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Background Disease and aging-related factors may predispose chronic obstructive pulmonary disease (COPD) patients to impaired balance, although the underlying determinants of impaired balance in COPD patients are still unknown. The purpose of this study was to identify the determinants of impaired balance in COPD patients. Also, we aimed to determine which balance measures (clinical or laboratory tests) are more indicative in determining balance impairment in these patients. Methods This cross-sectional study recruited 24 patients with moderate to severe COPD and 24 age-matched healthy subjects. Participants were evaluated regarding demographic and clinical data, previous falls history, lower limb muscle strength, exercise capacity, physical activity and balance level. Results COPD patients exhibited significantly a longer test duration on timed up and go test, a higher sway index on the postural stability and lower directional control score on the limit of stability of Biodex balance system (all, p < 0.001) compared to healthy controls, whereas there was no difference in Berg balance scale score between groups (p > 0.05). Balance impairment of the patient group was significantly associated with nonpulmonary conditions, such as physical activity level, exercise capacity, lower limb muscle strength, and with fall history. Also, COPD patients represented significantly lower physical activity level and exercise capacity, weaker lower limb muscle strength than healthy controls (all, p < 0.001). Conclusions Patients with moderate to severe COPD exhibit apparently important reductions in balance control that is directly associated with nonpulmonary consequences and fall history. These results may be extremely important to fall prevention and to guide the development of interventions for this population.

Purpose This study aimed to compare progressive muscle relaxation (PMR) + standard physiotherapy (PT) to standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of post-operative outcomes. The hypothesis was that PMR + standard PT would lead to better pain, function, and neuromuscular outcomes than standard PT. Methods A total of 106 patients were randomly allocated into PMR or standard rehabilitation (SR) groups. Both groups received standard PT during their hospital stay. PMR group additionally performed PMR exercise on post-operative days 1, 2, and 3. Patients were evaluated regarding pain intensity, functional outcomes, muscle strength, active range of motion, knee edema, anxiety, depression, and kinesiophobia. Results There were no differences between groups at baseline (n.s.). During the inpatient period and at discharge, the PMR group had better results in terms of pain relief (p < 0.05), quadriceps strength (p = 0.001), kinesiophobia level (p = 0.011) compared to the SR group. No difference was detected between groups regarding other evaluation parameters during the inpatient period, at discharge, and third post-operative month (n.s.). The within-group analysis showed statistically significant differences over time in both groups in each variable (p < 0.05). Conclusion Our findings support that PMR therapy offers beneficial results in subjective and objective measures of TKA patients during the inpatient period. Therefore, PMR therapy could be implemented into the rehabilitation program of TKA patients to enhance their early recovery from various symptoms following TKA.

The L test is a modified version of the timed up and go test (TUG), extending the walking distance from 6 to 20 meters and also requiring participants to make four turns in both (right/left) direction. It could be a useful measurement method in assessment of functional mobility for patients with Total Knee Arthroplasty (TKA). The aim of the study was to determine reliability, concurrent validity, and minimal detectable change (MDC) of L test in patients with TKA.The study included 43 patients with TKA. The Intraclass Correlation Coefficient (ICC) was used to assess the intra-rater reliability of the L test. The correlations of the L test with TUG were assessed for concurrent validity.Intra-rater (ICC 0.97) reliability of the L test was determined to be excellent. The SEM and MDCThe L test is a valid and reliable method in the assessment of functional mobility in patients with TKA. The L test can be used to quantify changes in functional mobility level in patients with TKA.Implications for rehabilitationThe L test is a reliable and valid measurement tool that can be used to assess functional mobility in patients with TKA.Clinicians and researchers can use a greater change than 2.84 seconds for the L test as a meaningful change in patients with TKA.

