It is replaced by a high-density plastic knee button (also known as a patellar button). Over time intervals ranging from 2 to 4 years, 5 to 7 years, or longer, there is no difference in anterior knee pain between resurfaced and unsurfaced patellae. Patella and tendon mobilizations are done to discourage adhesions from limiting motion (post-surgical) or to mobilize adhesions that have already formed to promote better mobility (post or non-surgical). In their view, leaving the patella unresurfaced avoids complications such as avascular necrosis, a tendonsaptolica, and other types of complications. 2019 Dec;29(8):1605-1615. doi: 10.1007/s00590-019-02499-z. He is the founder and main author of brandonorthopedics.com, a website that offers valuable resources, tips, and advice for patients looking to learn more about orthopedic treatments and physiotherapy. [13] The persistence of functional limitations signifies the need to find effective rehabilitation strategies for TKA surgery patients. J Arthroplasty. After the random distribution, patients with early postoperative TKA will be distributed to a control group (regular training), a physical modality therapy group (physical therapy with regular training), and an intervention group (mobilization with regular training). The patella is held in place by the quadriceps tendon, which attaches the thigh muscles to the patella. Complications; Patella; Total knee arthroplasty. Xu, Jiao BSa,b; Zhang, Juan MSb; Wang, Xue-Qiang PhDa,b,*; Wang, Xuan-Lin BSb; Wu, Ya BSb; Chen, Chan-Cheng MSb; Zhang, Han-Yu BSb; Zhang, Zhi-Wan MSb; Fan, Kai-Yi BSb; Zhu, Qiang BSb; Deng, Zhi-Wei BSb, aSport Medicine and Rehabilitation Center, Shanghai University of Sport. In the event of femoral and/or tibial rotational malalignment, revision surgery should be considered. 2022 Jul 5;93:623-633. doi: 10.2340/17453674.2022.3512. However, they have considerably less strength and flexibility in the operated knee compared to healthy peers.1,2,3 Standard physical therapy following knee replacement PWZxkq201102). [23]. if < 0 Patella mobilization [34]. In both groups, a total of 21 knees were out of alignment. The operation involves repopulating the back of the kneecap and the front of the thighbone. The region around the patellar tendon is a common area of scarring. With fracture, dislocation, abnormal structure, and other surgeries. Total knee replacement is a surgical procedure that replaces the joints joint segments with artificial (prosthetic) parts. It is intended to restore a gliding joint that does not require much friction between the surfaces. Over time, the surface of the patella can become worn down, making it difficult to move the knee. Rotational malalignment should be sought. Otherwise, secondary resurfacing is appropriate only after convincingly ruling out other causes of pain. On todays total knees it is important to mobilize the patella to improve the mobility with which the kneecap can move following knee replacement. Please try again soon. Cost utility modeling of early vs late total knee replacement in osteoarthritis patients. Traction-mobilization in 2-stage treatment of infected total knee prosthesis. Abstract Loosening and subsequent extra-articular migration of the patella component is a rare complication of total knee arthroplasty. Patients who have one of the conditions listed in Table 3, on the other hand, may be unable to have this operation. It may feel uncomfortable and swollen at first, but these are usually gone within a few weeks. Background Patellar mobilization technique during total knee replacement (TKR) has been debated, with some suggesting that lateral retraction, rather than eversion, of the patella may be beneficial. Place your fingers on the top border of the patella. The causes of the various types of instability of the patella are listed in a differentiated way and the importance of clinical and imaging diagnostics as well as preventive strategies are elaborated. The Authors. Subject develops a serious disease (eg, heart disease). Its function is to offer a means of extending the knee through force applied from the quad muscles. It can take anywhere from six to twelve months for a patient to return to normal activities after knee replacement surgery. In traditional knee replacement surgery, an incision is made in the middle of the knee and muscle, tendons, and ligaments are ripped out. Is pain relief after knee replacement possible? The mean age at surgery was 64 years (range, 48-72 years). Guerra ML, Singh PJ, Taylor NF. Fu M, Liao W, Yang Z, Lin Z, He A, Sheng P, Yang Z. