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PubMed2026

Systematic Review on the Effectiveness of Photobiomodulation Therapy on Enhancing Musculoskeletal Rehabilitation Outcomes after Total Knee and Hip Arthroplasty.

BACKGROUND: Total knee and hip arthroplasty (TKA/THA) effectively alleviate chronic pain and improve joint function and quality of life. However, postoperative recovery is often hindered by pain, edema, restricted range of motion (ROM), and muscle weakness, necessitating structured physical rehabilitation. Photobiomodulation Therapy (PBMT) has been proposed as an adjunct modality to enhance rehabilitation outcomes. This systematic review evaluates the efficacy of PBMT in reducing postoperative pain and edema as well as improving ROM and functional performance compared with placebo or standard physical therapy in post-arthroplasty patients. METHODS: A systematic search of PubMed, ProQuest, ScienceDirect, and Google Scholar was conducted from inception to May 31, 2025. Only prospective controlled trials assessing PBMT effects on postoperative pain, swelling, ROM, or functional performance following TKA or THA were included. Case reports, uncontrolled studies, and trials focusing on unrelated outcomes were excluded. Article selection involved title, abstract, and full-text screening, with additional studies identified through reference lists. The review is registered in PROSPERO (CRD420251123169). RESULTS: Four randomized controlled trials (RCTs; n = 133 participants) met the inclusion criteria, three studies focused on TKA, and one study examined THA. PBMT significantly improved postoperative pain and edema reduction in three trials, while two studies demonstrated enhanced ROM and functional outcomes compared with control or placebo interventions. PEDro scores ranged from 8 to 10, indicating moderate-to-high methodological quality. CONCLUSIONS: PBMT shows promising short-term benefits in reducing postoperative pain and swelling and improving functional performance after knee or hip arthroplasty. However, due to heterogeneity in treatment parameters and limited high-quality trials, conclusive evidence remains insufficient. Future large-scale RCTs with standardized PBMT parameters and extended follow-up are warranted to confirm its clinical efficacy.

Humans↗
PubMed2002

[Excellent results of surgical management of osteoarthritis. Arthroplasty and osteotomy provide pain relief and restore joint function].

The treatment of osteoarthrosis is through the insertion of an artificial joint, arthroplasty. Quantitatively, operations of the hip and the knee are the most important and the results are extremely well documented and good both in terms of functional results as well as in terms of longevity. In recent years, arthroplasty of other joints such as the elbow and the shoulder has been developed to a satisfactory degree of perfection. Even the ankle joint, hitherto resistant to arthroplasty, has yielded promising results. In the knee joint, osteotomy is a viable alternative.

Arthroplasty↗
PubMed1995

Cellular proliferation and cytokine responses to polymethylmethacrylate particles in patients with a cemented total joint arthroplasty.

The in vitro response of peripheral blood mononuclear cells (MNC) from patients with cemented total hip or knee arthroplasties, and control individuals, to polymethylmethacrylate (PMMA) was assessed by cell proliferation, cytokine production, and molecular techniques. After seven days in culture, a dose-dependent proliferative response to PMMA stimulation was observed in MNC from fifteen normal individuals. A concomitant dose-dependent production of both IL-1 beta and IL-2 in response to PMMA stimulation was detected. Reverse transcription-polymerase chain reactions (RT-PCR) indicated that both IL-1 beta and IL-2 mRNA was present after 48 hours in culture with PMMA. Cellular proliferation and cytokine production (both IL-1 beta and IL-2) in 10 patients with stable, painless, well-functioning, cemented arthroplasties was significantly lower (p < 0.025) than normal controls and patients with aseptically loosened, painful, arthroplasties. The findings suggest that patients with stable cemented total joint arthroplasties are either inherently or adaptively less responsive to PMMA at a cellular level.

Base Sequence↗
PubMed1999

Prevention of heterotopic bone formation after total hip arthroplasty: a prospective randomised study comparing postoperative radiation therapy with indomethacin medication.

