Current trends in early rehabilitation of patients after total hip and knee replacement

Abstract

The OBJECTIVE of the study was to analyze specialized publications concerning the tactics of rehabilitation treatment of patients after total knee and hip replacement based on the Fast-track protocol.METHODS AND MATERIALS. We presented a systematic review of current literature, including 80 publications with a search depth of up to 45 years.RESULTS. Components of the enhanced recovery program for large joint replacement are as follows: Preoperative stage: patient education, extremity joint exercises with a rehabilitation specialist, breathing exercises, avoidance of premedication with opioid analgesics, oral multimodal analgesia, preoperative oral carbohydrate load, absence of fluids in the oral cavity 2–3 hours before surgery, avoidance of preoperative fasting. Intraoperative stage: spinal or combined anesthesia, the use of regional anesthesia, intravenous dexamethasone, the use of tranexamic acid, intraoperative avoidance of excessive intravenous administration of colloid and crystalloid solutions, active intraoperative warming. Postoperative stage: multimodal oral analgesia, early mobilization (6–12–24 hours after surgery), passive-active exercises for 12–24 hours after surgery, preparation for verticalization.CONCLUSION. The most popular hardware methods are mechanotherapy, cryotherapy, laser therapy, magnetic therapy and electrical neuromyostimulation. The introduction of computer technology into the postoperative rehabilitation program after large joints replacement makes it possible to restore an individual gait stereotype. A potentially promising direction is the introduction of artificial intelligence into early rehabilitation methods.