Aims Approximately 10% to 20% of knee arthroplasty patients are not satisfied with the result, while a clear indication for revision surgery might not be present. Therapeutic options for these patients, who often lack adequate quadriceps strength, are limited. Therefore, the primary aim of this study was to evaluate the clinical effect of a novel rehabilitation protocol that combines low-load resistance training (LL-RT) with blood flow restriction (BFR). Methods Between May 2022 and March 2024, we enrolled 45 dissatisfied knee arthroplasty patients who lacked any clear indication for revision to this prospective cohort study. All patients were at least six months post-surgery and had undergone conventional physiotherapy previously. The patients participated in a supervised LL-RT combined with BFR in 18 sessions. Primary assessments included the following patient-reported outcome measures (PROMs): Knee injury and Osteoarthritis Outcome Score (KOOS); Knee Society Score: satisfaction (KSSs); the EuroQol five-dimension five-level questionnaire (EQ-5D-5L); and the pain catastrophizing scale (PCS). Functionality was assessed using the six-minute walk Test (6MWT) and the 30-second chair stand test (30CST). Follow-up timepoints were at baseline, six weeks, three months, and six months after the start. Results Six weeks of BFR with LL-RT improved all the PROMs except the sports subscale of the KOOS compared to baseline. Highest improvements after six weeks were found for quality of life (QoL) (mean 28.2 (SD 17.2) vs 19 (SD 14.7); p = 0.002), activities of daily living (mean 54.7 (SD 18.7) vs 42.9 (SD 17.3); p < 0.001), and KSSs (mean 17.1 (SD 8.8) vs 12.8 (SD 6.7); p < 0.001). PROMs improvements continued to be present at three-month and six-month follow-up compared to baseline. However, no significant differences were observed in the paired comparisons of the six-week, three-month, and six-month follow-up. The same trends are observed for the 6MWT and 30CST. Conclusion The reported regime demonstrates improved QoL and function of dissatisfied knee arthroplasty patients. In light of this, the pathway described may provide a valuable and safe treatment option for dissatisfied knee arthroplasty patients for whom therapeutic options are limited.

中文翻译：

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血流限制疗法能否改善不满意的膝关节置换术患者的生活质量和功能？


目的 大约 10% 至 20% 的膝关节置换术患者对结果不满意，而可能没有明确的翻修手术指征。这些患者的治疗选择往往缺乏足够的股四头肌力量，因此治疗选择有限。因此，本研究的主要目的是评估一种将低负荷阻力训练 （LL-RT） 与血流限制 （BFR） 相结合的新型康复方案的临床效果。方法 在 2022 年 5 月至 2024 年 3 月期间，我们招募了 45 名不满意的膝关节置换术患者，这些患者对这项前瞻性队列研究没有任何明确的修订指征。所有患者术后至少 6 个月，之前接受过常规物理治疗。患者在 18 个疗程中参加了有监督的 LL-RT 联合 BFR。主要评估包括以下患者报告结局指标 （PROM）：膝关节损伤和骨关节炎结局评分 （KOOS）;膝关节协会评分：满意度 （KSSs）;EuroQol 五维五级问卷 （EQ-5D-5L）;和疼痛灾难化量表 （PCS）。使用 6 分钟步行测试 （6MWT） 和 30 秒椅子站立测试 （30CST） 评估功能。随访时间点为基线、开始后 6 周、3 个月和 6 个月。结果 与基线相比，6 周的 BFR 和 LL-RT 改善了除 KOOS 的运动分量表外的所有 PROM。六周后生活质量 （QoL）（平均值 28.2 （SD 17.2） vs 19 （SD 14.7）;p = 0.002）、日常生活活动（平均值 54.7 （SD 18.7） vs 42.9 （SD 17.3）;p < 0.001）和 KSS（平均值 17.1 （SD 8.8） vs 12.8 （SD 6.7）;p < 0.001）。 与基线相比，PROMs 在 3 个月和 6 个月的随访中继续存在。然而，在 6 周、 3 个月和 6 个月随访的配对比较中未观察到显著差异。6MWT 和 30CST 也观察到相同的趋势。结论 报告的方案表明不满意的膝关节置换术患者的 QoL 和功能得到改善。有鉴于此，所描述的途径可能为治疗选择有限的不满意的膝关节置换术患者提供一种有价值且安全的治疗选择。