“The support helps patients return to daily activities faster”

After knee replacement surgery, compression supports can help speed up patients’ return to daily activities. A study with the GenuTrain performed under the direction of the rehabilitation specialist Professor Dr. Bernhard Greitemann is designed to deliver the corresponding scientific evidence.

In Germany, there is not enough science when it comes to orthopedic engineering,” says Professor Dr. Bernhard Greitemann, Medical Director of the Münsterland Clinic at RehaKlinikum Bad Rothenfelde. With a randomized, controlled trial investigating the effect of GenuTrain following knee joint replacement, he aims to fill a research gap regarding the post-operative use of supports and deliver scientific evidence to inform rehabilitation medicine. Although Covid has slowed down his schedule considerably, the professor nevertheless estimates that – halfway through the planned number of participants – the research hypotheses tend to have been confirmed: “Edema reduction is accelerated, and the knee support provides security and stability while exercising to regain function.” These are two important aspects in rehabilitation: rapid edema reduction is crucial for pain and mobility. When exercising, it takes confidence to slowly increase walking speed and stride length. According to Professor Greitemann, most patients who have undergone surgery respond well to the compression and enjoy wearing the support, only a few do not tolerate the pressure.

The study will cover the rehab phase at the clinic and a total observation period of three months. On admission, staff physicians select patients that meet the inclusion criteria. If they provide consent, they are randomly assigned to either the support or the control group. Then the typical rehab program starts, which usually lasts three weeks – with or without the additional use of the GenuTrain. Progress is monitored at regular intervals by physicians and therapists. The pre-defined goal for discharge: more than 90-degree knee flexion and, if possible, complete extension of the leg. Study participants complete physical activity tasks and keep a diary of their activities – even after discharge from the clinic to record potential long-term effects on stabilization.

Real-life situation on the walking trail

Study director, Professor Greitemann, is convinced of the post-operative use of knee supports. Rehab patients often exhibit insecurity regarding weight-bearing and an unsteady gait, impaired proprioception or functional stability as well as muscle atrophy due to many years of illness. “The alternative to a support are compression stockings,” explains the medical director. “However, they often lose their effectiveness once the edema subsides, as they no longer fit because of the smaller leg circumference. Also, a support is easier to put on and has a more positive, athletic look,” he adds. According to his hypothesis, “The support increases stability, helping patients to return to daily activities faster.”

That is what study participant Maria Richter is hoping for. On her second day at the rehab clinic, she was fitted with a GenuTrain, which she is now expected to wear for five hours a day. She received a unicondylar knee replacement two weeks ago and is already walking well again, as she demonstrates on the walking trail developed especially for the study. Here, patients can practice walking in everyday situations in the gymnasium, regardless of the weather outside: on gravel or sand, cobblestones or stairs, on a laterally sloped walking plane and an incline in walking direction. Maria Richter has a goal: “To finish the Way of St. James that I have started!” One year ago, she also had to give up Nordic walking because of her pain, but that should change soon: “Now it’s time to practice!”

A better quality of life

Walter Budde, who has been in Bad Rothenfelde for two weeks with a recently implanted prosthesis, is already further along in the process. He successfully practices keeping his balance during the Posturomed measurement, which is used as a test for collateral ligament stability. “Here, the support comes in useful!” he enthuses as he intently checks his posture in the mirror. Isometric force measurement on the leg press also shows good results. Over the course of the study, the patients are scheduled to complete three measurements. Nothing should stand in the way of a largely normal, active life – not least because of the added support provided by the GenuTrain. “Everybody with a knee prosthesis can benefit from a support in the long run, especially patients who stand a lot at work or who love exercising,” explains Professor Greitemann, who also prescribes them at discharge. The important thing is to do what you enjoy as soon as possible.

“Everybody with a knee prosthesis can benefit from a support in the long run.”

Prof. Dr. Bernhard Greitemann

Clinical study with GenuTrain in the post-operative follow-up treatment of knee endoprostheses

Under the direction of Professor Dr. Bernhard Greitemann, a study conducted at the Münsterland Clinic is investigating the effectiveness of compression supports in post-operative patients following knee replacement surgery. The rehab program is designed to reduce edema and irritation, promote mobility and strengthen the stabilizing muscles. This prospective, randomized and controlled interventional study compares the stabilizing effects of a standard rehabilitation program that includes pain medication and physical therapy with a program in which patients in the intervention group also wear a compression support (GenuTrain). For three months, the 82 participants aged between 50 and 80 keep an activity diary and complete the internationally recognized Oxford Knee Score (OKS) questionnaire. During the stay at the clinic, data is collected on functional joint stability, range of motion (ROM) of the joint and edema reduction as well as self-reported joint function (OKS), strength, daily walking distance, pain and medication use.

Images: Sven Hillert