Heterotopic ossification (HO) after total hip arthroplasty is known to be a major complication with an impact on the functional outcome. Efforts have been made to prevent the occurrence of HO by means of either radiation therapy or pharmacotherapy. To date, there are no data available regarding the relative benefit of radiation versus medication with non-steroidal anti-inflammatory drugs. The objective of this study was to compare single-dose 600-cGy radiation therapy with indomethacin medication for their effect on the prevention of heterotopic bone formation after total hip arthroplasty. In all, 154 patients were included in the study. All patients underwent primary total hip arthroplasty due to osteoarthritis. Patients were randomly assigned to three different therapeutic groups. (a) The radiation group received a single radiation dose of 600 cGy between the 2nd and 4th postoperative day. (b) The indomethacin group received an oral application of indomethacin 2 x 50 mg per day from the 1st to 42nd postoperative day. (c) The control group received neither radiation nor indomethacin medication. There were significant group differences (P < 0.001). A least significant difference test (LSD) revealed that the mean of the control group was significantly different from that of the radiation and indomethacin groups. The 13 patients (8.4%) classified Brooker 3 or 4 were all in the control group. Again, this effect was statistically significant (chi-square, P < 0.001). In conclusion, this study demonstrated that both radiation and indomethacin therapy are effective in the prevention of postoperative HO. The choice for either one of the treatments has to be based on availability, contraindications, side-effects, practicability, standardisation and cost. Based on these considerations together with the results of this study, we currently use postoperative radiation with 600 cGy for all patients undergoing primary total hip arthroplasty.

Administration, Oral↗
PubMed2005

Long-term outcome of patients with rheumatoid arthritis treated by multiple arthroplasty.

We conducted a study of 82 patients with rheumatoid arthritis (RA) who had undergone multiple arthroplasty and investigated their clinical findings and clinical courses. We reviewed the significance of multiple arthroplasty in the treatment of RA, its problems, and measures to solve them. All patients initially regained and maintained good walking capacity. However, the walking capacity of many patients again decreased over the long term; in the tenth year, 79% of patients were capable of a practical gait. The causes of decreased walking capacity included complications of artificial joints, cervical lesions, and vertebral compression fractures. Fractures were observed in as many as nine patients, indicating that it is important to prevent and treat their cause, that is, osteoporosis. The survival rate was 71% in 10 years. In RA patients, particularly those who have undergone multiple arthroplasty, the major causes of death are infection and rheumatic disease, suggesting that prevention of such diseases should be considered paramount. Appropriate systemic treatment of RA, patient education, and measures against osteoporosis for prevention of complications may preserve the worth of multiple arthroplasty for RA patients with multiple joint destruction.

Journal Article↗
PubMed1990

Lunate silicone replacement arthroplasty in Kienböck's disease: a long-term follow-up.

We report a long-term follow-up (average, 5 years) of 10 patients who had lunate silicone replacement arthroplasty for treatment of Kienböck's disease. Clinical results were assessed on relief of pain, return to normal occupation, and range of motion. At 18- to 20-months follow-up, eight patients had satisfactory results, whereas at final follow-up only five of the patients had satisfactory results. Three of five patients with radiographs averaging 57 months after operation had evidence of particulate synovitis. Contrary to our previous publications on silicone replacement arthroplasty, it was concluded that the success rate for silicone replacement arthroplasty and the incidence of particulate synovitis do not warrant the continued use of silicone replacement arthroplasty as a primary treatment modality for Kienböck's disease.

Adolescent↗
PubMed1993

Revision total wrist arthroplasty.

Biaxial design total wrist arthroplasty was used to salvage 13 failed total wrist arthroplasties of various designs. After a follow-up period of 31 months, two wrists had undergone further prosthetic revision for loosening and one wrist was arthrodesed. In the remaining 10 wrists, 8 had no pain, 1 had mild pain, and 1 had moderate pain. Eight patients reported feeling much better, one reported feeling better, and one reported no change. Postoperative range of motion averaged 36 degrees of extension, 19 degrees of flexion, 6 degrees of radial deviation, and 15 degrees of ulnar deviation. X-ray films at follow-up evaluation showed that two revision arthroplasties still in place were loose. The majority of patients had a satisfactory clinical result after revision total wrist arthroplasty with a biaxial design. Loosening of the revision is a significant problem.

