Avaliação somatossensorial e funcional em pacientes submetidos à artroplastia total do joelho

Abstract

Introduction: Osteoarthrosis (OA) of the knee is a degenerative and chronic disease that promotes intense pain and often compromises the elderly population. With the severity of OA and the lack of success of conventional methods, Total Knee Arthroplasty (KTA) has been the most frequently used treatment, however, in some patients pain persists. Therefore, to better understand the pain, it is necessary to use somatosensory and functional tests. Objective: To evaluate the Pressure Pain Threshold (LDP) of patients with OA and submitted to TKA, as well as to analyze the association of pain intensity with functional factors. Methods: A case-control study was carried out on 40 subjects, selected for convenience at the Specialized Center for Orthopedics and Trauma (CEOT), divided into two groups: TKA group consisting of 20 patients operated on, being evaluated in three phases: preoperative , six and 12 months; and the control group comprised of 20 healthy, asymptomatic, paired subjects by sex and age, evaluated in a single moment. The LDP was performed through the digital pressure algometer. The intensity of pain was measured on the numerical scale from 0 to 10, the muscular strength assessed by the digital manual dynamometer. Range of motion obtained by the fleximeter. Static balance measured by the baropodometer and the speed test used to measure gait speed. Results: It presented statistical difference between the control group and TKA in all peripatellar and tibial points (P) (p <0.002). P4, P5, P5, P6, P8 and P9 (p <0.05), and six and 12 months were significant at P4, P5, P6, P8 and P9 (p <0.05) and Preoperative period and 12 months in P9 (p <0.05). In the comparison between the P at each stage of the evaluation, only significant changes were observed between P3 and P6 (p <0.05), P4 and P6 (p <0.005). Correlations of moderate to strong and inversely proportional between pain in movement and flexor strength (r = - 0.46), knee extensors (r = -0.49), hip abductors (r = -0.59) And gait velocity (r = -0.6), in the preoperative phase. Conclusion: In the preoperative phase there was lower LDP, due to central and peripheral sensitization due to OA chronicity. At six months post-operatively, he found a decrease in pain, which could be related to the efficacy of TKA and rehabilitation. Similar to the pre-surgical phase, at 12 months, LDP decreased, which may be linked to the central pain sensitization mechanism, contributing negatively to the decline in muscle strength and gait velocity.