РЕАБИЛИТАЦИОННЫЕ МЕРОПРИЯТИЯ ПОСЛЕ ЭНДОПРОТЕЗИРОВАНИЯ СУСТАВОВ: НОВЫЕ ПОДХОДЫ ОПТИМИЗАЦИИ. ОБЗОР ЛИТЕРАТУРЫ
Введение: Операции по эндопротезированию являются эффективным методом лечения пациентов с дегенеративными заболеваниями суставов, и с каждым годом спрос постоянно увеличивается. Однако без квалифицированной реабилитации наблюдается нарушение функциональной деятельности. Цель: обзор и анализ литературных данных по вопросам реабилитационных мероприятий после эндопротезирования крупных суставов нижних конечностей. Стратегия поиска: Проведен поиск научных работ в базах данных Cochrane Library, PubMed и Wiley Online Library, Scopus, Web of Science, Google Scholar, CyberLeninka. Статьи были выбраны из этих баз данных с использованием следующих ключевых слов: сустав / остеоартроз / эндопротезирование / реабилитация. Глубина поиска составила 17 лет (2003-2020 гг.). Критерии включения: статьи, отчеты о рандомизированных и когортных исследованиях; метаанализы, нормативно-правовые документы; публикации на английском и русском языках, рекомендации научных сообществ по вопросам эндопротезирования и исследования по реабилитационным мерам. 83 публикации были отобраны для последующего анализа. Результаты и выводы: Восстановление функциональности суставов после эндопротезирования нижних конечностей является актуальным вопросом. Пациенты должны повысить качество жизни, свои социальные, трудовые, спортивные возможности, поэтому реабилитационные мероприятия являются ключевыми моментами для решения этой проблемы. Однако во всем мире не до конца разработан единый и подробный протокол для реабилитации, который включал бы тип упражнений и их продолжительность, временной интервал между сеансами и необходимое оборудование. Ключевые слова: реабилитация, эндопротезирование суставов, остеоартроз.
Айдана К. Мағауина1, Айнур Б. Кумар1 1 НАО «Казахский Национальный медицинский университет имени С.Д. Асфендиярова», г. Алматы, Республика Казахстан.
1. Айдаров В.И., Тахавиева Ф.В., Загидуллин М.В., Тимершин Р.Р. Оптимизация реабилитационной помощи при эндопротезировании крупных суставов нижних конечностей // Инновационные технологии в медицине. 2014. 4 (80) июнь, Т.2. С. 15-18. 2. Европейские рекомендации (ESCEO) 2014 г. по лечению больных остеоартрозом // Русский медицинский журнал. 2014. №30. С. 21-49 3. Зак Г.Г. Исторический анализ сущности понятия «реабилитация» в системе специального образования // Специальное образование. ФГБОу вПО. Екатеринбург, 2012 – No 3. – с. 152. 4. Затевахин И.И., Пасечник И.Н., Губайдуллин P.P., Решетников Е.А., Березенко М.Н. Ускоренное восстановление после хирургических операций: мультидисциплинарная проблема. Часть 1 // Хирургия Журнал им. Н.И. Пирогова. 2015. 9. С.4-8. 5. Клинический протокол по медицинской реабилитации поздняя реабилитация «реабилитация поздняя» профиль «травматология и ортопедия» (взрослые) от Республики Казахстан от «12» декабря 2014 года протокол No 9. 6. Конева Е.С. Комплексные программы реабилитации пациентов после операций тотального эндопротезирования суставов нижней конечности в раннем послеоперационном периоде. Вестник восстановительной медицины. 2014. No 3 (61). С. 55–65. 7. Кузнецова В.П., Кирчанов в.А., Буряков А.Е., Хе М.В. Реабилитация больных после эндопротезирования тазобедренного сустава на базе отделения травматологии и ортопедии // Культура физическая и здоровье. 2013. No 3. С. 29-33. 8. Николаев Н.С., Андреева В.