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. [14]. Resurfacing is an option if patellar thickness is greater than 12mm. The long-term durability of the implants has resulted in an increase in kneecap replacement surgeries, as has the risk of osteoarthritis in the other two compartments of the kneecap. You should be able to return to work and daily activities in two to six weeks. The resurfacing of the knee has been a contentious topic in the contemporary literature. He teaches as an Assistant Professor of Orthopedics at Emory School of Medicine in Atlanta, Georgia. Patellar complications of total knee arthroplasty (TKA) are fairly common [1]. The patella is held in place by the quadriceps tendon, which attaches the thigh muscles to the patella. A slight bend in the knee using a towel roll as described with the inferior glide is helpful with this mobilization too. Guo S, Sun W, Liu C, et al. Congenital hypermobility or laxity in your joints. Oluseun Olufade, MD, is a board-certified orthopedist. 8600 Rockville Pike Effect of laser therapy on chronic osteoarthritis of the knee in older subjects. Decostre V, Lafort P, Nadaj-Pakleza A, et al. of wt. -, J Arthroplasty. [1]. [7]. J Orthop Sports Phys Ther 2016;46:16876. CCC and QZ performed the statistical analysis. [30]. Unable to load your collection due to an error, Unable to load your delegates due to an error. What is a knee replacement? Reduced pain. Quality of life will be measured with the SF-36. This procedure involves a sustained stretching with or without tiny amplitude oscillations for 30 s or more depending on the patient's feedback and desired effects. [8]. Leijtens B, Kremers van de Hei K, Jansen J, et al. The quad tendon connects the quad muscles to the patella. Second, previous studies mainly focused on pain, deep vein thrombosis of lower limbs, range of motion, and quality of life. Adverse events associated with joint mobilization technique that will be recorded. Disclaimer. The patella (or kneecap) is a bone that is located in a shallow groove (called the trochlea) at the bottom of your thighbone (femur). ACL rehabilitationprogression: where are we now? Progress knee extension strength to >/= 3+/5 Independent with ambulation using rolling walker using he o Weight-bearing as tolerated . It is typically administered along with other strengthening exercises and stretches. If you are dealing with a restricted range of motion or soreness in the knee itself, be sure to speak to your healthcare provider. To eliminate any effect of mobilization, we will adopt joint mobilization in the Maitland level 4 grading method. The same can be said for activities such as running, jumping, and lifting weights, which put a high amount of strain on your knees. Mechanical and suboptimal pharmacologic prophylaxis and delayed mobilization but not morbid obesity are associated with venous thromboembolism after, [37]. Unable to load your collection due to an error, Unable to load your delegates due to an error. This type of mobilization is used in physical therapy for many conditions, including osteoarthritis, knee injuries, and post-operative therapy. Continue and progress these exercises until 6 weeks after surgery. Increased forces between these joints can lead to accelerated wear on the joint cartilage. We report a case of recurrent aseptic loosening and extra-articular migration . Patellar was present in five of six patients who were non-resurfaced, and in every other patient who was resurfaced. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a portion of the underlying bone. Inclusion criteria include the following: Exclusion criteria include the following: Early postoperative TKA patients will be allowed or be required to quit the study if. Registered Address: The KNEEguru, c/o Price Pearson Limited (att. The unstable patella after total knee arthroplasty: etiology, prevention, and management. Careers. The mobilizations may cause discomfort from stretching tissue, but any intense or sharp pain should be avoided. J Phys Ther Sci 2015;27:17235. Over the four-year period, the mean knee society combining clinical and function scores increased from 86.2 points (sd 28.4) pre-operatively to 135.5 points (sd 31.8) for patients who have never resurfaced the knee. If the patient has already had anterior knee pain prior to the operation and their patellar articular cartilage is weak, they should be stratified. [14,15] Two reasons explain why joint mobilization techniques may be useful for primary TKA. Prostheses, or artificial joints, are used to replace worn-out or diseased joints in the knee in knee replacement surgery. The procedure takes 1 to 3 hours: Your surgeon makes a cut down the front of your knee to expose your kneecap. Over 97% of patients report good or excellent pain relief as well as an improvement in their function following the procedure. Heightened flexor withdrawal response in individuals with knee osteoarthritis is modulated by joint compression and joint mobilization. It is estimated that the majority of people who have this procedure will be able to do their daily routines without pain or discomfort. Tim Petrie, DPT, OCS, is a board-certified orthopedic