Arthritis↗
PubMed1994

Flexible implant resection arthroplasty of the proximal interphalangeal joint in patients with systemic inflammatory arthritis.

Forty proximal interphalangeal joint silicone elastomer flexible implant arthroplasties in 19 patients with systemic inflammatory arthritis were reviewed. The follow-up period averaged 94 months. Before surgery, the average arc of motion was 26 degrees for the 20 digits with boutonniere deformities and 23 degrees for the 16 digits with swan-neck deformities. Eight digits had moderate (grade 2) pain, and four digits had severe (grade 3) pain. After surgery, the deformity was completely corrected in six digits. Digits with a preoperative boutonniere deformity (20 digits) achieved the same (26 degrees) arc of motion after surgery, whereas those with a preoperative swan-neck deformity (16 digits) actually lost 18 degrees. Six digits had moderate pain and one digit had severe pain at the final follow-up evaluation. Thirteen digits (7 patients) with a boutonniere deformity before surgery and a concurrent or previous silastic metacarpophalangeal arthroplasty had significantly better results than those without. Overall, there were 12 good, 18 fair, and 10 poor results. Based on this study, flexible silicone implant arthroplasty has a limited role in the treatment of proximal interphalangeal joints affected by systemic inflammatory arthritis. When performing the arthroplasty, attention should be directed first toward correction of the deformity at the metacarpophalangeal joint.

Adult↗
PubMed1992

Knee arthroplasty rating.

A number of rating systems used to evaluate the results of total knee arthroplasty exist. Many of these systems are based on different concepts, and might be expected to give divergent results. To see if this was so, the authors examined a consecutive series of 235 posterior stabilized knee arthroplasties recording the results according to five rating systems: HSS (The Hospital for Special Surgery), Brigham, Freeman, BOA (British Orthopaedic Association), and the VENN diagram. In spite of their apparent differences, all point systems and the BOA gave almost identical results, while the VENN diagram proved to be the most stringent. The authors suggest that any of the current point systems may be used to "score" arthroplasties, but the results should also be rated with the VENN diagram in order to see the quality of the arthroplasty and a comparison between the different series.

Aged↗
PubMed1994

Reinfusion of postoperative wound drainage in total joint arthroplasty. Red blood cell survival and coagulopathy risk.

Fifty patients with total joint arthroplasties (28 total hip arthroplasties, 11 total knee arthroplasties, and 11 bilateral total knee arthroplasties) received autotransfusions from their postoperative wound drainage. The blood was collected in a closed sterile drainage system without any additional anticoagulant. Pre- and postoperative measurements were made of the patient's hemoglobin, platelets, fibrinogen, haptoglobin, fibrin degradation products, and D-dimer (a specific type of fibrin degradation product). Red blood cell survival was assessed in 16 of the patients by labeling the shed blood with 51Cr sodium chromate prior to reinfusion. To control for fluid shifts, continued bleeding, and dilution effects of further transfusions in the immediate postoperative period, 10 patients also had their native blood labeled with 111In oxime. In this study, the mean estimated blood loss was 1,062 mL (+/- 1,247) with a mean wound drainage of 836 mL (+/- 338). Of this, a mean of 450 mL (+/- 261) of blood was was given back to the patient in addition to routine, preoperative autologous donated blood. Six (12%) patients experienced transient fevers at the time of retransfusion. Detailed hematologic studies were performed on the shed blood in 19 patients. The collected blood was completely defibrinated, but did contain fibrin degradation products, as indicated by the D-dimer level, and hemolyzed blood as the haptoglobin was reduced. Even though the blood containing the above breakdown products was reinfused to the patients, there were no clinical manifestations of disseminated intravascular coagulation. Both the hemolyzed and defibrinated products were subsequently cleared by the body.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation Factors↗
PubMed1994

Function after primary hemiarthroplasty and secondary total hip arthroplasty in femoral neck fracture.