Local infiltration analgesia (LIA) is a simple, surgeon-administered technique for the treatment of postoperative pain after total knee arthroplasty (TKA). The aim of the study was to investigate the efficacy of LIA and its effects on functional outcomes in TKA. A total of 135 patients with primary TKA were recruited and randomized either to receive LIA or to receive placebo injection (PI). Pain, active range of motion (ROM), knee function score, functional activities, and hospital length of stay (LOS) were assessed before surgery and from postoperative day (POD) 1 to at discharge. Lower pain scores at rest were recorded on POD1 and POD2 in the LIA group (p = 0.027 and p = 0.020, respectively). Lower pain score on walking was recorded on POD1 in the LIA group (p = 0.002). There was a statistically significant difference in active knee flexion between groups on POD1 (p = 0.038). There was a significant difference in LOS between LIA and PI groups. Shorter stay was seen in LIA group. There were no statistically significant differences between the groups in terms of knee function score and functional outcomes. LIA technique is effective for pain management in the early postoperative period. LIA added benefit for knee function in terms of active knee flexion ROM after TKA. A shorter hospital LOS was observed in LIA group. However, we did not find any differences in groups in terms of functional assessment such as ability to rise from a chair and walking capacity.The level of evidence is randomized controlled trial, level I.

Purpose The aim was to compare active heel-slide exercise (AHSE) + standard physiotherapy (PT) to continuous passive motion (CPM) + standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of postoperative outcomes. Methods Patients were randomly assigned into AHSE or CPM groups. Both groups received standard PT (range of motion and strengthening exercises, and ambulation) during hospital stay. Patients were evaluated regarding functional outcomes, knee proprioception, pain intensity, active range of motion, knee circumference, length of hospital stay, time for achieving straight leg raise actively, time for achieving 70 degrees knee flexion. Results Groups were similar at baseline (n.s.). At discharge, AHSE group was better in terms of pain intensity (p < 0.001), Hospital for Special Surgery knee score (p = 0.001), rise from sitting (p = 0.015), ascend/descend stairs (p = 0.038), and timed up and go test (p = 0.028) compared to CPM group. AHSE group was able to perform the straight leg raise earlier than CPM group during inpatient period (p = 0.001) and demonstrated improved proprioception at discharge and at 3-month follow-up (p < 0.05). No statistical differences were detected between groups in other evaluation parameters (n.s.). Conclusion Our findings support AHSE therapy offers a more functional rehabilitation and leads beneficial results for patients following TKA. Therefore, active exercise approach encouraging patients to participate in their rehabilitation should be first choice in acute postoperative rehabilitation following TKA rather than CPM.

According to our knowledge, there is no prior article that reports functional results of medial collateral ligament (MCL) primary repair and insert change after MCL rupture and mobile-bearing dislocation as a late complication of unicompartmental knee replacement (UKR). Firstly, 63-year-old woman was treated with UKR due to anteromedial knee osteoarthritis of the right knee joint. 1 year after UKR surgery, she suffered from MCL rupture and mobile-bearing dislocation because of falls while getting on a public bus, and therefore, secondly, she was operated with MCL primary repair and mobile-bearing change and followed up for 2 years. The patient was evaluated regarding functional capacity, pain intensity, range of motion (RoM), and quality of life. Our case showed an improvement in the functional level and the other outcomes (pain intensity and quality of life) at postoperative 2nd year when compared to the preoperative period. The wellbeing of our case in about the postop 2nd year functional capacity and also other outcomes after revision surgery prompted us to continue to this surgery approach in the surgical management of similar cases that may arise thereafter.

