ผลของการใช้แสงเลเซอร์กำลังต่ำต่อระดับอาการปวด มุมข้อเข่า และสมรรถภาพการเคลื่อนไหวในผู้ป่วยหลังผ่าตัดเปลี่ยนข้อเข่าเทียม

Phunyanuch  Sonsin

Authors

Phunyanuch Sonsin -

Keywords:

low-level laser therapy, total knee arthroplasty, pain, knee range of motion, functional mobility

Abstract

This quasi-experimental study aimed to investigate the effects of low-level laser therapy on pain levels, knee range of motion, and functional mobility in patients following total knee arthroplasty. The sample consisted of 10 patients with knee osteoarthritis aged 50-70 years awaiting total knee replacement surgery at the Orthopedic Surgery Department, Wichian Buri Hospital, selected through purposive sampling. Participants received low-level laser therapy (wavelength 804 nm, power 500 mW, energy 10 joules per session) combined with a standard rehabilitation program. Outcome measures included the Numerical Rating Scale (NRS) for pain, a goniometer for knee flexion angle measurement, and the 3-meter Timed Up and Go test (TUG), assessed preoperatively and on postoperative days 1, 14, and 30. Data were analyzed using repeated measures ANOVA.

Results showed statistically significant pain reduction on day 14 (2.4±1.65, p<0.05) and day 30 (0.8±1.32, p<0.001) compared to preoperative levels (6.0±2.05). Knee flexion angles on day 14 (108.70±13.38 degrees) and day 30 (113.0±12.04 degrees) returned to near-preoperative values (112.30±9.35 degrees, p>0.05). TUG scores on day 30 (35.80±9.32 seconds) approached preoperative values (29.10±8.03 seconds, p=0.20).

References

Varacallo M, Luo TD, & NA, J. (2022). Total Knee Arthroplasty Techniques. In. StatPearls Publishing LLC.

Leijtens, B., Kremers van de Hei, K., Jansen, J., & Koëter, S. (2014). High complication rate after total knee and hip replacement due to perioperative bridging of anticoagulant therapy based on the 2012 ACCP guideline. Archives of Orthopaedic and Trauma Surgery, 134(9), 1335-1341. https://doi.org/10.1007/s00402-014-2034-4

Sheth, N. P., Husain, A., & Nelson, C. L. (2017). Surgical Techniques for Total Knee Arthroplasty: Measured Resection, Gap Balancing, and Hybrid. JAAOS - Journal of the American Academy of Orthopaedic Surgeons, 25(7). https://journals.lww.com/jaaos/fulltext/2017/07000/surgical_techniques_for_total_knee_arthroplasty_.4.aspx

McClelland, J., Zeni, J., Haley, R. M., & Snyder-Mackler, L. (2012). Functional and Biomechanical Outcomes in a Patient After Total Knee Arthroplasty: Biofeedback for Retraining Symmetrical Movement Patterns. Journal of Orthopaedic & Sports Physical Therapy, 42(2), 135-144. https://doi.org/10.2519/jospt.2012.3773

Sloan, M., Premkumar, A., & Sheth, N. P. (2018). Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am, 100(17), 1455-1460. https://doi.org/10.2106/jbjs.17.01617

National Health Security Office (NHSO) NEWS. (2023). Retrieved cited 2023 Mar 19 from Available from: https://www.nhso.go.th/news/3864

Fitzsimmons, S. E., Vazquez, E. A., & Bronson, M. J. (2010). How to Treat the Stiff Total Knee Arthroplasty?: A Systematic Review. Clinical Orthopaedics and Related Research®, 468(4), 1096-1106. https://doi.org/10.1007/s11999-010-1230-y

de Ladoucette, A. (2023). Management of perioperative pain after TKA. Orthopaedics & Traumatology: Surgery & Research, 109(1, Supplement), 103443. https://doi.org/https://doi.org/10.1016/j.otsr.2022.103443

Harato, K., Nagura, T., Matsumoto, H., Otani, T., Toyama, Y., & Suda, Y. (2010). Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. J Arthroplasty, 25(2), 225-229. https://doi.org/10.1016/j.arth.2009.02.003

Kubota, M., Kokubo, Y., Miyazaki, T., Matsuo, H., Naruse, H., Shouji, K., Shimada, S., & Matsumine, A. (2022). Effects of knee extension exercise starting within 4 h after total knee arthroplasty. Eur J Orthop Surg Traumatol, 32(5), 803-809. https://doi.org/10.1007/s00590-021-03042-9

Saari, T., Tranberg, R., Zügner, R., Uvehammer, J., & Kärrholm, J. (2005). Changed gait pattern in patients with total knee arthroplasty but minimal influence of tibial insert design: gait analysis during level walking in 39 TKR patients and 18 healthy controls. Acta orthopaedica, 76(2), 253-260. https://doi.org/10.1080/00016470510030661

Yoshida, Y., Ikuno, K., & Shomoto, K. (2017). Comparison of the Effect of Sensory-Level and Conventional Motor-Level Neuromuscular Electrical Stimulations on Quadriceps Strength After Total Knee Arthroplasty: A Prospective Randomized Single-Blind Trial. Arch Phys Med Rehabil, 98(12), 2364-2370. https://doi.org/10.1016/j.apmr.2017.05.005

Mutsuzaki, H., Takeuchi, R., Mataki, Y., & Wadano, Y. (2017). Target range of motion for rehabilitation after total knee arthroplasty. J Rural Med, 12(1), 33-37. https://doi.org/10.2185/jrm.2923

Jette, D. U., Hunter, S. J., Burkett, L., Langham, B., Logerstedt, D. S., Piuzzi, N. S., Poirier, N. M., Radach, L. J. L., Ritter, J. E., Scalzitti, D. A., Stevens-Lapsley, J. E., Tompkins, J., & Zeni, J., Jr. (2020). Physical Therapist Management of Total Knee Arthroplasty. Phys Ther, 100(9), 1603-1631. https://doi.org/10.1093/ptj/pzaa099

Bahrami, H., Moharrami, A., Mirghaderi, P., & Mortazavi, S. M. J. (2023). Low-Level Laser and Light Therapy After Total Knee Arthroplasty Improves Postoperative Pain and Functional Outcomes: A Three-Arm Randomized Clinical Trial. Arthroplast Today, 19, 101066. https://doi.org/10.1016/j.artd.2022.10.016

Bjordal, J. M., Johnson, M. I., Iversen, V., Aimbire, F., & Lopes-Martins, R. A. (2006). Low-level laser therapy in acute pain: a systematic review of possible mechanisms of action and clinical effects in randomized placebo-controlled trials. Photomed Laser Surg, 24(2), 158-168. https://doi.org/10.1089/pho.2006.24.158

Alghadir, A. H., Anwer, S., Iqbal, A., & Iqbal, Z. A. (2018). Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. Journal of pain research, 11, 851-856. https://doi.org/10.2147/JPR.S158847

Fan, T., Wang, W., & Zhang, X. (2024). Effectiveness of low-level laser therapy for knee osteoarthritis and postoperative recovery: A systematic review and network meta-analysis. Frontiers in Physiology, 15(3), 1310–1322.

Cureus Editorial Board. (2023). Effect of low-level laser therapy on knee range of motion and functional abilities after total knee arthroplasty. Cureus, 15(12), e51290.