specialist who has practiced as a physical therapist for more than a decade. The Annals of Family Medicine.2018;16(6):521-529. doi:10.1370/afm.2320. Ann Rheum Dis 2001;60:917. Certification. Osteoarthritis Cartilage 2016;24:206976. arli AB, Turgut H, Bozkurt Y. In muscle morphology, a musculoskeletal ultrasound is performed with the use of an ultrasonic machine to measure the thickness of the muscle around the knee joint. [3335] The trial duration has a 4-week intervention period and 3 months of follow-up and a total of 6 months of study. High complication rate after total knee and hip replacement due to perioperative bridging of anticoagulant therapy based on the 2012 ACCP guideline. Studies have shown that after a TKA, the majority of improvement in gait function occurs within the first few weeks. Rehabilitation after, [6]. Decreased mobility or tilting of the patella is an indication to mobilize in this direction. Goodman SM, Mandl LA, Parks ML, et al. Youssef EF, Muaidi QI, Shanb AA. This is a way to check if you are on the right structure. Manual muscle testing is used to evaluate the knee joint muscle strength. Assiotis A, To K, Morgan-Jones R, Pengas IP, Khan W. Eur J Orthop Surg Traumatol. -, Clin Orthop Relat Res. If you have severe arthritis or injury to your knee, the surgery may be able to alleviate pain and restore function. Penninqton M, Grieve R, Black N, et al. Participants in the control group will be subjected to regular training, including static quadriceps contraction, straight leg-raising, bridge, ankle pumps, knee joint active movement, and so on. NCI CPTC Antibody Characterization Program. In total knee replacement surgery, a polymer implant is placed over the knee caps under surface to reinforce the structure. National Library of Medicine Underwent first unilateral total knee replacement. Would you like email updates of new search results? The important features of this trial for joint mobilization techniques in primary TKA are randomization procedures, single-blind, large sample size, and standardized protocol. Each group will finish usual training protocol twice a day for 4 weeks, and each section will receive health education before intervention. 3 x/day 15 minutes 3 x/day 15 minutes As required Range of motion ROM (0-90) - hang 10-20 lbs. We can conclude that our hypothesis that knee resurfacing with patellar bands in osteoarthritic knees has a direct effect on disease-specific outcomes in patients undergoing knee replacement is not supported. Patellar dislocation is infrequent but can cause disabling symptoms. 2022; 23(1):104 (Jan 2019). Choosing the right imaging method in muscle hernias: musculoskeletal ultrasonography. [3638] Knee proprioception and rectus muscle movement are seldom canvassed for mobilization on early TKA. Clin Rehabil.2018;32(6):722-733. doi:10.1177/0269215517753971. Total knee arthroplasty (TKA) has become the most preferred procedure by patients for the relief of pain caused by knee osteoarthritis. It applies the following criteria: pain, 30 points; function activity, 22 points; range of motion, 18 points; muscle strength, 10 points; flexion deformity, 10 points; and stability, 10 points. The effects of joint mobilization on individuals with patellofemoral pain: a systematic review. doi: 10.1097/MD.0000000000031584. In most cases, the majority of knee replacements will last more than 15 years. The effects of joint mobilization on individuals with patellofemoral pain: a systematic review. To have a successful patellofemoral replacement procedure, you should seek the assistance of a surgeon who has experience with this procedure. With the same operation method, normal blood clotting index. The pain and limitations of knee joint arthritis make it difficult to move around. One of these deaths occurred during a patellofemoral revision procedure in a patient who had recently undergone resurfacing of the knee as part of the primary procedure. Tragord BS, Gill NW, Silvernail JL, et al. Patellar mobilization involves the application of pressure or force on the kneecap in an effort to restore the normal up and down movement in the trochlea. Our assessment includes: These are reasons NOT to mobilize (unless it has been cleared by your doctor or physical therapist). Decreased excursion in a specific direction is an indication to mobilize the patella or tendon in this direction. However, relevant randomized controlled trials showing the curative effect of these techniques remain lacking to date. When either factor is present, revision surgery is needed (extensor apparatus reconstruction, prosthetic implant removal). This review will examine the evidence base used to evaluate the effectiveness of patellar resurfacing using the most up-to-date literature. Before The patellar tendon is a long, broad joint with a thickness of 5 to 7 mm that extends 30 mm wide by 50 mm long. Kim