Э. Опыт организации восстановительного лечения при оказании высокотехнологичной медицинской помощи по профилю «Травматология и ортопедия» // Вестник восстановительной медицины. 2013. No 1 (53). С. 56–59. 9. Полякова А.Г., Карева О.А., Новиков А.В. Современные аспекты комплексной реабилитации больных после эндопротезирования крупных суставов нижних конечностей // Физиотерапия, бальнеология и реабилитация. 2013. No 3. С.41-51. 10. Реабилитация при эндопротезировании коленного сустава. Федеральные клинические рекомендации. Союз реабилитологов РФ, 2015. 236с. 11. Романовский Г.Б. Правовые основы медицинской реабилитации. Все ли пациенты имеют доступ к реабилитационным мероприятиям? // Правовые вопросы в здравоохранении. 2014. № 12. С. 44–57. 12. Федонников А.С., Андриянова Е.А., Еругина М.В., Норкин И.А. Реабилитация пациентов после эндопротезирования тазобедренного и коленного суставов: отдельные результаты медико-социологического мониторинга // Саратовский научно-медицинский журнал. 2017. Т13. №4. С. 796-799. 13. Ardali G. A daily adjustable progressive resistance exercise pro- tocol and functional training to increase quadriceps muscle strength and functional performance in an elderly homebound patient following a total knee arthroplasty // Physiother Theory Pract. 2014. 30(4):287–297. 14. Bade M.J., Stevens-Lapsley J.E. Early high-intensity rehabilitation following total knee arthroplasty improves outcomes // J Orthop Sports Phys Ther 2011. 41(12):932–941. 15. Beaupre L.A., Masson E.C., Luckhurst B.J., et al. A randomized pilot study of a comprehensive postoperative exercise pro- gram compared with usual care following primary total hip arthroplasty in subjects less than 65 years of age: feasibility, selection of outcome measures and timing of assessment // BMC Musculoskelet Disord. 2014. 15:192. 16. Benz T., Angst F., Oesch P., et al. Comparison of patients in three different rehabilitation settings after knee or hip arthroplasty: a natural observational, prospective study // BMC Musculoskelet Disord. 2015;16:317. 17. Berges I.M., Kuo Y.F., Ostir G., et al. Gender and ethnic differences in rehabilitation outcomes after hip-replacement surgery // Am J Phys Med Rehabil. 2008. 87:567–572. 18. Bischoff-Ferrari H., Lingard E., Losina E., et al. Psychosocial and geriatric correlates of functional status after total hip replacement. Arthritis Rheum—Arthritis Care Res. 2004. 51:829–835. 19. Bjerke J., Öhberg F., Nilsson K.G., Stensdotter A.K. Compensatory strategies for muscle weakness during stair ascent in subjects with total knee arthroplasty // J Arthroplasty. 2014. 29(7): 1499–1502. 20. Brander V., Stulberg S.D. Rehabilitation after hip and knee-joint replacement // Am J Phys Med Rehabil 2006;85:S98-118. 21. Catherine J. Minns Lowe, Karen L. Barker, Michael Dewey, Catherine M Sackley. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials // BMJ. 2007 Oct 20. 335(7624): 812. 22. Collins N., Roos E. Patient reported outcomes for total hip and knee arthroplasty: commonly used instruments and attributes of a “good” measure // Clin Geriatr Med. 2012. 28:367–394. 23. Coulter C.L., Scarvell J.M., Neeman T.M., et al. Physiotherapist directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review // J Physiother. 2013. 59:219–226. 24. Crepeau E. “I need someone to keep an eye on me” the power of attention in patient-practitioner interactions // Disabil Rehabil. 2016. 12:1–9. 