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Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2021; 31(03): 170-176
DOI: 10.1055/a-1368-6429
Review

Hydrotherapy Intervention for Patients Following Total Knee Arthroplasty: A Systematic Review

Hydrotherapie-Interventionen für Patienten nach Knie-Totalendoprothesen: eine systematische Übersicht
Youguang Zhuo
1   Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
,
Rongguo Yu
1   Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
,
Chunling Wu
1   Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
,
Yiyuan Zhang
2   Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou Fujian, People’s Republic of China, Fuzhou, China
› Author Affiliations Funding: There is no funding for this article.
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Abstract

Background Hydrotherapy or aquatic exercise has long been known as a source of postoperative rehabilitation proposed in routine clinical practice. However, the effect on clinical outcome as well as the optimal timing of hydrotherapy in patients undergoing total knee arthroplasty (TKA) remain unclear. The purpose of this review was to assess the influence of aquatic physiotherapy on clinical outcomes and evaluate the role of the timing of aquatic-therapy for clinical outcomes after undergoing TKA.

Methods An extensive literature search was performed in Embase, PubMed, and the Cochrane Library for randomized controlled trials (RCTs) that evaluated the impact of hydrotherapy on patients after TKA. The methodological quality of the trials was evaluated based on the Cochrane Risk of Bias Tool.

Results All available studies on postoperative hydrotherapy after TKA were included. The primary endpoint was to evaluate the effect of hydrotherapy on clinical outcomes. The secondary outcome was to explore the role of the timing of aquatic therapy for clinical outcomes following TKA.

Conclusion Although definitive conclusions could not be reached due to insufficient data, most studies indicated that participants benefited from aquatic-therapy in muscle strength, rather than gait speed, after TKA. Currently available data demonstrated that early postoperative hydrotherapy possessed a greater potential to improve clinical outcomes in main clinical scores and quality-adjusted life years (QALYs).

Zusammenfassung

Hintergrund Hydrotherapie oder Wassergymnastik ist seit langem als Therapieoption in der postoperativen Rehabilitation bekannt und ist Teil der klinischen Routinepraxis. Die Auswirkung auf das klinische Ergebnis sowie der optimale Zeitpunkt für eine Hydrotherapie bei Patienten nach einer Knietotalendoprothese (Knie-TEP) sind jedoch noch unklar. Ziel dieser Übersichtsarbeit war es, den Einfluss von Physiotherapie im Wasser auf das klinische Ergebnis sowie die Rolle des Zeitpunkts einer Wassertherapie für das klinische Ergebnis nach einer Knie-TEP zu bewerten.

Methoden Es wurde eine umfangreiche Literatursuche in Embase, PubMed und der Cochrane Library nach randomisierten kontrollierten Studien (RCTs) durchgeführt, die den Einfluss von Hydrotherapie auf Patienten nach Knie-TEP evaluierten. Die methodische Qualität der Studien wurde anhand des Cochrane Risk of Bias Tools bewertet.

Ergebnisse Alle verfügbaren Studien zur postoperativen Hydrotherapie nach Knie-TEP wurden eingeschlossen. Der primäre Endpunkt war die Bewertung der Wirkung einer Hydrotherapie auf das klinische Ergebnis. Der sekundäre Endpunkt war die Untersuchung der Rolle des Zeitpunkts einer Wassertherapie für die klinischen Ergebnisse nach Knie-TEP.

Schlussfolgerung Obwohl aufgrund der unzureichenden Datenlage keine endgültigen Schlussfolgerungen gezogen werden konnten, deuteten die meisten Studien darauf hin, dass die Teilnehmer nach Knie-TEP von der Aquatherapie eher in Bezug auf die Muskelkraft als auf die Ganggeschwindigkeit profitierten. Die derzeit verfügbaren Daten zeigten, dass eine frühe postoperative Hydrotherapie eher eine Verbesserung der klinischen Ergebnisse in den wichtigsten klinischen Scores und qualitätskorrigierten Lebensjahren (QALYs) bewirken konnte.

Key words

Aquatic exercise - Hydrotherapy - Rehabilitation - Systematic review - Total knee arthroplasty

Schlüsselwörter

Wassergymnastik - Hydrotherapie - Rehabilitation - Systematische Übersichtsarbeit - Knietotalendoprothese (Knie-TEP)