Background:Total knee arthroplasty (TKA) is a very common procedure, particularly implemented for the treatment of knee osteoarthritis (OA). Patient expectations after TKA surgery now include being able to enjoy appropriate recreational activities representing ambulatory activities beyond that of just pain relief and adequate knee motion (1). Since recreational activity comprises of more complex functions and requires longer standing durations, walking for 6-meter in a straight line in the timed up and go test (TUG) does not fully reflect the functional capacity of patients with TKA, and TUG test may be limited to detect the balance and mobility capacity in TKA patients (2, 3). As such, there is a need to determine more effective and functional evaluation tools that better reflect realistic situations in order to assess ambulatory performance level for patients with TKA. However, no studies have been conducted in patients with TKA to examine the applicability of the L-test, which assesses ambulation of individuals and consists of complex mobilization activity.Objectives:The purposes of this study were to determine the test-retest reliability and the minimal detectable change (MDC) of the L-test for TKA patients.Methods:Twenty-four patients with TKA due to knee OA, operated by the same surgeon, were included in this study. Patients performed trials for L-test twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The tester recorded the performance time while the participant was asked to get up from a chair, walk 3 m in a straight line, turn right, continue walking for 7 m in a straight line, turn left, walk back along the same path and sit down in the chair at their usual walking speed. Prior to the real testing session, the L-test was demonstrated by the tester and all participants were allowed to a practice trial.Results:The L-test showed an excellent test-retest reliability (ICC2,1= 0,98) in this study. Standard error of measurement (SEM) and MDC95for L-test were 1,01 second and 2,8 second, respectively.Conclusion:This study found that the L-test is a reliable test for patients following TKA. Overall, the excellent test-retest reliability of the L-test indicates that it may be an applicable standardized method to assess TKA patients who are able to walk greater distances and have better gait in more functional situations. Clinicians and researchers can be confident that changes in L-test time above 2,8 seconds, represent a “real” clinical change in an individual patient with TKA. We, therefore, recommend the use of L-test as complementary outcome measures for balance and functional evaluation in TKA patients.References:[1]Swinkels, A., & Allain, T. J. (2013). Physical performance tests, self-reported outcomes, and accidental falls before and after total knee arthroplasty: an exploratory study. Physiotherapy theory and practice, 29(6), 432-442.[2]Deathe, A. B., & Miller, W. C. (2005). The L test of functional mobility: measurement properties of a modified version of the timed “up & go” test designed for people with lower-limb amputations. Physical therapy, 85(7), 626-635.[3]Kim, J. S., Chu, D. Y., & Jeon, H. S. (2015). Reliability and validity of the L test in participants with chronic stroke. Physiotherapy, 101(2), 161-165.Disclosure of Interests:None declared

Background:Patients with TKA show impairments in standing balance up to 1 year after surgery. The impaired standing balance in TKA patients was found to be associated with falls risk and decreased functional level. Assessing of standing balance with objective and reliable assessments tools would therefore be extremely useful for determining accurate exercise program, and risks of falling, especially during the rehabilitative period when ambulation is at its most unsteady (1, 2). The stepping maneuver requires adequate strength and motor control to stabilize the body over the stance limb while the other leg is stepping, therefore the Step Test (ST) provides significant information for dynamic standing balance and lower limb motor control (3). The reliability of ST is reported in patient groups such as stroke, however, there is not any study that investigates the reliability of ST in patients with TKA in the current literature.Objectives:The purposes of this study were to determine the test-retest reliability and the minimal detectable change (MDC) of the ST in patients with TKA.Methods:40 patients with TKA due to knee osteoarthritis, operated by the same surgeon, were included in this study. Patients performed trials for ST twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. The ST assesses an individual’s ability to place one foot onto a 7.5-cm-high step and then back down to the floor repeatedly as fast as possible for 15 seconds. The score is the number of steps completed in the 15-second period for each lower extremity. Scores for each lower extremity were recorded separately. Prior to the testing, the ST was demonstrated by the tester and all participants were allowed to a practice trial.Results:The ST showed an excellent test-retest reliability (ICC2,1=0.95) in this study. Standard error of measurement (SEM) and MDC95for ST were 0.37 and 1.02, respectively.Conclusion:This study found that the ST has an excellent test–retest reliability in patients with TKA. It is an effective and reliable tool for measuring dynamic standing balance and participant falls. As a performance-based clinical test, the ST is easy to score, can be applied in a short time as part of the routine medical examination. Therefore, inclusion of ST into a more comprehensive battery of performance-based measures of standing balance and lower limb motor control function in subjects with TKA should be considered.References:[1]Si, H. B., Zeng, Y., Zhong, J., et al. (2017). The effect of primary total knee arthroplasty on the incidence of falls and balance-related functions in patients with osteoarthritis. Scientific reports, 7(1), 1-9.[2]Moutzouri, M., Gleeson, N., Billis, E., et al. (2017). The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 25(11), 3439-3451.[3]Hill, K. D., Bernhardt, J., McGann, A. M., et al. (1996). A new test of dynamic standing balance for stroke patients: reliability, validity and comparison with healthy elderly. Physiotherapy Canada, 48(4), 257-262.Disclosure of Interests:None declared