25. Dauty M., Genty M., Ribinik P. Physical training in rehabilitation programs before and after total hip and knee arthroplasty // Annales de readaptation et de medicine physique. 2007. 50:462-8. 26. Deborah L. Snell, Julia Hipango, K. Anne Sinnott, Jennifer A. Dunn, Alastair Rothwell, C. Jean Hsieh Rehabilitation after total joint replacement: a scoping study // Disabil Rehabil. 2018 Jul. 40(14):1718-1731. doi: 10.1080/09638288.2017.1300947.Epub 2017 Mar 23. 27. DeJong G., Horn S., Smout R., et al. Joint replacement rehabilitation outcomes on discharge from skilled nursing facilities and inpatient rehabilitation facilities // Arch Phys Med Rehabil. 2009. 90:1284–1296. 28. Dejong G., Tian W., Smout R. et al. Long-term outcomes of joint replacement rehabilitation patients discharged from skilled nursing and inpatient facilities // Arch Phys Med Rehabil. 2009. 90:1306–1316. 29. Devers B.N., Conditt M.A., Jamieson M.L., Driscoll M.D., Noble P.C., Parsley B.S. Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty? // J Arthroplasty. 2011. 26(2):178–186. 30. Ebert J.R., Munsie C., Joss B. Guidelines for the Early Restoration of Active Knee Flexion After Total Knee Arthroplasty: Implications for Rehabilitation and Early Intervention. Archives of Physical Medicine and Rehabilitation. 2014. 95(6), 1135–1140. doi:10.1016/j.apmr.2014.02.015 31. European League Against Rheumatism (EULAR). Horizon 2020 Framework Programme. EULAR’s position and recommendations. 2020. 115р. 32. Foucher K.C., Hurwitz D.E., Wimmer M.A. Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients // J Biomech. 2007. 40:3432-7. 33. Gage M.J., Schwarzkopf R., Abrouk M., Slover J.D. Impact of metabolic syndrome on perioperative complication rates after total joint arthroplasty surgery // Arthroplasty. 2014. 29(9):1842-1845. 34. Goodman S., Wimmer M.A., Ploeg H. Recent Advances in Total Joint Replacement // Journal of Orthopaedic Research. 2020. doi:10.1002/jor.24734 35. Guerra M.L., Singh P.J., Taylor N.F. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review // Clin. Rehabil. 2015. Vol.29. P.844–854. 36. Herbold J.A., Bonistall K., Blackburn M., et al. Randomized controlled trial of the effectiveness of continuous passive motion after total knee replacement // Arch Phys Med Rehabil. 2014. 95:1240–1245. 37. Hesse S., Werner C., Seibel H., von Frankenberg S., Kappel E.M., Kirker S. Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial // Arch Phys Med Rehabil 2003. 84:1767-73. 38. Hooper G., Rothwell A., Hooper N. et al. The relationship between the American Society of Anesthesiologists physical rating and outcome following total hip and knee arthro- plasty: an analysis of the New Zealand Joint Registry // J Bone Joint Surg Am. 2012. 94:1065–1070. 39. Inacio M.C.S., Paxton E.W., Graves S.E., Namba R.S., Nemes S. Projected increase in total knee arthroplasty in the United States - an alternative projection model // Osteoarthritis Cartilage. 2017. 25:1797–803. 40. Jakobsen T.L., Kehlet H., Husted H., et al. Early progressive strength training to enhance recovery after fast-track total knee arthroplasty: a randomized controlled trial // Arthritis Care Res (Hoboken). 2014. 6:1856–1866. 41. Jasvinder A. Singh, Shaohua Yu, Lang Chen and John D. Cleveland. Rates of Total Joint Replacement in the United States: Future Projections to 2020–2040 Using the National Inpatient Sample. The Journal of Rheumatology September 2019, 46 (9). 