人工股関節全置換術後のリハビリテーションを今回は見ていきたいと思います。病院内で働かないので、結構見ないんですよね。だから、多少忘れてしまうので、復習の意味も込めてみていきたいと思います！！＾＾
術後のリハだから、はっきりいって簡単です。楽勝です！
According to Okoro et al. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2012, 4:5,
’Standard physiotherapy’, (i.e. not involving resistance training) following major surgery enables most patients to regain basal levels of function but leaves them with significant muscle wasting as it lacks the intensity of exercise required to elicit muscle hypertrophy. The most commonly used rehabilitation regimes for it seems that elderly individuals are based on functional types of exercises without external loading. However, this type of intervention not only fails to elicit increases in muscle mass but does not prevent further muscle atrophy.
In contrast, high-intensity PRT is an extremely effective and safe method for inducing muscle hypertrophy and increasing muscle strength and subsequently improving functional performance in healthy individuals, those with chronic disease e.g. rheumatoid arthritis, and the elderly.
interestingly, these authors described that
An unpublished survey from our institution of physiotherapy practice around the UK after THR revealed that 73% of qualified physiotherapists knew what progressive resistance training entailed but only 32% used it in their prescribed programs after THR.
術前の時点でかなり筋肉量また機能性も著しく低下していますから、術後１年たっても、低下したままなんて報告もありますから、注意が必要です。 （ROMと痛みは改善してるけど、機能性は回復してないみたいです、標準のリハでは）
まず、術後にて注意事項を箇条書きにしていきます。 （Total hip arthroplasty - By Mark A. Brimer)
注意しなければいけないのが、いつから、どれだけ歩行していいのか、って事ですね。その次に重要なのが、自己ケア、ベットからの移動、そして、可動域制限ですね。これは、かなり重要ですね。
脱臼は必ず避けていきましょう！(Avoid dislocation forces at hip, which are a combination of hip flexion, adduction and internal rotation; no hip flexion greater than 90）
Initial 6 weeks (術後6週間まで）
1. Most THA procedures require the presence of an abduction pillow or wedge placed between the legs when the patient is in bed or in a wheelchair.
2. Patients are cautioned not to exceed 90 of flexion of the operative hip.
3. Passive or forcible movement of the hip that causes pain is contraindicated.
4. Internal rotation and adduction are contraindicated.
5. The patient is encouraged to perform active ankle exercises (rhythmic active dorsal and plantar flexion) frequently during the first few days postoperatively to prevent thrombophlebitis.
6. No weight-bearing or standing should take place unless under the direct supervision of the physical therapist.
7. Transfers and log-rolling should be performed away from the operative side, with the leg supported by a staff member.
(From Echternach J 1990 Physical Therapy of the Hip. Churchill Livingstone, New York)
Strengthening rehabilitation (筋トレリハビリ）
- In the 6 weeks following surgery, rehabilitation should focus on hip abduction (presuming no contraindications exist) and mild hip flexor and extensor strengthening.
- The patient may progress tostanding with full weight-bearing, as permitted by the surgeon.
- A patient who has undergone the cementless technique may be required to maintain limited weight-bearing until sufficient new bone growth can be seen by the physician on a radiograph.
- A falls risk assessment should be part of the continuous re-examination process during rehabilitation.