J, Nelson CL, Lotke PA. Stiffness after. The patella is also connected to the shinbone (tibia) by the patellar ligament. Disclaimer. The movements that a therapist applies on the kneecap can be either rhythmic and gentle or more forceful and sustained, depending on the goals of the mobilization and the causes of the impaired mobility. The effect of addition of pregabalin and s-ketamine to local infiltration analgesia on the knee function outcome after total knee arthroplasty. Assessment of the patella should be done by shifting or gliding the patella in different directions. To mobilize the patella medially, place your fingers on the lateral border of the patella. This helps to gain more access to the patella, however it will tighten the structures that restrict patellar motion a bit. Principles of Arthrofibrosis Rehabilitation, Principles of Arthrofibrosis Rehabilitation, Funding, Advertising & Sponsorship Policy, Medial glide - gliding the patellar toward the centerline of the body, Lateral glide - gliding the patella away from the centerline of the body, Superior glide - gliding the patella to the top of body, Inferior glide - gliding the patella toward the feet, Patellar Tendon - assessing the amount of movement of the patellar tendon medially and laterally, Suprapatellar region - assessing the amount of movement of the region above the patella, It is not recommended by your doctor or physical therapist, Do not mobilize the patella laterally if you have had a lateral release procedure, Do not mobilize the patella laterally if you have subluxed or dislocated your patella, Avoid all mobilizations if you have had a quad or patellar tendon rupture or repair, unless this is cleared by your doctor or physical therapist. Scar tissue will start forming within hours after surgery. [19]. official website and that any information you provide is encrypted A knee replacement is a significant operation and should only be considered if other treatment options such as physiotherapy have failed. Patellar complications are dreaded as a source of poor outcomes. Bethesda, MD 20894, Web Policies The quad tendon and the suprapatellar pouch are not easy structures to palpate and are not very distinct from one another. In total knee arthroplasty, the patient must manage the patella. [20]. Patella maltracking after total knee arthroplasty is multifactorial and requires an accurate clarification. Information provided on the site is meant to complement and not replace any advice or information from a health professional. Patellofemoralpain syndrome. A t-test will be performed to compare the changes in measures within groups. short-term clinical outcomes of TKA performed with and without the patella resurfacing. As a result, your leg may be difficult to straighten completely due to a loss of range of motion. Orthop Surg Glob Res Rev. It is not possible to mobilize a total knee replacement. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Jansen E, Brienza S, Gierasimowicz-Fontana A, et al. The result of knee resurfacing surgery can vary depending on the type of surgery performed and the patients age. Selecting a prosthetic trochlea that will ensure proper patellar tracking is important. Rev Chir Orthop Reparatrice Appar Mot 1999;85:6405. Zeng X, Yang Y, Jia Z, Chen J, Shen H, Jin Y, Lu Y, Li P. Front Surg. The patient should be evaluated for causes amenable to treatment (fracture, instability, clunk, osteonecrosis, bony impingement on the prosthetic trochlea). You can resume most daily activities three to six weeks after surgery, including shopping and light housekeeping. J Am Acad Orthop Surg. In contrast to total knee replacement, which involves replacing all three compartments of the knee (femur, tibia, and patella) with a prosthesis, this is a less invasive procedure that involves resurfacing the back of the kneecap and the front of the thighbone. A knee resurfacing procedure is an option for patients who have knee pain. He is passionate about helping his patients achieve the best possible outcome and is committed to providing the highest quality of care. Buy Bauerfeind - GenuTrain P3 - Patella Knee Support - For Misalignment of the Kneecap - Right Knee . There is a chance that physical therapy will help you regain some range of motion and mobility, but it may take up to four weeks. A study conducted by Inoue et al. The objective of this work is to answer six questions. While you may feel stretching or strain during this hands-on technique, patellar mobilizations should generally not cause pain. If you are suffering from joint pain, stiffness, or swelling after receiving a total joint replacement, please request an appointment online or call us. Unauthorized use of these marks is strictly prohibited. Patellar replacement surgery is a type of knee surgery that is performed to replace a damaged or diseased patella (knee cap) with a artificial one. When a person has knee stiffness or a decrease in range of motion, knee manipulation is an effective treatment. Apropos of 12 cases. Accordingly, this study aims to investigate whether joint mobilization techniques are valid for primary TKA. 2000 Feb;(371):161-8 In some cases, it can be done robotically. 