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The main aim of this bachelor study is concentrated on an after- total- knee- joint endoprosthesis physiotherapy from the surgical solution point of view. The total endoprosthesis is used as the very last possible option of an invasive means of therapy that is possible to take an advantage of when there is extensive damage of biomechanics of a knee joint. When speaking about the frequency of this operation, it is very high, and it is becoming a more and more common way of surgery that is nowadays being practised. The only more frequent orthopaedic surgery these days is a total hip endoprosthesis implantation. As a result of longer durability of the endoprostheses as well as better joint stability and owing to the great technological development it is possible to use various materials for making endoprostheses. However, there are appropriate demands on both the competence of the operational and consequently the rehabilitative staff working with a complicated structure of the prostheses. The study is divided into the theoretical and practical part. First, in the theoretical part there you can find analysed anatomy and biomechanics of a knee joint. Secondly, there are described indications and contra- indications of the total endoprosthesis implantation, types of total endoprostheses as well as the possibility of consequent physiotherapy. In addition, a method of qualitative research was used in the practical part of the study. There were two groups of patients under the reseach- including two women aged between 61 and 70 in each group.A different means of surgery for the total endoprosthesis of the knee joint was applied in each of the groups. There was also the same amount of time for the research of both groups. An entry kinesiological analysis was taken the sixth day after the surgery. Consequently the output kinesiological analysis was done after the second orthopaedical check- up (approximately the third month after the surgery), when a hundred per cent tread on the operated limb was permitted. The research itself took place in a hospital, afterwards it continued in domestic surrounding at home using available aids. Providing anamneses of all patients a goniometrical, anthropometrical and palpational check- ups of the knee joint were done. Furthermore, according to Janda, a muscle test and a check- up of shortened muscle groups related to the knee- joint were done as well. A functional check- up of a knee- joint muscles and an endoprosthesis itself was included in the output kinesiological analysis. All the patients were offered the same exercise unit to make better evaluation of the research. The frequency of regular exercise was set to a four-time period per week. An anthropometric check up showed that a post surgical swelling was more significant with the patients after the lateral parapatelar cut, that slows down patients' active joining the short- period kinesiotherapeutic schedule. The range of the movement in the operated knee joint was one of the main observing aspects that much differed already at the entry kinesiological check- up. The aim of the therapy was to achieve the minimum of 90 degree- active flexion of the knee joint at the end of the research. Both the patients after the medial parapatelar cut achieved the given point a few days earlier because the patients after the lateral parapatelar cut were provided with a motorial splint. This motorial splint enabled the patients to extend the range of movement in the joint. The power of muscles did not fundamentally differ comparing the output check- ups of both the groups, however the patients after the medial parapatelar cut achieved the muscle power degree 5. In addition, after the third month from the surgery, permitting 100 per cent tread on the operated limb, a functional check- up of muscles and the endoprosthesis of the operated knee joint was taken. It revealed stronger stability of the patients after the lateral parapatelar cut |
