This article is more than 5 years old. Information may no longer be current.
Novel protocol with femoral, sciatic nerve blocks for knee stiffness increased range of motion
Researchers noted a significant increase in mean flexion at final follow-up.
Click Here to Manage Email Alerts
Use of intermittent femoral and sciatic nerve block combined with an in-house physiotherapy protocol among patients with knee stiffness produced early gain of range of motion, less range-of-motion loss at follow-up and fewer possible complications, according to study results.
“Intermittent femoral and sciatic nerve blocks followed by physiotherapy is a feasible method for improving passive knee flexion and extension for the treatment of postoperative knee stiffness,” Florian Wanivenhaus, MD, of the Department of Orthopedics at Balgrist University Hospital, University of Zurich, told Orthopedics Today. “The improved knee flexion and extension was preserved until the final follow-up at a median of 10 months.”
Physiotherapy sessions
Wanivenhaus and his colleagues evaluated 68 patients with postoperative knee stiffness for passive knee flexion, extension and total range of motion (ROM) preoperatively and during a median 10-month follow-up after mobilization intervention. Researchers performed physiotherapy sessions twice per day, which was supported by a continuous passive ROM machine with sciatic and femoral nerve catheters activated 1 hour prior to each session.
Researchers categorized patients into three groups depending whether or not they underwent total knee arthroplasty (TKA), arthroscopy or arthroscopically assisted ligament reconstruction or surgery for patellofemoral instability for comparative analysis.
There was a significant increase in mean overall passive knee flexion between admission and catheter discontinuation, as well as a significant mean decrease in flexion from the end of the catheter treatment to hospital discharge. Although researchers did not find a significant difference in mean knee flexion at 6-week follow-up compared with at discharge, researchers noted a significant increase in mean flexion at final follow-up.
Time between admission and catheter discontinuation showed a significant decrease in mean overall passive knee extension lag. Compared with mean extension lag at time of discharge, results showed a significant increase in mean knee extension lag at 6-week follow-up. However, researchers noted no significant difference in mean extension lag at final follow-up.
“Typically, a substantial decrease in ROM after [manipulation under general anesthesia] MUA can be observed overtime,” Wanivenhaus said. “With the described mobilization protocol, we did not observe this effect in our study population. This may be explained by the fact that forceful manipulation can instantly tear the adhesions and fibrous bands, which on the one side immediately increases the ROM [and] on the other side may cause massive inflammation. With the described protocol, we witnessed small gains of ROM each day of treatment instead of the one large improvement typically seen in MUA.”
Subgroup analysis
Subgroup analysis revealed patients who underwent TKA had significantly decreased mean passive knee flexion at catheter discontinuation compared with the control group. Patients who underwent TKA had significantly increased mean knee extension lag at discharge.
“Knee stiffness after TKA is a frustrating problem for the patient and the treating surgeon,” Wanivenhaus said. “This novel treatment protocol may in comparison to manipulation of the knee under general anesthesia decrease the complication rate and increase the functional outcome for the patient.” – by Casey Tingle
- Reference:
- Wanivenhaus F, et al. Orthopedics. 2016;doi:10.3928/01477447-20160419-07.
- For more information:
- Florian Wanivenhaus, MD, can be reached at Balgrist University Hospital, University of Zurich, 340 Forchstrasse, Zurich 8008, Switzerland; email: florian@wanivenhaus.at.
Disclosure: Wanivenhaus reports no relevant financial disclosures.