Supplementary Material



Publication History

Received: 23 September 2020

Accepted: 18 January 2021

Article published online:
26 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Tang X, Wang S, Zhan S. et al. The prevalence of symptomatic knee osteoarthritis in china: results from the china health and retirement longitudinal study. Arthritis Rheumatol 2016; 68: 53
    CrossrefPubMedGoogle Scholar
  • 2 Postler A, Ramos AL, Goronzy J, Günther KP, Lange T, Schmitt J, Zink A, Hoffmann F. Prevalence and treatment of hip and knee osteoarthritis in people aged 60 years or older in Germany: an analysis based on health insurance claims data. Clin Interv Aging 2018; 13: 2339-2349
    CrossrefPubMedGoogle Scholar
  • 3 Kucharz EJ, Szántó S, Ivanova Goycheva M, Petronijević M, Šimnovec K, Domżalski M, Gallelli L, Kamenov Z, Konstantynowicz J, Radunović G, Šteňo B, Stoilov R, Stok R, Vrana R, Bruyère O, Cooper C, Reginster JY. Endorsement by Central European experts of the revised ESCEO algorithm for the management of knee osteoarthritis. Rheumatol Int 2019; 39: 1117-1123
    CrossrefPubMedGoogle Scholar
  • 4 Bruyère O, Honvo G, Veronese N. et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Seminars in Arthritis and Rheumatism 2019; 49: 337-350
    CrossrefPubMedGoogle Scholar
  • 5 Koh IJ, Kim TK, Chang CB, Cho HJ. In Y. Trends in use of total knee arthroplasty in Korea from 2001 to 2010. Clin Orthop Relat Res 2013; 471: 1441-1450
    CrossrefPubMedGoogle Scholar
  • 6 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89: 780-785
    CrossrefPubMedGoogle Scholar
  • 7 Duggal N. Improving orthopedic outcomes: focus on rehabilitation. Orthopedics 2007; 30: 339-341
    PubMedGoogle Scholar
  • 8 Youm T, Maurer SG, Stuchin SA. Postoperative management after total hip and knee arthroplasty. J Arthroplasty 2005; 20: 322-324
    CrossrefPubMedGoogle Scholar
  • 9 Harmer AR, Naylor JM, Crosbie J, Russell T. Land-based versus water-based rehabilitation following total knee replacement: a randomized, single-blind trial. Arthritis Rheum 2009; 61: 184-191
    CrossrefPubMedGoogle Scholar
  • 10 Chae CS, Jun JH, Im S, Jang Y, Park GY. Effectiveness of Hydrotherapy on Balance and Paretic Knee Strength in Patients With Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Phys Med Rehabil 2020; 99: 409-419
    CrossrefPubMedGoogle Scholar
  • 11 Tidhar D, Drouin J, Shimony A. Aqua lymphatic therapy in managing lower extremity lymphedema. J Support Oncol 2007; 5: 179-183
    PubMedGoogle Scholar
  • 12 Mannerkorpi K, Nyberg B, Ahlmen M, Ekdahl C. Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. J Rheumatol 2000; 27: 2473-2481
    PubMedGoogle Scholar
  • 13 Dong R, Wu Y, Xu S. et al. Is aquatic exercise more effective than land-based exercise for knee osteoarthritis?. Medicine (Baltimore) 2018; 97: e13823
    CrossrefPubMedGoogle Scholar
  • 14 Erler K, Anders C, Fehlberg G, Neumann U, Brucker L, Scholle HC. Objective assessment of results of special hydrotherapy in inpatient rehabilitation following knee prosthesis implantation [German]. Z Orthop Ihre Grenzgeb 2001; 139: 352-358
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Becker BE. Biophysiologic aspects of hydrotherapy. In Cole AJ, Becker BE. Comprehensive aquatic therapy. Philadelphia: Butterworth Heinemann; 2004
    Google Scholar
  • 16 Sekome K, Maddocks S. The short-term effects of hydrotherapy on pain and self-perceived functional status in individuals living with osteoarthritis of the knee joint. S Afr J Physiother 2019; 75: 476 Published 2019 Jul 24
    CrossrefPubMedGoogle Scholar
  • 17 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med 2009; 6: e1000097
    CrossrefPubMedGoogle Scholar
  • 18 Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC. et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928
    CrossrefPubMedGoogle Scholar
  • 19 Rahmann AE, Brauer SG, Nitz JC. A specific inpatient aquatic physiotherapy program improves strength after total hip or knee replacement surgery: a randomized controlled trial. Arch Phys Med Rehabil 2009; 90: 745-755
    CrossrefPubMedGoogle Scholar
  • 20 Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. Effects of aquatic resistance training on mobility limitation and lower-limb impairments after knee replacement. Arch Phys Med Rehabil 2010; 91: 833-839
    CrossrefPubMedGoogle Scholar