Four to 12 years after primary treatment of femoral neck fracture with hemiarthroplasty in a group of Finnish patients and secondary total hip arthroplasty as a salvage procedure for healing complication after primary osteosynthesis in a group of Swedish patients, function was classified and the Nottingham Health Profile questionnaire was applied. The two groups were comparable with regard to age, sex, and social status. The patients with secondary total hip arthroplasty used walking aids to a lesser extent than the patients with hemiarthroplasty and experienced less problems in several aspects of life. Walking ability was considered unchanged, compared to prefracture, to a larger extent in the secondary total hip arthroplasty group. Thus, secondary total hip arthroplasty in patients with healing complication following primary osteosynthesis gives better long-term functional capacity than that obtained with a primary hemiarthroplasty.

Activities of Daily Living↗
PubMed2005

A study of effectiveness of knee arthroscopy after knee arthroplasty.

PURPOSE: The purpose of this study was to investigate the outcome of arthroscopy in painful knee arthroplasty without evidence of infection, fracture, wear, and component loosening or malposition that had been refractory to conservative treatment. In addition, a literature review of 498 cases (MEDLINE 1966 to 2002) was performed. TYPE OF STUDY: Case series. METHODS: From 1997 to 2000, 27 patients (20 women, 7 men) had undergone arthroscopies because of poor results following total knee arthroplasty. Before the operation, the patients had suffered symptoms for an average of 11 months (range, 3 to 41 months). The average onset of symptoms after knee arthroplasty was 26 months (range, 3 to 59 months). The average patient age was 70 years (range, 42 to 81 years) and the average follow-up was 34 months (range, 24 to 52 months). At the initial operation, 19 patients had received total condylar surface replacement and 8 had received hemireplacement. Patients were evaluated using the Knee Society rating system. A review of the literature was performed by initial identification of the articles from a MEDLINE database followed by the use of cross references. RESULTS: All of the patients were available for follow-up. Eighteen of the 27 procedures resulted in an improvement in the patient's knee score. The average Knee Society ratings increased from 71 points before arthroscopy to 85 at follow-up for the knee score. The average functional scores were 69 and 83 points, respectively. The Knee Society pain score improved from 32 to 41 points. Nine patients underwent a subsequent open revision after arthroscopic diagnosis or treatment. Operative diagnoses included arthrofibrosis, impinging hypertrophic synovitis, impinging posterior cruciate ligament stump, prosthesis loosening or wear, symptomatic pseudomeniscus, an infrapatellar spur, and meniscal rupture. There was 1 infection as a complication associated with the arthroscopic procedure. CONCLUSIONS: Arthroscopic treatment of painful knee arthroplasty provides reliable expectations for improvement in function, decrease in pain, and improvement in knee scores for most patients. LEVEL OF EVIDENCE: Level IV, Case Series.

Adult↗
PubMed2006

Hydrogen peroxide as an irrigation solution in arthroplasty - a potential contributing factor to the development of aseptic loosening.

The reason for revision of primary total hip arthroplasty is quoted as aseptic loosening in 60.6% of cases between 1979 and 2003 in the Swedish National Hip Arthroplasty Registry. Much research effort has been directed toward enhancing the bone-cement interface of total joint arthroplasties, in an attempt to reduce this complication. Haemostatic agents have been popularized as effective means of retarding the development of potentially harmful debris interposition adjacent to, and blood lamination patterns within, the methylmethacrylate. Such agents include hydrogen peroxide (H(2)O(2)), local freezing saline, saline at room temperature and adrenaline solution. One main concern with the use of hydrogen peroxide is whether it affects the material properties of bone cement such that in the long term it contributes to aseptic loosening. This would have enormous clinical consequences. Preliminary studies indicate that porosity increases and that the tensile strength and yield stresses are reduced by up to a factor of 10 by contaminating samples with increasing concentrations of hydrogen peroxide. We postulate that the current use of hydrogen peroxide as an irrigation solution in arthroplasty contributes to the development of aseptic loosening.

