The UPMC Aut Even hospital is a private hospital in Kilkenny, Ireland delivering specialist rehabilitation services.
They make use of the Biodex Isokinetic System 4 which was a key factor on this case study.

Patient Profile

The patient is a 64 year old nurse who had undergone a knee replacement surgery. Despite all her efforts and understanding of the importance of post-operative care, she faced significant challenges in achieving her range of motion (ROM) goals.

Rehabilitation Process

The patient attended weekly rehabilitation sessions, which consisted of passive stretching, active range exercises, and strengthening work. Despite these efforts, her range of motion remained limited at 0-50 degrees after 4 weeks.

Intervention

At the four-week mark, it was decided to manipulate the knee under anaesthetic (MUA). The knee was manipulated with ease to 120 degrees, indicating that the problem was not due to arthrofibrosis.

Rehabilitation Program

To facilitate an increase in ROM and gain patient confiednce, the Biodex System 4 isokinetic machine was introduced into her rehabilitation program. Attendance at rehab was  increased to twice a week. The biodex was used, in passive mode, to simulate a continuous passive motion (CPM) machine.

The range was set based on the patient’s comfort response initially, with two-minute sets at low speeds (30 degrees/second). The range was increased as the patient’s tolerance increased, and a pause was added/increased at the end of the range in flexion.

This was supplemented with a home exercise program to support her recovery and maintain the improvements gained during her sessions with the Biodex machine.

Progression

Co-contractions were introduced in passive mode, first eccentric and then concentric. Once the patient’s range started to increase, active exercising was reintroduced.

Outcome

The combined approach of the Biodex System 4 and the home exercise program provided a comprehensive rehabilitation strategy for the patient. The patient’s range on discharge at 14 weeks post-operation was 0-115 degrees, which surpassed her pre-opertaive range of 96 degrees.

Conclusion

The case demonstrates the potential benefits of using advanced rehabilitation equipment like the Biodex System 4 in conjunction with traditional rehabilitation programmes for TKR patients.