  • 21 Valtonen A, Pöyhönen T, Sipilä S, Heinonen A. Maintenance of aquatic training-induced benefits on mobility and lower-extremity muscles among persons with unilateral knee replacement. Arch Phys Med Rehabil 2011; 92: 1944-1950
    CrossrefPubMedGoogle Scholar
  • 22 Giaquinto S, Ciotola E, Dall'Armi V, Margutti F. Hydrotherapy after total knee arthroplasty. A follow-up study. Arch Gerontol Geriatr 2010; 51: 59-63
    CrossrefPubMedGoogle Scholar
  • 23 Liebs TR, Herzberg W, Rüther W. et al. Multicenter randomized controlled trial comparing early versus late aquatic therapy after total hip or knee arthroplasty. Arch Phys Med Rehabil 2012; 93: 192-199 DOI: 10.1016/j.apmr.2011.09.011.
    CrossrefPubMedGoogle Scholar
  • 24 Liebs TR, Herzberg W, Rüther W, Russlies M, Hassenpflug J. Multicenter Arthroplasty Aftercare Project, MAAP. Quality-Adjusted Life Years Gained by Hip and Knee Replacement Surgery and Its Aftercare. Arch Phys Med Rehabil 2016; 97: 691-700 DOI: 10.1016/j.apmr.2015.12.021.
    CrossrefPubMedGoogle Scholar
  • 25 Villalta EM, Peiris CL. Early aquatic physical therapy improves function and does not increase risk of wound-related adverse events for adults after orthopedic surgery: a systematic review and meta-analysis. Arch Phys Med Rehabil 2013; 94: 138-148
    CrossrefPubMedGoogle Scholar
  • 26 Bartels EM, Juhl CB, Christensen R. et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev 2016; 3: CD005523 DOI: 10.1002/14651858.CD005523.pub3.
    CrossrefPubMedGoogle Scholar
  • 27 Bartholdy C, Juhl C, Christensen R, Lund H, Zhang W, Henriksen M. Therole of muscle strengthening in exercise therapy for knee osteoarthritis: A systematic review and meta-regression analysis of randomized trials. Semin Arthritis Rheum 2017; 47: 9-21
    CrossrefPubMedGoogle Scholar
  • 28 Aquatic Cycling Improves Knee Pain and Physical Functioning in Patients With Knee Osteoarthritis: A Randomized Controlled Trial [published online ahead of print, 2020 Mar 10]. Arch Phys Med Rehabil. 2020; S0003-999330147-30147
    PubMed
  • 29 Ivey FM, Tracy BL, Lemmer JT. et al. Effects of strength training and detraining on muscle quality: age and gender comparisons. J Gerontol A Biol Sci Med Sci 2000; 55: B152-7 discussion B158-B159
    CrossrefPubMedGoogle Scholar
  • 30 Taaffe DR, Henwood TR, Nalls MA, Walker DG, Lang TF, Harris TB. Alterations in muscle attenuation following detraining and retraining in resistance-trained older adults. Gerontology 2009; 55: 217-223
    CrossrefPubMedGoogle Scholar
  • 31 Gusi N, Tomas-Carus P, Hakkinen A, Hakkinen K, Ortega-Alonso A. Exercise in waist-high warm water decreases pain and improves health-related quality of life and strength in the lower extremities in women with fibromyalgia. Arthritis Rheum 2006; 55: 66-73
    CrossrefPubMedGoogle Scholar
  • 32 Tomas-Carus P, Hakkinen A, Gusi N, Leal A, Hakkinen K, OrtegaAlonso A. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Med Sci Sports Exerc 2007; 39: 1044-1050
    CrossrefPubMedGoogle Scholar
  • 33 Paxton EW, Torres A, Love RM, Barber TC, Sheth DS, Inacio MCS. Total joint replacement: A multiple risk factor analysis of physical activity level 1-2 years postoperatively. Acta Orthop 2016; 87: 44-49
    CrossrefPubMedGoogle Scholar
  • 34 Ranawat CS, Ranawat AS, Mehta A. Total knee arthroplasty rehabilitation protocol: what makes the difference?. J Arthroplasty 2003; 18 (3 Suppl 1): 27-30
    CrossrefPubMedGoogle Scholar
  • 35 Antonelli M, Donelli D. Effects of balneotherapy and spa therapy on levels of cortisol as a stress biomarker: a systematic review. Int J Biometeorol 2018; 62: 913-924 DOI: 10.1007/s00484-018-1504-8.
    CrossrefPubMedGoogle Scholar
  • 36 Antonelli M, Donelli D, Fioravanti A. Effects of balneotherapy and spa therapy on quality of life of patients with knee osteoarthritis: a systematic review and meta-analysis. Rheumatol Int 2018; 38: 1807-1824
    CrossrefPubMedGoogle Scholar
  • 37 Mayr HO, Reinhold M, Bernstein A, Suedkamp NP, Stoehr A. Sports activity following total knee arthroplasty in patients older than 60 years. J Arthroplasty 2015; 30: 46-49
    CrossrefPubMedGoogle Scholar
  • 38 Winther SB, Foss OA, Wik TS, Davis SP, Engdal M, Jessen V, Husby OS. 1-year follow-up of 920 hip and knee arthroplasty patients after implementing fast-track. Acta Orthop 2015; 86: 78-85
    CrossrefPubMedGoogle Scholar