Comorbidity in the context of medical rehabilitation in patients after total arthroplasty of major lower limb joints

BACKGROUND: The effectiveness of restoring motor activity after total arthroplasty of major lower limb joints (TAMLJ) is determined by baseline physical activity, demographic characteristics, body mass index, comorbidities, and the presence of chronic pain. AIM: To assess the impact of comorbid conditions on the effectiveness of medical rehabilitation in patients after TAMLJ and to substantiate optimal approaches to restorative treatment. METHODS: A prospective cohort study involving 120 patients aged 55–70 years was conducted. Four groups were formed: control (without comorbidity), with hypertension (HT), diabetes mellitus (DM), and overweight (OW). The rehabilitation program included individualized therapeutic exercise, mechanotherapy, physiotherapy, and locomotor correction using the HP Cosmos robotic system. Its effectiveness was evaluated with the visual analog scale (VAS), WOMAC score, Lequesne index, Harris Hip Score, goniometry, and biomechanical gait analysis. RESULTS: All groups demonstrated positive trends, though the degree of improvement depended on the presence and type of comorbidity. The most pronounced results were observed in the control group: VAS decreased from 5.56 ± 0.82 to 1.21 ± 0.07; flexion angle improved from 122.06 ± 3.39° to 95.58 ± 1.27°; Lequesne index decreased from 14.42 ± 0.33 to 7.24 ± 0.16; Harris Hip Score improved from 47.90 ± 1.55 to 79.92 ± 0.75; WOMAC score improved from 48.36 ± 1.54 to 13.42 ± 1.04. In patients with HT, DM, and OW, the trends were less pronounced: pain reduction was from 5.62 ± 0.95 to 1.45 ± 0.09, from 5.89 ± 0.98 to 1.68 ± 0.11, and from 5.93 ± 1.01 to 1.89 ± 0.12 points, respectively. The smallest functional gain was observed in OW patients (WOMAC: 48.33 ± 1.53 to 24.74 ± 3.47). CONCLUSION: The presence of comorbid conditions slows functional recovery after TAMLJ. The implementation of robotic mechanotherapy into early postoperative rehabilitation improves its effectiveness.