Adhesiveness↗
PubMed2004

[Metal serum levels in 48 patients bearing a chromium-cobalt total hip arthroplasty with a metal-on-polyethylene combination].

PURPOSE OF THE STUDY: Component wear and dissemination of wear debris, particularly with metal-on-metal combinations, is the predominant long-term complication of total hip arthroplasty. The purpose of our work was to search for metal pArticles released when using the metal-on-polyethylene combination by analyzing serum levels of chromium (Cr), cobalt (Co), nickel (Ni), and molybdium (Mo) in patients with a metal-on-polyethylene chromium-cobalt total hip arthroplasty. We compared the observed levels with those observed in a control population and studied changes as a function of signs of loosening. MATERIAL AND METHODS: During a thirty-Month period, 53 patients with degenerative hip disease underwent total hip arthroplasty. The same implant, PVL, being used for all hips. Forty-eight patients were available for analysis at a minimum follow-up of 32 Months. Results of the clinical and radiological examination of the operated hip were recorded. Serum metal levels were assayed by mass spectrometry on total blood samples. Patient activity was determined with the Devane classification and hip function with the Postel-Merle-d'Aubligné score; walking distance was recorded in kilometers. Signs of prosthetic loosening were identified on plain radiograms (AP and lateral views) searching for femoral and/or acetabular lucent lines, cement fracture, granuloma. The control group included 56 patients scheduled for total hip arthroplasty. Non-parametric statistical analysis was used to search for correlations between the clinical, radiological, and biological parameters. RESULTS: At mean 44 Months follow-up, 17% of the patients had a fair or mediocre function score and 37% had radiological signs of femoral component loosening. Serum cobalt increased significantly in the implanted group (serum cobalt >or=0.60 microg/L in 50% of patients) compared with the control group (serum cobalt >or=0.60 microg/L in 9%) (P<0.001, Mann-Whittney test). Increased serum cobalt was highest in patients with radiographic signs of loosening. This significant difference was not found for other metals. Patient activity, hip function, and follow-up were not correlated with serum levels. DISCUSSION: Serum cobalt appears to be a good biological marker of prosthetic function although intra- and inter-individual variations are influenced by assay technique, metal ion solubility, and metal dissemination in the organism. The metal-on-metal combination does not appear to be the only friction couple which increases the serum level of metal ions. Our results do not allow defining a time of latency between onset of radiographic signs and increased serum levels.

Aged↗
PubMed1996

Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty.

BACKGROUND: In-vitro studies indicate that platelet function and the coagulation cascade are impaired by hypothermia. However, the extent to which perioperative hypothermia influences bleeding during surgery remains unknown. Accordingly, we tested the hypothesis that mild hypothermia increases blood loss and allogeneic transfusion requirements during hip arthroplasty. METHODS: Blood loss and transfusion requirements were evaluated in 60 patients undergoing primary, unilateral total hip arthroplasties who were randomly assigned to normothermia (final intraoperative core temperature 36.6 [0.4] degrees C) or mild hypothermia (35.0 [0.5] degrees C). Crystalloid, colloid, scavenged red cells, and allogeneic blood were administered by strict protocol. FINDINGS: Intra- and postoperative blood loss was significantly greater in the hypothermic patients: 2.2 (0.5) L vs 1.7 (0.3) L, p < 0.001). Eight units of allogeneic packed red cells were required in seven of the 30 hypothermic patients, whereas only one normothermic patient required a unit of allogeneic blood (p < 0.05 for administered volume). A typical decrease in core temperature in patients undergoing hip arthroplasty will thus augment blood loss by approximately 500 mL. INTERPRETATION: The maintenance of intraoperative normothermia reduces blood loss and allogeneic blood requirements in patients undergoing total hip arthroplasty.

Adult↗
PubMed1997

Wrist arthrodesis for failed wrist implant arthroplasty.

