Ağrıda Odak Noktası Kalça

agridaodaknoktasikalcakapak

TOTAL KALÇA ARTROPLASTİSİ SONRASI REHABİLİTASYON

Merve Banu Doğan

Ankara Atatürk Sanatoryum EAH, Fiziksel Tıp ve Rehabilitasyon Kliniği, Ankara, Türkiye

Doğan MB. Total Kalça Artroplastisi Sonrası Rehabilitasyon. Çalış M, Talay Çalış H ed. Ağrıda Odak Noktası Kalça 1. Baskı. Ankara: Türkiye Klinikleri; 2025. p.213-224.

ÖZET

Total kalça artroplastisi (TKA) ve total diz artroplastisi (TDA) kalça ve diz eklemlerinin dirençli semptomatik dejeneratif ve romatolojik hastalıklarının tedavisinde uluslararası altın standart olarak kabul edilmektedir. TKA için endikasyonlar osteoartrit başta olmak üzere kalça osteonekrozu, kalça displazisi, konjenital kalça bozuklukları, travma sonrası artrit ve inflamatuar artritik durumlardır. TKA en yaygın yapılan ortopedik uygulamalardan biridir. Kalça enfeksiyonu, aktif enfeksiyon veya bakteriyemi varlığında, sepsiste ve şiddetli vasküler hastalıkta, yüksek doz immünsupresif ajan veya kortikosteroid alan hastalarda, kas atrofisi veya nöromüsküler hastalıklar nedeniyle kalçanın postoperatif iyileşmesi ve stabilitesinin sağlanamayacağı hastalarda kontrendikedir. TKA’da cerrahi yaklaşımlar genel olarak posterior, direk anterior, anterolateral, lateral yaklaşımlardır. Tromboz, yağ embolisi-pulmoner emboli, miyokard enfarktüsü, tekrar yatış gerektiren enfeksiyon, kırıklar, protezin mobilizasyonu (dislokasyon), aseptik gevşeme ve osteoliz (protezde aşınma) en sık görülen majör komplikasyonlardır. İmplant tasarımı ve cerrahi tekniklerdeki gelişmeler TKA’nın komplikasyon riskini önemli ölçüde azaltmış, böylece revizyon cerrahisi riskini azaltırken yüksek düzeyde işleve geri dönüş sağlanmıştır. Primer TKA’da postoperatif erken dislokasyon riskini azaltmak ve yumuşak doku onarımının iyileşmesini kolaylaştırmak için posterior yaklaşımda kalça önlemleri alınmalıdır. Kalçanın 90 derece fleksiyonu geçmeyecek şekilde hareket kısıtlaması için tuvalet yükselticileri, banyo sehpası, mobilya yükselticileri, oturma tabureleri; aşırı öne fleksiyonun önlenmesi için çorap yardımcısı gibi ergonomik uzatıcılar ve ayakkabı çekeceği, iç rotasyon kısıtlanması ve addüksiyonun önlenmesi için abdüksiyon yastıkları; denge, destek ve koordinasyona yardımcı olmak için yardımcı cihaz kullanımı (walker, baston, koltuk değneği) önerilir. TKA’dan sonra fiziksel fonksiyondaki eksiklikleri yönetmek için ideal rehabilitasyon stratejisi henüz belirlenmemiştir. Son zamanlarda cerrahi tekniklerdeki yenilikler ve minimal invaziv cerrahiye yapılan vurgu nedeniyle cerrahi günü erken mobilizasyon ve rehabilitasyon önerilmektedir. TKA sonrası bir hastada rehabilitasyonda temel amaç ameliyat sonrası altıncı haftanın sonunda kalçada tam eklem hareket açıklığına ulaşmak ve 12. haftaya kadar bağımsız yürümeyi sağlamaktır. TKA sonrası rehabilitasyon protokolleri, hem kullanılan özel egzersizler hem de bunların uygulanması için gereken zaman dilimleri açısından büyük ölçüde farklılık gösterir. TKA sonrası konvansiyonel (standart) rehabilitasyon programları eklem hareket açıklığı egzersizleri, düşük dirençli izometrik ve kalça abdüktörlerine yönelik eksantrik egzersizlerden oluşur. Ancak günümüzde progresif direnç egzersizleri, eklem replasmanından sonra en sık kullanılan egzersiz yöntemlerinden biri olmuştur.

Anahtar Kelimeler: Artroplasti; Rehabilitasyon; Egzersiz; Osteoartrit; Komplikasyonlar

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