1134-1140. DOI: https://doi.org/10.3899/jrheum.170990 42. Jeffery A., Wylde V., Blom A., et al. “It's there and I'm stuck with it”: patients' experiences of chronic pain following total knee replacement surgery // Arthritis Care Res. 2011. 286–292. 43. Jennifer M. Weiss, Philip Noble. What functional activities are important to patients with knee replacements? // lin Orthop Relat Res 2002 Nov. (404):172-88.doi: 10.1097/00003086-200211000-00030. 44. Johnson E., Horwood J., Gooberman-Hill R. Trajectories of need: understanding patients' use of support during the journey through knee replacement // Disabil Rehabil. 2016. 10. 1–14. 45. Jordan R.W., Smith N.A., Chahal G.S., et al. Enhanced education and physiotherapy before knee replacement; is it worth it? // A systematic review. Physiotherapy. 2014. 100:305–312. 46. Jørgensen C.C., Kehlet H. Role of patient characteristics for fast-track hip and knee arthroplasty // Br. J. Anaesth. 2013. Vol. 110 (6). P. 972–980. 47. Judd D.L., Winters J.D., Stevens-Lapsley J.E., et al. Effects of neuromuscular reeducation on hip mechanics and func- tional performance in patients after total hip arthroplasty: a case series // Clin Biomech (Bristol, Avon). 2016. 32:49–55. 48. Kenji D., Andrea G., Jodie M. The Effects of Balance Training on Balance Performance and Functional Outcome Measures Following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis // Sports Med. 2018. Oct. 48(10):2367-2385. doi: 10.1007/s40279-018-0964-7. 49. Khan F., Ng L., Gonzalez S., Hale T., Turner-Stokes L. Multidisciplinary rehabilitation programmes following joint replacement at the hip and knee in chronic arthropathy // Cochrane Database Syst Rev 2008. CD004957. 50. Lavernia C., Alcerro J., Brooks L., et al. Mental health and out- comes in primary total joint arthroplasty // J Arthroplasty. 2012. 27:1276–1282. 51. Lemanu D.P., Singh P.P., Stowers M.D., Hill A.G. A systematic review to assess cost effectiveness of enhanced recovery after surgery programs in сolorectal surgery // Colorectal Dis. 2014. Vol. 16. P. 338–346. 52. Lespasio M. Knee Osteoarthritis: A Primer // The Permanente Journal. 2017. doi:10.7812/tpp/16-183 53. Li W., Ayers D.C., Lewis C.G., Bowen T.R., Allison J.J., Franklin P.D. Functional gain and pain relief after total joint replacement according to obesity status? // J Bone Joint Surg Am. 2017 Jul 19. 99(14):1183-1189. DOI: 10.2106/JBJS.16.00960. PMID:28719557 54. Li Z., Jiang L., Lin J. The effect of education for daily physical activity level recovery of osteoarthritis patients after total knee arthroplasty. A prospective randomized controlled clinical trial using accelerometry // Osteoarthritis Cartilage. 2015. 23:A373. 55. Liao C.D., Liou T.H., Huang Y.Y. et al. Effects of balance train- ing on functional outcome after total knee replacement in patients with knee osteoarthritis: a randomized controlled trial // Clin Rehabil. 2013. 27:697–709. 56. Mau-Moeller A., Behrens M., Finze S., et al. The effect of continuous passive motion and sling exercise training on clincal and functional outcomes following total knee arthroplasty: a randomised active-controlled clinical study // Health Qual Life Outcomes. 2014. 12:68–78. 57. Michael J. Bade, Wendy M. Kohrt, Jennifer E. Stevens-Lapsley. Outcomes before and after total knee arthroplasty compared to healthy adults // Journal of Orthopaedic & Sports Physical Therapy. 2010. Sep. 40(9): 559–567. 