Up to 25% of patients after knee arthroplasty are not satisfied with the results of the operation. Revision interventions are performed in 60–80% of cases in the first 2–5 years after the primary arthroplasty. Aim. To evaluate the effectiveness of the early postoperative rehabilitation comprehensive program from the standpoint of the International Classification of Functioning (ICF) to improve the results of rehabilitation after arthroplasty. Material and methods. The results of 180 patients rehabilitation after the total knee arthroplasty (TKA) with simultaneous reconstruction of the lower limb biological axis were evaluated in two groups: I – observations (n=120), II – comparisons (n=60). Postoperative rehabilitation in the group I was carried out according to of the early rehabilitation comprehensive program after TKA, developed in the clinic, in the group II – according to the standard scheme. State of the patient was assessed by the dynamics of the pain syndrome, lower limbs muscle strength, goniometric indicators, the severity of lameness, muscle hypotrophy, limb shortening value, functional activity and quality of life. For analysis of changes in the level of damage according to the ICF, clinical tests were used. Results. From the standpoint of the ICF, the results of patients using the early postoperative rehabilitation program were equal or superior to the results of the comparison group. Conclusion. A rehabilitation program for patients after TKA, formed on the basis of a system for assessing the structural, functional and social adaptation characteristics of the patient, is effective and allows to predict the effectiveness of the rehabilitation technologies.

BACKGROUND: General injury rates tend to increase in most federal districts of Russia. The patients with fractures of the bones of the lower extremities reaches for 8.525% of the total number of patients with fractures. Fractures of the bones of the lower extremities are characterized by long period of reparation, persistent contractures, a violation of the congruence of the articular surfaces, and changes in the biomechanics of walking. Only full course of rehabilitation can eliminate the these complications and restore the previous motor activity. АIMS: The study aimed to analyze the structure of injuries in patients of the traumatology department and to present and the results of the recovery of patients with fractures of the bones of the lower extremities using and algorithm of organization of medical rehabilitation in the case study. MATERIALS AND METHODS: A retrospective analysis of statistical data on 995 patients of the traumatology department № 1 of the Kazan City Clinical Hospital, who underwent 981 operations, was carried out. Randomly selected two groups of patients ― I main (n=45) and II control (n=45). Patients of group II after the treatment at the trauma center underwent outpatient medical rehabilitation, group I received inpatient medical rehabilitation in the rehabilitation department of the Kazan City Clinical Hospital № 7. In a hospital setting, a comprehensive rehabilitation program included physiotherapy exercises, CPM-veloergometry, exercises on rehabilitation simulators, the PNF kinesiotherapy technique, etc. RESULTS: A more pronounced statistically significant positive dynamics at the end of the course of medical rehabilitation was noted in patients of group I (reduction of pain syndrome, increased joint mobility, degree of dependence on others, increased mobility index, the ability to dress independently, maintain body position in space, reduced dysfunction in lifting and carrying objects, walking disorders, and caring for body parts). The dynamics of motor function and psycho-emotional sphere also improved to a greater extent in patients of group I. CONCLUSIONS: The effectiveness of the presented algorithm of organization of medical rehabilitation of patients with fractures of the bones of the lower extremities is confirmed by the results of present study. It is revealed that patients in the I (main) group showed more significant improvement in functions, activity and participation, a decrease of disability, reduce of pain, anxiety and depression, as well as an increase of the level of quality of life compared to patients of group II (control), who did not receive comprehensive medical rehabilitation in the hospital (p 0.1).

To date, the introduction of the International Classification of Functioning, Disability and Health (ICF) into the practical work of rehabilitation institutions and units of different levels and different profiles is a key moment in the organization of the rehabilitation process in accordance with a new legislative framework and a new model of the medical rehabilitation system being created in Russia. Namely, the ICF is the basis for the rehabilitation diagnosis formulation as well as rehabilitation goals and the development of the rehabilitation strategy for each individual patient, and the practical ICF use presents the greatest difficulties for members of the multidisciplinary rehabilitation team (MDRT), since it requires to restructure their thinking stereotypes and behavior « from dysfunction – to limitation of activity», «from correction of disorders to restoration of activity». In this regard, the ICF usage issues in the process of rehabilitation of patients who underwent arthroplasty of large joints, presented in this article, are very relevant. Aim. To describe the most frequent ICF domains used in the formulation of a rehabilitation diagnosis in patients who have undergone the lower limb joints replacement. Conclusion. Identification of key problems based on ICF in patients undergoing total knee and hip arthroplasty allows a more focused and specialized approach to the rehabilitation process for this category of patients, correct formulation of rehabilitation goals and drawing up a plan of rehabilitation measures. In patients who have yet to undergo joint replacement, the use of classification allows to clarify the indications for surgical intervention.