Background Many patients in need of total knee arthroplasty (TKA) have bilateral symptoms and require surgery to both extremities. Performance of a bilateral procedure under a single anaesthetic provides a reduced hospitalisation time, an isolated anaesthesia risk, a single rehabilitation, and substantial cost savings. However, previous studies’ reports vary from unilateral TKA producing better outcomes than bilateral TKA, the 2 procedures producing no significant difference, and bilateral TKA producing a better outcome than unilateral TKA. There is a need for new studies to examine the differences between unilateral and bilateral TKA in terms of the early postoperative outcomes. Objectives The aim of this study was to compare the effect of the unilateral and bilateral TKA on the early postoperative outcomes. Methods The study group consisted of 71 patients (106 knees), who underwent primary TKR because of arthrosis were stratified either unilateral or bilateral TKA status. The mean age of unilateral (n=36) subjects were 66.00±10.71 years, and the mean age of bilateral (n=35) subjects were 64.17±7.61 years. Patients were evaluated regarding the knee function score (Hospital for Special Surgery (HSS) score), pain (Numeric Pain Rating Scale (NPRS)), knee range of motion, length of hospital stay, the day of active straight leg raise, the day of knee flexion angle achieved 70 degrees, quality of life (Short-Form 12 Health Survey (SF-12)). Functional activities were evaluated using the Iowa Level of Assistance Scale and walking speed was evaluated using the Iowa Ambulation Velocity Scale. Patients were evaluated preoperatively and at discharge. All patients underwent the same rehabilitation program. Results At baseline, demographic and anthropometric characteristics were similar in groups and there was no statistically difference between groups (p>0.05). When the patients’ knee range of motion were compared, there were statistically differences (p=0.027) between groups after surgery. The unilateral group had better results in terms of postoperative knee flexion degree. There were no statistical differences in terms of the pain degree, HSS score, length of hospital stay, the day of active straight leg raise, the day of knee flexion angle achieved 70 degrees, IOWA help level and IOWA walking speed, SF-12 score between groups before and after TKA (p>0.05). Conclusions According to our results, the unilateral group had better result in term of postoperative knee flexion degree. On the other hand, the bilateral method may provide an advantage in terms of a single rehabilitation, and substantial cost savings. Therefore, in this comparison to obtain more comprehensive results studies on larger series are needed. In this way, a more uniform and objective data can be achieved. Disclosure of Interest None declared

Background The joint related structures such as joint capsule, menisci, ligaments, muscles, skin provide the sensory input for the knee proprioception. Individuals with knee osteoarthritis (OA) have poor proprioceptive sense when compared with the same ages healthy individuals. Due to OA, the joint structures such as menisci, ligaments, and joint capsule rapidly undergo degeneration, and the deficiency of the knee proprioception progresses. Daily activities such as stair climbing, rise from a chair, walking require different knee joint angles. Therefore, the evaluation of the knee position sense at different joint angles is necessary for a better understanding of the knee proprioceptive sense deficit and for planning rehabilitation program in patients with knee OA. Objectives The purpose of this study was to analyse the knee joint position sense in different knee joint angles and to compare the results. Methods The study group consisted of 80 patients (62 female/18 male, 124 knees), with unilateral or bilateral knee OA and with a mean age 65.5±9.1 years were included in the study. Patients were evaluated regarding knee proprioception in knee joint angle 30°, 60° and 75°. The starting position was in knee joint angle 90° flexion, and the target angles was attempted to replicate using active knee extension movements. Patients performed active joint angle replication test in sitting position at a standard back supported chair. The average of the 3 repetitions of active joint repositioning test was recorded position sense score. The angular displacements from the target angles (in knee joint angle 30°, 60°, 75°) at the end of the active reproduction tests were recorded as position sense deficit scores. Results When the patients’ knee position sense deficit at different joint angles (in knee joint angle 30°, 60° and 75°) were compared, there were statistically differences between at joint angle 75° and 60° (p=0.002), and also there were statistically differences between at joint angle 75° and 30° (p=0.001). However, there were not statistically differences between the patients’ knee position sense deficit at joint angle 30° and 60° (p>0.05). Conclusions According to our results, the patients with knee OA have better proprioceptive acuity at knee joint angle 30°, 60° than at knee joint angle 75°. Specifically, the detection of active knee movement occurred with lower target angle displacement at a starting knee angle close to terminal extension (30°) than at knee angles closer to midrange (75°). These results can be reasonably speculated that proprioceptive input arose primarily from hamstring muscle stretching, posterior capsule tautness, and possibly ligament strain. It could be argued that the observation of the greater motor responses at decreased angles likely have been facilitated from enhanced sensitivity of these sensory terminals. Also, the results of this study may provide guidance for future proprioceptive sensory evaluations and provide guidance for planning rehabilitation programs in patient with knee OA. Disclosure of Interest None declared

Background Total knee arthroplasty (TKA) is offered to patients who have end-stage knee osteoarthritis (OA) to reduce pain and improve functional performance. Pain and functional level in patients with TKA can be measured using self-report questionnaires such as the Numeric Pain Rating Scale (NPRS), Hospital for Special Surgery (HSS), Iowa Level of Assistance Scale (ILAS), and Iowa Ambulation Velocity Scale (IAVS). Proprioception plays an integral role in neuro-motor control of the knee joint and deficits in knee joint proprioception are well documented in individuals with knee osteoarthritis. However, the patient-reported functional level relevance of these deficits is not clear in both individuals with knee OA and with TKA. Objectives The aim of this study was to assess relationship between pre-/post-surgery patient-reported outcomes and proprioceptive acuity in patient with TKA due to knee OA. Methods The study group consisted of 68 patients (12 males, 56 females), who underwent primary TKR because of knee arthrosis were included in the study with mean age 64.9±9.1 years. Patients were evaluated regarding the knee proprioception (in knee joint angle 15°, 30°), pain (NPRS), HSS knee function score. Functional activities were evaluated using the ILAS and walking speed was evaluated using the IAVS. Patients were evaluated preoperatively and at discharge. All patients underwent the same rehabilitation program. Results While there were correlations in different rates in individuals with knee OA between patient-reported outcomes and proprioceptive acuity, there were no correlations in individuals with TKA between patient-reported outcomes and proprioceptive acuity. Preoperatively, low-to-moderate significant correlations was found between pain and proprioceptive acuity deficit scores in knee joint angle 15°, 30° (r=−0.196, p=0.046 and r=−0.378, p 0.05). Conclusions There were correlations in different rates in patients with knee OA between patient-reported outcomes and proprioceptive acuity, however there were no correlations in patients with TKA between patient-reported outcomes and proprioceptive acuity. These results suggest that patients who have knee OA and with poor proprioception show more limitation in functional ability and have more pain level. On the other hand, deficits in joint position sense in patients with TKA may be due to factors other than pain and functional disability. Poor proprioception in patients with TKA may be due to surgery related resection of articular cartilage, meniscuses, articular ligaments. Disclosure of Interest None declared

