title: lower limbs kinematic assessment of the effect of a gym and hydrotherapy rehabilitation protocol after knee megaprosthesis: a case report.
abstract: [Purpose] To quantitatively assess the effect of a personalized rehabilitation protocol after knee megaprosthesis. [Subject and Methods] The gait patterns of a 33-year-old male patient with knee synovial sarcoma were assessed by a computerized analysis before and after 40 rehabilitation sessions. [Results] The rehabilitation protocol improved the gait pattern. After rehabilitation, hip flexion was nearly symmetric, with normalized affected limb hip flexion, and improved ankle flexion. Ankle in/eversion was asymmetric and did not improve after physiotherapy. Before physiotherapy, the hip flexion on the affected side anticipated the movement but nearly normalized in the follow-up assessment. Hip abduction range of motion increased, with wider movements and good balance. Knee range of motion nearly symmetrized, but maintained an anticipated behavior, without shock absorption at heel-strike. [Conclusion] Instrumental gait analysis allowed us to gain evidence about the training and how to expand rehabilitative interventions to improve efficacy. In particular, we recommend quadriceps and gastrocnemius eccentric contraction training (to improve the shock absorption phase, preventing early failures of the prosthesis); one-leg standing performance (to improve the support phase of the affected limb); adductor strength training (to aid in hip control during the swing phase); and peroneus strength training (to increase ankle joint stabilization).
authors.affiliation: Laboratorio di Anatomia Funzionale dell'Apparato Locomotore, Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano: via Mangiagalli 31 I-20133 Milano, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Lovecchio
authors.affiliation: Scuola di Specializzazione in Medicina Fisica e Riabilitazione, Università degli Studi di Milano, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Sciumè
authors.affiliation: Laboratorio di Anatomia Funzionale dell'Apparato Locomotore, Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano: via Mangiagalli 31 I-20133 Milano, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Zago
authors.affiliation: S.C. Medicina Fisica e Riabilitazione, Istituto Ortopedico G. Pini, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Panella
authors.affiliation: S.C. Medicina Fisica e Riabilitazione, Istituto Ortopedico G. Pini, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lopresti
authors.affiliation: Laboratorio di Anatomia Funzionale dell'Apparato Locomotore, Functional Anatomy Research Center (FARC), Department of Biomedical Sciences for Health, Università degli Studi di Milano: via Mangiagalli 31 I-20133 Milano, Italy.
authors.forename: Chiarella
authors.initials: C
authors.lastname: Sforza
keywords: Gait; Knee megaprosthesis; Limb-saving surgery