58. Mikkelsen L., Mechlenburg I., Soballe K., et al. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast track total hip replacement applied to patients with preoperative functional limitations: a single-blinded randomised controlled trial // Osteoarthritis Cartilage. 2014. 22: 2051–2058. 59. Monticone M., Ambrosini E., Rocca B., et al. Task-oriented exercises and early full weight-bearing contribute to improving disability after total hip replacement: a randomised controlled trial // Clin Rehabil. 2014. 28:658–668. 60. Neil Artz, Karen T. Elvers, Catherine Minns Lowe, Cath Sackley, Paul Jepson, Andrew D. Beswick. Effectiveness of physiotherapy exercise following total knee replacement: systematic review and meta-analysis // BMC Musculoskelet Disord. 2015. 16: 15. 61. New Zealand Orthopaedic Association (NZOA). New Zealand Joint Registry: Sixteen Year Report (January 1999 to December 2014) // Christchurch New Zealand; 2015. 315р. 62. O’Donnell S., Kennedy D., Mac Leod A.M., Kilroy C., Gollish J. Achieving team consensus on best practice rehabilitation guidelines following primary total hip replacement (THR) surgery // Healthcare Quarterly. 2006. 9:60-4. 63. Pablo P., Losina E., Phillips C.B. et al. Determinants of discharge destination following elective total hip replacement // Arthritis Rheum. 2004. 51: 1009–1017 64. Peter W.F., Nelissen R.G., Vlieland T.P. Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: are they used in daily clinical practice? // Musculos-kelet Care 2014. 12(3):125–131 65. Philip C. Noble, Michael J. Gordon, Jennifer M. Weiss, Robert N. Reddix, Michael A. Conditt, Kenneth B. Mathis. Does total knee replacement restore normal knee function? // Clin Orthop Relat Res. 2005 Feb. (431):157-65. doi: 10.1097/01.blo.0000150130.03519.fb. 66. Piva S.R., Gil A.B., Almeida G.J., DiGioia A.M., Levison T.J., Fitzgerald G.K. A balance exercise program appears to improve function for patients with total knee arthroplasty: a randomized clinical trial // Phys Ther 2010;90(6):880–894 67. Ravi B., Croxford R., Reichmann W.M., Losina E., Katz J.N., Hawker G.A. The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007 // Best Pract Res Clin Rheumatol. 2012. 26:637–47 68. Segun Dawodu Osteoarthritis. Originally published: November 10, 2011, Last updated: April 4, 2017. American Academy of physical medicine and rehabilitation PM&R (AAPM&R). 69. Singh J.A., Vessely M.B., Harmsen W.S., Schleck C.D., Melton L.J., Kurland R.L. et al. A population-based study of trends in the use of total hip and total knee arthroplasty, 1969–2008 // Mayo Clin Proc 2010. 85:898–904 70. Starks I., Wainwright T.W., Lewis J. et al. Older patients have the most to gain from orthopaedic enhanced recovery programmes // Age Ageing. 2014. Vol.43. P.642–648. 71. Stevens-Lapsley J.E., Balter J.E., Kohrt W.M., Eckhoff D.G. Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty // Clin Orthop Relat Res. 2010. 468(9):2460–2468 72. Taniguchi M., Sawano S., Kugo M., Maegawa S., Kawasaki T., Ichihashi N. Physical activity promotes gait improvement in patients with total knee arthroplasty // J Arthroplasty. 2015. doi: 10.1016/j.arth.2015.11.012 73. Tomohiro O., Osamu W., Tsuyoshi A. Importance of knee flexion range of motion during the acute phase after total knee arthroplasty // Phys Ther Res. 2020. 23(2): 143–148. 74. Trudelle-Jackson E., Smith S.S. Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial // Arch Phys Med Rehabil 2004. 