Transcutaneous Electrical Nerve Stimulation After Total Knee Arthroplasty.
Condition: Transcutaneous Electric Nerve Stimulation; Pain
Study type: Interventional

Summary: 
      Total knee arthroplasty (TKA) consists of a surgical replacement of this joint by a
      prosthesis, and it is mainly carried out in cases of knee osteoarthrosis. In the
      postoperative period of TKA, the pain is intense and limits the mobility of patients, so the
      analgesia is one of the goals of the physical therapy. One of the alternatives available for
      pain management is the transcutaneous electrical nerve stimulation (TENS), characterized by
      the application of an electric pulsed current through electrodes positioned on the skin.
      Therefore, the present study aims to evaluate the acute effects of TENS associated with
      conventional physical therapy compared with conventional physical therapy on the pain level,
      knee range of motion and administration of morphine in the rehabilitation of patients after
      TKA.
    

Detailed description: 
      The study included patients who underwent TKA surgery in the Hospital de Clínicas de Porto
      Alegre (HCPA) and met the study eligibility criteria. The sample was randomly divided into
      experimental group, which received conventional physical therapy associated with the
      application of TENS, and control group, which held only conventional physical therapy, both
      on the first day after the surgery. The pain level, the range of motion of the operated knee
      and the Administration of morphine.

      The experimental group received TENS application held by two self-adhesive electrodes size
      5x9cm positioned parallel to the lumbar spine, on the nerve roots L3, L4 and L5. TENS was
      applied in conventional mode, emitting a pulsed biphasic, symmetrical rectangular wave with
      frequency of 100 Hz and pulse duration of 100 µs, for 30 minutes. The intensity was set
      according to the tolerance of the patient and was gradually increased during the application.
      The device used was the Neurodyn II model, by Ibramed.

      Subsequently, the conventional physical therapy was performed, with the use of the CPM device
      and performing exercises. The CPM device was used for 30 minutes, and realized continuous
      passive flexion and extension of the operated knee. The amplitudes of these movements were
      gradually increased in accordance with the tolerance of the patient. The device used was
      Spectra model, by Kinetec.

      Then, the patients realized active exercises of plantar flexion and dorsal flexion of the
      ankles and adduction and abduction of the hips, isometric exercises of flexion and extension
      of the operated knee and active exercises of flexion and extension of the non-operated knee.
      All exercises were performed in 10 repetitions, with the patient positioned in the supine
      position in the bed.

      The control group received only conventional therapy consisting of the use of the CPM device
      in the operated leg and the exercises in both lower limbs, identical to those performed in
      the experimental group.
    

Intervention name(s): Transcutaneous electrical nerve stimulation; Continuous passive movement device; Exercises
Intervention type(s): Device; Device; Other
Intervention description(s): TENS was applied in the conventional mode, through two self-adhesive electrodes of size 5x9cm positioned parallel to the lumbar spine, on the nerve roots of L3, L4 and L5, with frequency of 100 Hz and pulse duration of 100 μs, for 30 minutes. The intensity was adjusted according to the maximum tolerance of the patient and was gradually increased, with his permission, during the application time.; CPM device was used for 30 minutes and realized continuous passive flexion and extension of the operated knee.; Active exercises of plantar flexion and dorsal flexion of the ankles, adduction and abduction of the hips and flexion and extension of the operated knees. All exercises were performed in 10 repetitions, with the patient positioned in the supine position in the bed.
Other intervention name(s): TENS; CPM
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment