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The efficacy of the reconstruction of the external robotic walking (RRH) on the device "Lokomat" in patients after total knee arthroplasty (TKA) in the early postoperative period (priori). The patients were divided into two groups: the study group (n=112) in patients whose priori to train walk on robotic device (EDM) and control group (n = 80), where the restoration was carried out in an active stereotype motoring instructor-led exercise therapy without use of mechanized equipment. Comparative analysis of the test results revealed more efficient recovery stereotype walk from the main group. In the analysis of the main group in the dynamics dinamoplantgrafii showed improvement in economic structure step, restoring the symmetry of the load while walking between the lower limbs, improved suspension function of the operated limb. According to the analysis parameter of the trajectory of migration center under the feet, we noted an increase in the effective axial load on the operated leg in the main group 1161.29 267.49 g/cm2 compared with the control group 460.28 52.42 g/cm2 (p ≤ 0,05). In the main group also showed a decrease of anxiety and increasing motivation. Conducted an X-ray - control the implanted joint in the long-term (12 months after surgery) did not show any signs of instability in the case of prosthetic components. Thus, conducting robotic training walk in patients in the early postoperative period is an effective and safe method of rehabilitation.

Purpose - to assess the effect of multimodal analgesia in the early rehabilitation of patients after hip replacement. Materials and methods. A prospective single-centre randomized research, which included 32 patients. Patients of the 1st group received paracetamol, ketorolac and tramadol, the 2nd group of patients - ketorolac intravenously and the 3rd group of patients - etoricoxib and gabapentin. Patients of the 2nd and the 3rd groups underwent epidural analgesia with ropivacaine. Multimodal analgesia was carried out for 48 hours after the surgery. Assessment of pain intensity was performed by the VAS (visual analogue scale), a neuropathic pain component - on the DN4 questionnaire . Time was recorded during the first and second verticalization of patients, using the distance walkers and by fixing the distance covered with in 2 minutes. Results. The intensity of pain for more than 50 mm on VAS at movement at least once every 48 hours after the surgery was occurred among 9% of the 1st group, 22% of patients from the 2nd group and 8% of patients of the 3rd group. Number of patients with neuropathic pain component decreased from 25% to 3% (p ≤ 0.05). The first verticalization was performed 10 ± 8 hours after the surgery, the second - 21 ± 8 hours later. Two-minute walk distance was 5 ± 3 and 8 ± 4 m, respectively. It is noted more frequent adverse events in patients of the 1st group was noted compared to patients of the 2nd and the 3rd groups during first (91%, 33% and 25%, p ≤ 0.05) and the second verticalization (70%, 25% and 17%, p ≤ 0.05). Multimodal analgesia allows to proceed with the successful activation of patients after hip replacement with in the first day after the surgery. The 3rd group patients are noted with a tendency for the optimal combination of efficient and safe of analgetic therapy.

The aim of the study was to assess the severity of pain in patients after total replacement of joints of the lower extremities in the exercise of walking on the day of the surgery. Walking on the day of the operation was carried out for 46 patients the comparison group included 41 patients. As a result of the study, patients carrying walking on the day of operation, assessed the severity of pain in the 3.54+1.75 on a scale of pain NRS, and patients carrying walking on the next day after surgery 5.49+1.42 points. The results indicate not only the possibility of practical implementation of the function of walking on the day of operation, but also about the possibility of its implementation at a lower level of pain at the time of its implementationon the day of surgery.