title: Perioperative Physiotherapy for Total Ankle Replacement in Patients with Inherited Bleeding Disorders: Outline of an Algorithm.
abstract: The treatment of end-stage hemophilic arthropathy of the ankle joint remains a controversial problem, and total ankle replacement (TAR) is considered to be a valuable management option. Physiotherapy continues to be an extremely important part of TAR and has a tremendous impact on the outcomes of this procedure. Given the lack of data on the latter, this study details a protocol of perioperative physiotherapy in TAR in patients with inherited bleeding disorders (IBD). The protocol outlined in this paper was devised via consultations within an interdisciplinary group, the authors' own experiences with TAR in hemophilic and non-hemophilic patients, previous reports on this issue in the literature, and patient opinions. Our working group followed the criteria of the International Classification of Functioning, Disability and Health. The algorithm includes 4 physiotherapy phases with specified time frames, aims, interventions, and examples of exercises for each phase. We emphasize the importance of preoperative rehabilitation, and recommend introducing intensive physiotherapy immediately after the surgery, with regard to the wound protection and avoiding full weight-bearing in the first weeks. The intensity of physiotherapy should be adjusted individually depending on individual patient progress. This study details a rehabilitation protocol for TAR in patients with IBDs, which can be equally applicable to clinicians and researchers. Further scientific studies are required to investigate the beneficial effect of different protocols as well as to clarify the effectiveness of various frequencies, durations, and intensities of selected interventions.
authors.affiliation: Department of Orthopedics and Traumatology of the Musculoskeletal System, 1st Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.|Department of Orthopaedic Surgery and Traumatology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kotela
authors.affiliation: Department of Kinesiotherapy and Manual Therapy, Faculty of Health Sciences, Vincent Pol University in Lublin, Lublin, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Wilk-Frańczuk
authors.affiliation: Department of Physiotherapy, Lekmed Medical Center, Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Jaczewska
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Żbikowski
authors.affiliation: Department of Orthopedics and Traumatology of the Musculoskeletal System, 1st Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Łęgosz
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Ambroziak
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.|Department of Physiotherapy, Jan Kochanowski University in Kielce, Kielce, Poland.
authors.forename: Ireneusz
authors.initials: I
authors.lastname: Kotela
mesh_terms: D000465:Algorithms; D000843:Ankle Joint / Q000502:physiology / Q000601:surgery; D058737:Arthroplasty, Replacement, Ankle / Q000379:methods* / Q000534:rehabilitation; D025861:Blood Coagulation Disorders, Inherited / Q000503:physiopathology*; D006801:Humans; D007592:Joint Diseases / Q000601:surgery / Q000628:therapy*; D019990:Perioperative Care / Q000379:methods; D026741:Physical Therapy Modalities; D016059:Range of Motion, Articular; D016474:Weight-Bearing