are the Rehabilitation Route Scale developed at the Center and integrated into the medical information system, individual programs for the medical rehabilitation of patients after knee and hip arthroplasty, and an individual patient record in the early postoperative period. The “know-how” of the Center’s staff is also the Patient School information and educational system for working with patients described in the monograph. The given clinical examples of rehabilitation of patients with various rehabilitation potential are of some value to the reader. The important role of an integrated approach to this process with the participation of a multidisciplinary team of specialists with the definition of the role of each of them is emphasized. The book has many illustrations, diagrams and applications for use in the daily work of a doctor. Complexes of physiotherapy exercises for patients after hip knee arthroplasty are intended to replenish the baggage of knowledge of exercise therapy instructors and exercise therapy doctors.Conclusions. The monograph is an excellent practical tool not only for the specialists mentioned above, but also an aid for teachers of medical universities in the fields of «Traumatology and Orthopedics», «Medical Rehabilitation», students and residents of this specialty, will also bring undeniable benefits to the specialists of rehabilitation centers. The expert in rehabilitation, M. B. Tsykunov - doctor of medical sciences, professor, head of the rehabilitation department of the National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorova »Ministry of Health of Russia. After reading this book, each specialist will find something new for himself, expand his medical horizons and actualize his vision of the problem of rehabilitation of patients with osteoarthritis, which, ultimately, will improve the quality of medical care for patients after such a serious type of surgical treatment as endoprosthetics.

About the authors

Alexander V. Novikov

Federal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian Federation

Email: novik2.55@mail.ru
ORCID iD: 0000-0001-8099-3791

Russian Federation, 10/1, Minin and Pozharsky square, Nizhny Novgorod, 603005

MD, PhD

Elena A. Galova

Federal State Budgetary Educational Institution of Higher Education “Privolzhsky Research Medical University” of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: galova75@mail.ru
ORCID iD: 0000-0002-9574-2933

Russian Federation, 10/1, Minin and Pozharsky square, Nizhny Novgorod, 603005

PhD

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Copyright (c) 2020 Novikov A.V., Galova E.A.

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