1). J Rheumatol 2016;43:16006. J Appl Oral Sci 2016;24:18897. It can be helpful to place a towel roll under your knee in order to bend the knee slightly. All participants will sign a consent form before the study. The ratings of this type of scale are as follows: 020 points, balance ability is poor; 2140, with medium fall risk; and 4156, with low fall risk. Patellofemoral complications after total knee arthroplasty are responsible for a variety of surgical revisions. After surgically replacing damaged cartilage, doctors can restore pain-free motion and full joint function. Early on after an injury, surgery, or flare-up of arthritis, patellar mobilizations are typically gentle in nature. Its function is to offer a means of extending the knee through force applied from the quad muscles. Kang MH, Lee DK, Kim SY, et al. Shatrov J, Colas A, Fournier G, Batailler C, Servien E, Lustig S. SICOT J. Early-stage TKA patients mainly lie in bed to perform straight leg-raising to increase quadriceps muscle strength and active joints. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Knee Mobilization is a passive, skilled, manual therapy approach applied to joints and related to the soft tissue at various speeds and amplitudes taking physiological or accessory movement for therapeutic purposes small amplitude force applies at a fast velocity, and a large amplitude force applies at to slow velocity Akti S, Cankaya D, Kilinc S, Oztemur Z, Ozturk H, Bulut O. Rev Assoc Med Bras (1992). [16]. (1) Have risk factors been identified, and can they help to prevent patellar complications? ACTIVITIES: Patellar Mobilizations . This can vary depending on your individual diagnosis and the goals of the rehab treatment. extension after total knee replacement: A randomized controlled study. Patients with the Miller-Galante II (Zimmer, Warsaw, Indiana) TKR were fitted with a polyethylene patellar component or a Miller-Galante II with a polyethylene patellar component without a polyethylene patellar component. In ten years after surgery, 22 patients died, seven developed dementia, and ten others were lost to follow-up. Thank you, {{form.email}}, for signing up. New approach for the rehabilitation of patients following, [12]. Due to irritation of the surrounding tissues as a result of various activities, knee replacement surgery causes pain. It usually takes six to eight weeks for the majority of people to drive again following surgery. Epub 2019 Jul 13. [1,2] Total knee arthroplasty (TKA) is recommended to ease the pain and increase the joint function of end-stage knee OA patients. In primary total knee arthroplasty, whether or not to resurface the patella is a sensitive issue. The choice to use the patellar resurfacing in the total knee prosthesis (TKP) is decided by the surgeon's experience; he analyzes the thickness, the shape, consumption of the surface and he chooses the use of patellar resurfacing or to limit itself to cheiloplasty, denervation, or often to the release of the lateral wing . Tests included all combinations of external femoral component rotation of 0 degree, 2.5 degrees, and 5 degrees and patellar placement at the geometric center and at 3.75 mm medial . Total knee replacement is a type of surgery to replace a damaged knee joint. Assess the amount of excursion of the patella. Modalities to control pain . The patella is an important component of the total knee arthroplasty (replacement)( procedure and as such, are resurfaced with a button of plastic which provides an increased articular surface for the quadriceps/extensor mechanism to kick up the knee bilaterally. Lecuire F, Rubini J, Basso M, et al. This can be found by feeling for the edges of the patella with your fingers. Gait Posture 2016;[Epub ahead of print]. [31]. [11]. modify the keyword list to augment your search. Along the same lines, your knee cap moves in a downward direction in the groove when the leg is bent or flexed. When Patellar osteophytes became available, they were resected. 