Exercise Recommendations After Total Joint Replacement
Exercise Recommendations After Total Joint Replacement
复制标题
全关节置换术后的运动建议
作者：
M. Kuster
摘要本文对全关节置换术后的运动建议进行了文献综述，并提出了有科学依据的指导方针。应鼓励患者保持身体活动，以保持整体健康和骨骼质量。有证据表明，骨质量的提高将改善假体固定并降低早期松动的发生率。为了推荐全膝关节或髋关节置换术后的特定活动，必须考虑每个患者和运动的磨损，关节负荷，强度和假体类型等因素。研究表明，减少磨损是改善全关节置换术后长期结果的主要因素之一。磨损取决于载荷、步骤数和全关节置换的材料特性。最重要的问题是，某项活动究竟是为了获得和维持体能而进行的运动，还是纯粹为了消遣而进行的活动。为了保持身体健康，每周将进行几次高强度的耐力活动。由于负荷将以指数方式影响磨损量，因此仅建议进行关节负荷较低的活动，如游泳、骑自行车或可能的竞走。如果一项活动是在低强度的娱乐基础上进行的，那么也可以进行关节负荷较高的活动，如滑雪或徒步旅行。在全关节置换术后开始技术要求高的活动是不明智的，因为对于不熟练的人来说，这些活动的关节负荷和受伤风险通常较高。最后，重要的是要区分全膝关节置换术和全髋关节置换术后的适当活动。在全膝关节置换术后推荐合适的身体活动时，重要的是要考虑负荷和峰值负荷的膝关节屈曲角度，而对于涉及球窝关节的全髋关节置换术，屈曲角度并不起重要作用。在徒步旅行或慢跑等活动期间，膝关节屈曲40 °至60 °之间会出现高关节负荷，许多膝关节设计不符合要求，并且会出现高聚乙烯嵌体应力。对于目前大多数全膝关节假体，定期慢跑或徒步旅行会产生高嵌体应力，并有分层和聚乙烯破坏的危险。基于髋关节和膝关节置换之间的这些设计差异，对于膝关节屈曲时关节载荷较高的活动，全膝关节置换术后比全髋关节置换术后更保守是明智的。
AbstractThis article presents a literature review of the current recommendations regarding sports after total joint replacement and also suggests scientifically based guidelines. Patients should be encouraged to remain physically active for general health and also for the quality of their bone. There is evidence that increased bone quality will improve prosthesis fixation and decrease the incidence of early loosening. To recommend a certain activity after total knee or hip replacement, factors such as wear, joint load, intensity and the type of prosthesis must be taken into account for each patient and sport. It has been shown that the reduction of wear is one of the main factors in improving long-term results after total joint replacement. Wear is dependent on the load, the number of steps and the material properties of total joint replacements. The most important question is, whether a specific activity is performed for exercise to obtain and maintain physical fitness or whether an activity is recreational only. To maintain physical fitness an endurance activity will be performed several times per week with high intensity. Since load will influence the amount of wear exponentially, only activities with low joint loads such as swimming, cycling or possibly power walking should be recommended. If an activity is carried out on a low intensity and therefore recreational base, activities with higher joint loads such as skiing or hiking can also be performed. It is unwise to start technically demanding activities after total joint replacement, as the joint loads and the risk for injuries are generally higher for these activities in unskilled individuals. Finally, it is important to distinguish between suitable activities following total knee and total hip replacement. To recommend suitable physical activities after total knee replacement, it is important to consider both the load and the knee flexion angle of the peak load, while for total hip replacement, which involves a ball and socket joint, the flexion angle does not play an important role. During activities such as hiking or jogging, high joint loads occur between 40 and 60° of knee flexion where many knee designs are not conforming and high polyethylene inlay stress will occur. Regular jogging or hiking produces high inlay stress with the danger of delamination and polyethylene destruction for most current total knee prostheses. Based on these design differences between hip and knee replacements it is prudent to be more conservative after total knee arthroplasty than after total hip arthroplasty for activities that exhibit high joint loads in knee flexion.