Thirteen wrist arthrodeses were performed for failed wrist implant arthroplasties between 1984 and 1992. Twelve patients were available for review, with an average follow-up period of 28 months. The original arthroplasties consisted of 8 silicone implants and 4 metal-plastic total wrist implants. The surgical method involved a tricortical iliac bone graft and an intramedullary Steinmann pin. There were 7 excellent results, 4 good results, and 1 poor result. All but 1 patient had markedly improved function with no or mild pain. Seven patients had solid fusions and 5 patients had pseudarthroses. Four pseudarthroses occurred at the graft-metacarpal junction and 1 occurred at the graft-radius junction. Each patient with a solid fusion had an excellent result. All graft-metacarpal pseudarthroses were painless and did not limit the patients' activities. There were 17 complications in 9 patients. Wrist arthrodesis can be a successful salvage procedure for failed wrist implant arthroplasty in patients with rheumatoid arthritis. However, the complication rate can be high. Owing to the high incidence of distal graft-metacarpal pseudarthrosis, we recommend using more rigid fixation techniques in patients with failed wrist arthroplasties.

Adult↗
PubMed1985

Total trapeziometacarpal arthroplasty. Report on seventeen cases of de generative arthritis of the trapeziometacarpal joint.

The authors have studied the results of 17 total trapeziometacarpal arthroplasties, performed in 15 patents between 1973 and 1983. The indications were essentially arthritis of the trapeziometacarpal joint either isolated or associated with peritrapezial lesions. The mean follow-up period was 3 years, the extremes ranged from 1 to 10 years. Results were judged as good in 13 cases, average in one case with 3 failures. Good results allow to recuperate complete mobility with adequate strength and stability.. The key point of this study was that first, cemented total arthroplasty does not represent a surgical escalade, a repeat operation is always possible in case of failure, and second, the concept of peritrapezial arthritis, and especially Crosby's stage 1 or stage 2 scaphotrapezial arthritis, is not a contraindication for total trapeziometacarpal arthroplasty. The best indications seems to be intense Dell's stage 3 or stage 4 trapeziometacarpal arthritis either isolated or associated with moderated peritrapezial arthritis. Two elements must be particularly studied before thinking about total trapeziometacarpal arthroplasty: the size, the consistancy and the configuration of trapezium; the degree of eventually associated scaphotrapezial arthritis.

Adult↗
PubMed1997

[Primary metacarpophalangeal and proximal interphalangeal arthrosis of the hand. Indications and results of 27 DJOA arthroplasty].

The authors report 27 Digital Joint Arthroplasties (DJOA), implanted exclusively in cases of osteoarthritis, between 1985 and 1994. The metacarpophalangeal joint was involved in 8 cases and the proximal interphalangeal joint was involved in 19 cases in a series of 20 patients with a mean age of 58 years (49-84). The mean interval between the first clinical signs and the surgical operation was 34 months (12-72). An anterolateral incision was used in 5 cases for the PIP joint, and an anterior incision was used in one case for the MP joint. All other cases were operated via a dorsal incision. Two early complications were observed: septic ulceration of the skin and dislocation of the PIP prosthesis on the 8th day. Good results were obtained in terms of pain. Range of movement was only slightly improved by arthroplasty and exclusively in the extension sector. The range of movement of the MP joint increased from 35 degrees to 50 degrees, while the range of movement of PIP joint remained unchanged at 50 degrees with a slight displacement of 5 degrees towards the extension sector. This can be explained by the radiological follow-up of our implants which showed impaction of the prosthetic shaft during the first two postoperative years with appearance of signs of periarticular ossification. The results concerning range of movement and pain were analogous to those of other series in the literature, particularly with the use of Swanson implants. On the other hand, DJOA arthroplasty presents a low incidence of axial deviation problem (1 case out of 27). The authors are currently trying to improve the results of DJOA arthroplasty by creating a size 0 to suit anatomical requirements and by adopting the anterolateral incision to preserve the extensor apparatus in order to decrease postoperative flexion deformity.

Aged↗