6 Things That Can Make Your Knee Give Out, Causes of Knee Pain and Treatment Options, Joint Subluxation Injury: Symptoms and Treatment, Chondromalacia Patella Treatment: Relief for Knee Pain, Walking Backwards on a Treadmill in Physical Therapy, An Overview of Patellofemoral Stress Syndrome, What To Do When You Have No Cartilage in Your Knee, Patellar Subluxation: What to Do About an Unstable Kneecap. The knee joint is a joint at which three bones meet the thighbone, the shinbone, and the patella. Cost-effectiveness of five commonly used prosthesis brands for total knee replacement in the UK: a study using the NJR dataset. Because there is more pain, the recovery process can take longer. By restoring normal patellar mobility in the trochlear groove, movements like bending and straightening your knee become easier, and overall daily function improves. You may search for similar articles that contain these same keywords or you may Traditional solutions have a fairly high failure rate, with approximately 30% of the time (Table 1). MeSH This is called patellar dissociation. Tools to measure primary indicators include the following: Tools to measure secondary indicators include the following: Statistical analyses will be implemented by SPSS 17.0 and Microsoft Excel 2007 software. 152Patellar Mobility After Knee ReplacementThe patella, or kneecap, is an important part of the knee joint. Clin Orthop Relat Res. The Truth About Spinal Stenosis: Causes Symptoms And Treatments, Can Years Of Surfing Contribute To Spinal Stenosis, The Effects Of Spinal Stenosis And Carpal Tunnel, Should I Apply Ice Or Heat To A Compression Fracture, How Does A Soft Bed Prevent Healing Of Herniated Disc, Herniated Discs: How To Sleep Without Worrying About Rupturing Your Discs, If You Have A Herniated Disc You Know The Excruciating Pain It Can Cause. They will be treated with a laser dose of 6 J/cm2 over 8 points around the knee. During patellar resurfacing, the surgeon will remove the damaged surface of the patella and replace it with a new piece of bone or a metal implant. Begin patellar mobilization techniques when incision stable to avoid contracture. If other treatments have failed or are no longer appropriate, a surgical procedure may be required. Kappetijn O, van Trijffel E, Lucas C. Efficacy of passive extension mobilization in addition to exercise in the osteoarthritic knee: an observational parallel-group study. When the lateral retinaculum is tight, you may feel that the patella tilts toward you. It is possible that patients with limited knee damage, such as apatella and a groove in the thighbone where the kneecap rests, will require knee replacement surgery. LEVEL OF EVIDENCE: V, expert opinion. Gait training with . The average recovery time following knee replacement surgery is six months, but it can be as long as twelve months for some people to fully recover. Neuromuscul Disord 2016;29:58492. Acta Orthop. This randomized controlled trial was to investigate the effects of patellar eversion on functional outcomes in TKR. Published by Wolters Kluwer Health, Inc. The position of entry point in total knee arthroplasty is associate with femoral bowing both in coronal and sagittal planes. Data will be represented as mean standard deviation (SD). The physical modality therapy group will undergo physical therapy once a day and regular training twice a day for a month. Without a clearly identified cause surgical measures are unrewarding and almost regularly lead to an unsatisfactory outcome. Besides postoperative genu valgum with malalignment of the extensor mechanisms, other risk factors for patellar maltracking are insufficiency of the medial retinaculum, weakening of the vastus medialis muscle, contracture of the quadriceps femoris or tractus iliotibialis muscle, residual valgus deformity after total knee replacement, femoral or tibial malrotation as well as malpositioning of the patella, inappropriate design of the prosthesis and asymmetrical resection of the patella. Keep your quad muscles relaxed while mobilizing. In one of the three compartments, arthritis of the knee joint can be found, though a knee replacement can last up to 20 years. This is not always possible, particularly for older people, as you can see in the image. The undersides of the patellar bones were covered with fibrous tissue and cartilage. [16] Joint mobilization may assist in reducing pain and increasing motion by passive oscillatory movements of small or large amplitude and sustained stretching. For example, a tibiofemoral anteroposterior movement or patellofemoral movement may be performed to improve the knee flexion angle. Place one finger lateral to the tendon and the other medial. The Effect of an Exercise Program with Patella Mobilization on Range of Motion, Muscle Strength and Gait in Patients with Total Knee Arthroplasty. HHS Vulnerability Disclosure, Help While it is possible to resurface the patella in primary total knee arthroplasty, the issue remains contentious. doi: 10.1016/s0883-5403(89)80013-0. and transmitted securely. PFPS can be treated more effectively if it is diagnosed and treated as soon as possible. Clipboard, Search History, and several other advanced features are temporarily unavailable. [9] In the United States, the latest research data show that the mean total TKA-related expenses are US $ 30,831; speeding up the recovery process can lessen TKA-related expenses.[10].

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