85:1056-62. 75. Turner A., Barlow J., Buszewicz M., et al. Beliefs about the causes of osteoarthritis among primary care patients // Arthritis Rheum. 2007. 57:267–271. 76. Umpierres C.S., Ribeiro T.A., Marchisio AE, et al. Rehabilitation following total hip arthroplasty evaluation over short follow-up time: randomized clinical trial // J Rehabil Res Dev. 2014. 51:1567–1578 77. Unver B., Bakirhan S., Karatosun V. Does a weight-training exercise programme given to patients four or more years after total knee arthroplasty improve mobility: a random- ized controlled trial // Arch Gerontol Geriatr. 2016. 64:45–50. 78. Vincent H.K., Alfano A.P., Lee L., Vincent K.R. Sex and age effects on outcomes of total hip arthroplasty after inpatient rehabilitation // Arch Phys Med Rehabil. 2006. 87:461-7. 79. Westby M., Backman C. Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis: a focus group study // BMC Health Serv Res. 2010. 10:119–134. 80. Westby M.D. Rehabilitation and total joint arthroplasty // Clin Geriatr Med. 2012. 28:489–508. 81. Westby M.D., Brittain A., Backman C.L. Expert Consensus on Best Practices for Post-Acute Rehabilitation After Total Hip and Knee Arthroplasty: A Canada and United States Delphi Study. Arthritis Care & Research, 2014. 66(3), 411–423. doi:10.1002/acr.22164 82. World Health Organization. Available from: http:// www.who/.int/topics/rehabilitation/en/- 04.03.2021. 83. Yoshida Y., Mizner R.L., Snyder-Mackler L. Association between long-term quadriceps weakness and early walking muscle contraction after total knee arthroplasty // Knee. 2013. 20(6): 426–431 References: [1-13] 1. Aidarov V.I., Takhavieva F.V., Zagidullin M.V., Timershin R.R. Optimizatsiya reabilitatsionnoi pomoshchi pri ehndoprotezirovanii krupnykh sustavov nizhnikh konechnostei. [Optimization of rehabilitation measures after total joint replacement of the lower extremities.] Innovatsionnye tekhnologii v meditsine. [Innovative technologies in medicine. 4 (80) June, 2014, V.2. pp. 15-18.] [in Russian] 2. Evropeiskie rekomendatsii (ESCEO) 2014 g. po lecheniyu bol'nykh osteoartrozom. European guidelines (ESCEO) for the treatment of patients with osteoarthritis 2014 y. Russkii meditsinskii zhurnal [Russian medical journal]. 2014. No.30. p. 2149] [in Russian] 3. Zak G.G. Istoricheskii analiz sushchnosti ponyatiya «reabilitatsiYA» v sisteme spetsial'nogo obrazovaniya [Historical analysis of the essence of the concept of "rehabilitation" in the system of special education]. Spetsial'noe obrazovanie [Special education] — Ekaterinburg, 2012. №3. 152p. [in Russian] 4. Zatevakhin I.I., Pasechnik I.N., Gubaidullin P.P., Reshetnikov E.A., Berezenko M.N. Uskorennoe vosstanovlenie posle khirurgicheskikh operatsii: mul'tidistsiplinarnaya problema. Chast' 1 [Accelerated recovery from surgery: a multidisciplinary problem. Part 1]. Khirurgiya Zhurnal im. N.I. Pirogova [Surgery Journal. N.I. Pirogov. 2015. 9. pp.4-8.] [in Russian] 5. Klinicheskii protokol po meditsinskoi reabilitatsii pozdnyaya reabilitatsiya «reabilitatsiya pozdnyaya» profil' «travmatologiya i ortopediYA» (vzroslye) ot Respubliki Kazakhstan ot «12» dekabrya 2014 goda protokol No 9. [Clinical protocol for late medical rehabilitation "late rehabilitation "profile "traumatology and orthopedics" (adults), Republic of Kazakhstan dated December 12, 2014, protocol No. 9.] [in Russian] 6. Koneva E.S. Kompleksnye programmy reabilitatsii patsientov posle operatsii total'nogo ehndoprotezirovaniya sustavov nizhnei konechnosti v rannem posleoperatsionnom periode [Comprehensive rehabilitation programs for patients after total arthroplasty of the lower limb joints in the early postoperative period] Vestnik vosstanovitel'noi meditsiny [Bulletin of restorative medicine. 