Background Total Knee Arthroplasty (TKA) is a common procedure performed mainly due to advanced osteoarthritis (OA), pain, physical disability and reduced quality of life. However, approximately 20% of the patients respond poorly to the surgery and chronic pain and disability following TKA remains a major health burden for many patients. Among the most well documented predictors of poor outcome following TKA is pain catastrophizing. Inadequate pain relief can cause impaired functional performance, increased skeletal muscles tension which are close to surgery related incision site, longer length of hospital stay, unnecessary psychological distress and decreased patient satisfaction. There is high need of developing treatments aimed at improving self-management for patient with TKA at early postoperative period. Objectives The aim of this study is to investigate the effectiveness of progressive muscle relaxations exercises (PMR) on pain coping, physical function and muscle strength among patients with TKA due to OA. Methods The study group consisted of 22 patients (33 knees), who underwent primary TKA because of OA were consecutively allocated to an intervention group (n=11, with mean age; 66.18±13.29 years), and were allocated to a control group (n=11, with mean age; 62.45±7.28 years). After surgery, all patients underwent the same rehabilitation program. The intervention group also was instructed preoperative patient education about PMR exercises, and the intervention group received PMR exercises focusing on reducing overall body tension, anxiety and pain managed by a physiotherapist. Patients were evaluated regarding the pain (Numeric Pain Rating Scale (NPRS)), muscle strength, knee function score (Hospital for Special Surgery (HSS) score), pain-related fear (Tampa Scale for Kinesiophobia (TSK)), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale (HADS)) and quality of life (Short-Form 12 Health Survey (SF-12)). Functional activities were evaluated using the Iowa Level of Assistance Scale and walking speed was evaluated using the Iowa Ambulation Velocity Scale. Also functional outcomes were evaluated with timed up and go (TUG) test and 10-metre walk test (10 MWT). Patients were evaluated preoperatively and at discharge. Results At baseline, demographic characteristics were similar in groups and there was no statistically difference between groups (p>0.05). It was determined at postoperatively that; the intervention group had better results in terms of reduction of pain severity (p=0.001), improvement of HADS anxiety level (p 0.05). Conclusions The current results suggest that the PMR exercises at early stage after TKA might be an effective method for patient rehabilitation outcomes. However, in this comparison to obtain more comprehensive results studies on larger series are needed. In this way, a more uniform and objective data can be achieved. Disclosure of Interest None declared

Background Proprioception has been defined as the perceived sense of knee joint position (joint position sense) and movement (kinesthesis) (1). The sensory input from the joint capsule, muscles, ligaments, skin improve proprioceptive acuity. With total knee arthroplasty (TKA) surgery articular cartilage, meniscuses, articular ligaments are removed. Also articular effusion and hematoma formation increase following surgery. Therefore, proprioceptive acuity decrease after TKA surgery (2). The proprioceptive improvement might prevent patients with TKA from falling down and increase their sense of security during physical activities. The clinical effect of neoprene knee sleeves on knee proprioception has been evaluated by studies in both injured and uninjured populations (3). But there is not any study research on the effect of neoprene knee sleeves on knee proprioception in patients with TKA. Objectives The aim of this study was to determine the effect of the neoprene knee sleeves on knee joint proprioception in patients with TKA. Methods Sixty patients (50 female/10 male) with a median age 64.95±8.84 years were included in the study. Knee joint proprioception of all the patients was evaluated with and without a neoprene knee sleeves preoperatively and at discharge. Patients attempted to replicate target angles (in knee joint angle 15°, 30°, 60°) using active knee extension movements in sitting position. The average of the 3 repetitions of active joint repositioning test was recorded position sense score. The angular displacements from the target angles (in knee joint angle 15°, 30°, 60°) at the end of the active reproduction tests were recorded as position sense deficit scores. Results Preoperatively (p 0.05). Conclusions In patients with TKA due to osteoarthritis, application of neoprene knee sleeves has increased the proprioceptive acuity. The current results suggest that neoprene knee sleeves might be used for improving proprioception in early stage of patients with TKA. References Herrington L, Simmonds C, Hatcher J. The effect of a neoprene sleeve on knee joint position sense. Research in Sports Medicine. 2005; 13(1):37–46. Pap G, Meyer M, Weiler H-T, et al. Proprioception after total knee arthroplasty: a comparison with clinical outcome. Acta Orthopaedica Scandinavica. 2000;71(2):153–9. Chuang S-H, Huang M-H, Chen T-W, et al. Effect of knee sleeve on static and dynamic balance in patients with knee osteoarthritis. The Kaohsiung Journal of Medical Sciences. 2007;23(8):405–11. Disclosure of Interest None declared

Background Continuous passive motion (CPM) is a common procedure in total knee replacement (TKR), but its effectiveness is controversial at early stage after TKR. Some studies have claimed that CPM promoting rapid postoperative recovery and the range of motion (ROM). However, some studies have demonstrated that CPM have any benefit on ROM, length stay of hospital and postoperative recovery (1, 2). Several studies have examined the use of CPM, but there is not any study that compared the effect of repetitive active range of motion (AROM) vs. CPM on early functional outcomes after TKR. Objectives The aim of this study was to compare the effect of AROM vs. CPM on early functional outcomes after TKR. Methods The study group consisted of 71 patients, who underwent primary TKR because of arthrosis were consecutively allocated to a AROM group (n=40, with median age; 70.8±7.9 years), and were allocated to a CPM group (n=31, with median age; 69.7±8.4 years). Patients were evaluated regarding knee function score (Hospital for Special Surgery (HSS) score), pain (Numeric Pain Rating Scale (NPRS)), knee circumference, knee range of motion, length of hospital stay, the day of knee flexion angle achieved 70 degrees and quality of life (Short-Form 12 Health Survey (SF-12). Functional activities were evaluated using the Iowa Level of Assistance Scale and walking speed was evaluated using the Iowa Ambulation Velocity Scale. Also functional outcomes were evaluated with timed up and go (TUG) test and 10-meter walk test (10 MWT). Patients were evaluated preoperatively and at discharge. Results At baseline, demographic and anthropometric characteristics were similar in groups and there was no statistically difference between groups (p>0.05). It was determined that; the AROM group had better results in terms of reduction of pain severity (p 0.05). Conclusions In patients with TKR, application of repetitive AROM has better results than CPM to decrease pain severity, improve the HSS knee score. However, AROM has no effect on the early functional outcomes and the other early patients9 outcomes. The current results suggest that application of AROM might be an effective method to decrease pain severity, improve the HSS knee score. References Maniar RN, Baviskar JV, Singhi T, et al. To use or not to use continuous passive motion post–total knee arthroplasty: Presenting functional assessment results in early recovery. The Journal of Arthroplasty. 2012;27(2),193–200. Bruun-Olsen V, Heiberg KE, Mengshoel AM. Continuous passive motion as an adjunct to active exercises in early rehabilitation following total knee arthroplasty–a randomized controlled trial. Disability and Rehabilitation. 2009;31(4), 277–283. Disclosure of Interest None declared