2014. No 3 (61). pp. 55-65]. [in Russian] 7. Kuznetsova V.P., Kirchanov v.A., Buryakov A.E., Khe M.V. Reabilitatsiya bol'nykh posle ehndoprotezirovaniya tazobedrennogo sustava na baze otdeleniya travmatologii i ortopedii [Rehabilitation of patients after hip arthroplasty in the Department of Traumatology and Orthopedics]. Kul'tura fizicheskaya i zdorov'e [Physical Culture and Health]. 2013. No 3. P. 29-33]. [in Russian] 8. Nikolaev N.S., Andreeva V.E. Opyt organizatsii vosstanovitel'nogo lecheniya pri okazanii vysokotekhnologichnoi meditsinskoi pomoshchi po profilyu «Travmatologiya i ortopediya» [Experience in organizing rehabilitation in the provision of high-tech medical care in the field of "Traumatology and Orthopedics"]. Vestnik vosstanovitel'noi meditsiny [Bulletin of Restorative Medicine. 2013. No 1 (53). pp. 56-59. [in Russian] 9. Polyakova A.G., Kareva O.A., Novikov A.V. Sovremennye aspekty kompleksnoi reabilitatsii bol'nykh posle ehndoprotezirovaniya krupnykh sustavov nizhnikh konechnostei [Modern aspects of complex rehabilitation of patients after endoprosthetics of large joints of the lower extremities]. Fizioterapiya, bal'neologiya i reabilitatsiya [Physiotherapy, balneology and rehabilitation. 2013. No 3. pp.41-51. [in Russian] 10. Reabilitatsiya pri ehndoprotezirovanii kolennogo sustava. Federal'nye klinicheskie rekomendatsii. Soyuz reabilitologov RF [Rehabilitation for knee arthroplasty. Federal clinical guidelines. Union of Rehabilitation Therapists of the Russian Federation]. 2015. [in Russian] 11. Romanovskii G.B. Pravovye osnovy meditsinskoi reabilitatsii. vse li patsienty imeyut dostup k reabilitatsionnym meropriyatiyam? [Legal bases of medical rehabilitation. Do all patients have access to rehabilitation services?]. Pravovye voprosy v zdravookhranenii [Legal issues in health care]. 2014. No. 12. P.44–57 [in Russian] 12. Fedonnikov A.S., Andriyanova E.A., Erugina M.V., Norkin I.A. Reabilitatsiya patsientov posle ehndoprotezirovaniya tazobedrennogo i kolennogo sustavov: otdel'nye rezul'taty mediko-sotsiologicheskogo monitoringa [Rehabilitation of patients after hip and knee arthroplasty: some results of medical and sociological monitoring]. Saratovskii nauchno-meditsinskii zhurnal. [Saratov Journal of Medical Scientific Research]. 2017. T13. No. 4. pp. 796-799. [in Russian]
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Мағауина А.К., Кумар А.Б. Реабилитационные мероприятия после эндопротезирования суставов: новые подходы оптимизации. Обзор литературы // Наука и Здравоохранение. 2022. 3(Т.24). С. 171-181. doi 10.34689/SH.2022.24.3.020 Magauina A.K., Kumar A.B. Rehabilitation measures after total joint replacement: new approaches to optimization. Literature review // Nauka i Zdravookhranenie [Science & Healthcare]. 2022, (Vol.24) 3, pp. 171-181. doi 10.34689/SH.2022.24.3.020 Мағауина А.К., Құмар А.Б. Буынды эндопротездеуден кейінгі реабилитациялық шаралар: оңтайландырудың жаңа тәсілдері. Әдебиетке шолу // Ғылым және Денсаулық сақтау. 2022. 3 (Т.24). Б. 171-181. doi 10.34689/SH.2022.24.3.020