Background With total knee replacement (TKR) surgery articular cartilage, meniscuses, articular ligaments are removed. Also articular effusion and hematoma formation increase following surgery. Therefore, proprioceptive acuity decrease after TKR surgery (1). Drainage is a common procedure in TKR, but its effectiveness is controversial. Some studies have claimed that drainage decreases the risk of articular effusion and hematoma formation. However, some studies have demonstrated that drainage increases postoperative blood loss and does not improve the surgical result (2). Several studies have examined the effect of using drainage, but they have not involved improvement in proprioception for patients who had drains compared with those who did not after TKR. Objectives The aim of this study was to compare the effect of the drainage on proprioception acuity inpatients with total knee prosthesis. Methods The study group consisted of 60 patients (95 knees), who underwent primary TKR because of arthrosis were consecutively allocated to a drainage group (n=26 (41 knees), with median age; 66.23±8.63 years), and were allocated to a non-drainage group (n=34 (54 knees), with median age; 63.97±8.99 years). Patients were evaluated regarding knee proprioception (in knee joint angle 15°, 30° and 60°), knee function score (Hospital for Special Surgery (HSS) score), pain (Numeric Pain Rating Scale (NPRS)), knee circumference, knee range of motion. Functional activities were evaluated using the Iowa Level of Assistance Scale and walking speed was evaluated using the Iowa Ambulation Velocity Scale. Patients were evaluated preoperatively and at discharge. All patients underwent the same rehabilitation program. Results At baseline, demographic and anthropometric characteristics were similar in groups and there was no statistically difference between groups (p>0.05). When knee proprioceptive acuity measurements (in knee joint angle 15°, 30° and 60°) were compared before and after surgery, there was no statistical differences in proprioceptive acuity between groups (p>0.05). It was determined that; the drainage group had better results in terms of reduction of pain severity after surgery (p 0.05). Conclusions According to our results, the use of drainage did not improve the knee proprioceptive acuity inpatients with TKR. But, it is suggested that using drainage decreases pain severity and improves the HSS knee score. Also the use of drains has no effect on patients9 outcomes after TKR, in terms of improvements knee range of motion, knee circumference, functional activities and walking speed. References Pap G, Meyer M, Weiler H-T, et al. Proprioception after total knee arthroplasty: a comparison with clinical outcome. Acta Orthopaedica Scandinavica. 2000;71(2):153–9. Zhang QD, Guo WS, Zhang Q, et al. Comparison between closed suction drainage and nondrainage in total knee arthroplasty: a meta-analysis. The Journal of Arthroplasty. 2011;26(8):1265–1272. Disclosure of Interest None declared

Background Various measurement methods have been defined to assess the alignment of the lower extremities. The Q-angle measurement is reported to be associated with knee injury and patellofemoral dysfunction. The Q-angle has been assessed using radiography scans, goniometer and photogrammetry methods in supine and standing positions. The radiography method is accepted to be the most accurate and valid measurement technique in measurement the Q-angle. But as a result of being expensive and time-consuming, this invasive method is not mostly preferred in research and clinics. The goniometric measurement of Q-angle is practical because it is simple, requires inexpensive equipment (only a goniometer), and can be applied in a short time. Photogrammetry measurement technique is also an advantageous method for reducing measurement errors caused by goniometers and reduction of investigator errors. Objectives The aim of the present study, was to compare the clinical assessment of the Q-angle (goniometric and photogrammetric measurement methods) to a radiological assessment using radiograph (criterion validity) in patients with varus knee osteoarthritis. Methods The study group consisted of 15 (median age 68.6±11.9 years) patients with unilateral and bilateral varus knee osteoarthritis. Q-angle measurements were assessed on both lower extremities with three different goniometric methods (goniometric measurement method in standing position with quadriceps muscle relaxed; goniometric measurement method in supine position with quadriceps muscle relaxed; and contracted) using a 360° universal goniometer. After the goniometric measurements, photographs were taken with quadriceps muscle relaxed in standing position. For radiographic assessment, we used patients9 lower extremity scanograms, which had been taken to determine the diagnosis and treatment from the Computer Patient Archiving System database. Results There was a good correlation between the radiographic assessment and photogrammetric measurement (r=0.623, p Conclusions According to our result, the photogrammetric measurement and the goniometric measurement appear to be valid alternatives to the radiographic measurement for determining the Q-angle. These alternative measures might be used by clinicians and researchers to measure the Q-angle of patients with varus knee osteoarthritis in orthopaedic clinics. Disclosure of Interest None declared