{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:01:21Z","timestamp":1791259281824,"version":"4.1.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"cyberdyne care robotics gmbh"},{"name":"Berufsgenossenschaftliches Klinikum Bergmannsheil gGmbH"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>The first weeks after total knee arthroplasty (TKA) are crucial for the functional outcome. To improve knee mobility, a continuous passive motion (CPM) motor rail is commonly used during in-hospital rehabilitation. The single-joint hybrid assistive limb (HAL-SJ) is a new therapy device. The aim of the study was to improve patients\u2019 range of motion (ROM), mobility, and satisfaction using the active-assistive support of the HAL-SJ.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>Between 09\/2017 and 10\/2020, 34 patients, who underwent TKA and matched the inclusion criteria, were randomized into study (HAL-SJ) and control (CPM) group. Treatment began after drain removal and was carried out until discharge. Primary outcome parameters were raised pre- and postoperatively and included the Oxford knee score (OKS), visual analog scale (VAS), and acquired range of motion. Furthermore complications caused by the device were recorded.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>OKS increased in both groups postoperatively, but only significantly in the HAL-SJ group. Postoperative pain improved in both groups without significant differences. Flexion improvement was significant in both groups between days 3\/7 and 8\u00a0weeks postoperatively. We did not encounter any complications related to HAL-SJ.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In conclusion, use of the HAL-SJ during rehabilitation in the early postoperative period after TKA was safe without disadvantages compared to the control group and seems to have advantages in terms of daily life impairment.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00402-021-04245-9","type":"journal-article","created":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T10:02:47Z","timestamp":1637056967000},"page":"3941-3947","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Rehabilitation during early postoperative period following total knee arthroplasty using single-joint hybrid assistive limb as new therapy device: a randomized, controlled clinical pilot study"],"prefix":"10.1007","volume":"142","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2095-7574","authenticated-orcid":false,"given":"Silvia J.","family":"Mrotzek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahir","family":"Ahmadi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"von Glinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Brinkemper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Aach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Schildhauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Cibura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,16]]},"reference":[{"key":"4245_CR1","doi-asserted-by":"publisher","first-page":"424","DOI":"10.2519\/jospt.2005.35.7.424","volume":"35","author":"RL Mizner","year":"2005","unstructured":"Mizner RL, Petterson SC, Snyder-Mackler L (2005) Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 35:424\u2013436. https:\/\/doi.org\/10.2519\/jospt.2005.35.7.424","journal-title":"J Orthop Sports Phys Ther"},{"key":"4245_CR2","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1016\/j.arth.2013.12.005","volume":"29","author":"CK Boese","year":"2014","unstructured":"Boese CK, Weis M, Phillips T et al (2014) The efficacy of continuous passive motion after total knee arthroplasty: a comparison of three protocols. J Arthroplasty 29:1158\u20131162. https:\/\/doi.org\/10.1016\/j.arth.2013.12.005","journal-title":"J Arthroplasty"},{"key":"4245_CR3","doi-asserted-by":"publisher","first-page":"CD004260","DOI":"10.1002\/14651858.CD004260.pub3","volume":"2014","author":"LA Harvey","year":"2014","unstructured":"Harvey LA, Brosseau L, Herbert RD (2014) Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev 2014:CD004260. https:\/\/doi.org\/10.1002\/14651858.CD004260.pub3","journal-title":"Cochrane Database Syst Rev"},{"key":"4245_CR4","doi-asserted-by":"publisher","first-page":"2578","DOI":"10.1007\/s00167-015-3754-x","volume":"24","author":"C-D Liao","year":"2016","unstructured":"Liao C-D, Huang Y-C, Lin L-F et al (2016) Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24:2578\u20132586. https:\/\/doi.org\/10.1007\/s00167-015-3754-x","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"4245_CR5","doi-asserted-by":"publisher","first-page":"2847","DOI":"10.1016\/j.spinee.2014.03.042","volume":"14","author":"M Aach","year":"2014","unstructured":"Aach M, Cruciger O, Sczesny-Kaiser M et al (2014) Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. Spine J 14:2847\u20132853. https:\/\/doi.org\/10.1016\/j.spinee.2014.03.042","journal-title":"Spine J"},{"key":"4245_CR6","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1055\/s-0036-1593805","volume":"6","author":"C Fisahn","year":"2016","unstructured":"Fisahn C, Aach M, Jansen O et al (2016) The effectiveness and safety of exoskeletons as assistive and rehabilitation devices in the treatment of neurologic gait disorders in patients with spinal cord injury: a systematic review. Global Spine J 6:822\u2013841. https:\/\/doi.org\/10.1055\/s-0036-1593805","journal-title":"Global Spine J"},{"key":"4245_CR7","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1007\/s00113-014-2616-1","volume":"118","author":"M Aach","year":"2015","unstructured":"Aach M, Meindl RC, Ge\u00dfmann J et al (2015) Exoskelette in der Rehabilitation Querschnittgel\u00e4hmter. M\u00f6glichkeiten und Grenzen (Exoskeletons for rehabilitation of patients with spinal cord injuries. Options and limitations). Unfallchirurg 118:130\u2013137. https:\/\/doi.org\/10.1007\/s00113-014-2616-1","journal-title":"Unfallchirurg"},{"key":"4245_CR8","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12984-015-0058-9","volume":"12","author":"M Sczesny-Kaiser","year":"2015","unstructured":"Sczesny-Kaiser M, H\u00f6ffken O, Aach M et al (2015) HAL\u00ae exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients. J Neuroeng Rehabil 12:68. https:\/\/doi.org\/10.1186\/s12984-015-0058-9","journal-title":"J Neuroeng Rehabil"},{"key":"4245_CR9","doi-asserted-by":"publisher","first-page":"259","DOI":"10.3389\/fnins.2019.00259","volume":"13","author":"M Sczesny-Kaiser","year":"2019","unstructured":"Sczesny-Kaiser M, Trost R, Aach M et al (2019) A randomized and controlled crossover study investigating the improvement of walking and posture functions in chronic stroke patients using HAL exoskeleton\u2014the halestro study (HAL-Exoskeleton STROke Study). Front Neurosci 13:259. https:\/\/doi.org\/10.3389\/fnins.2019.00259","journal-title":"Front Neurosci"},{"key":"4245_CR10","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1177\/2192568217713754","volume":"7","author":"O Jansen","year":"2017","unstructured":"Jansen O, Schildhauer TA, Meindl RC et al (2017) Functional outcome of neurologic-controlled HAL-Exoskeletal neurorehabilitation in chronic spinal cord injury: a pilot with one year treatment and variable treatment frequency. Glob Spine J 7:735\u2013743. https:\/\/doi.org\/10.1177\/2192568217713754","journal-title":"Glob Spine J"},{"key":"4245_CR11","doi-asserted-by":"publisher","first-page":"e73","DOI":"10.1016\/j.wneu.2017.10.080","volume":"110","author":"O Jansen","year":"2018","unstructured":"Jansen O, Grasmuecke D, Meindl RC et al (2018) Hybrid assistive limb exoskeleton HAL in the rehabilitation of chronic spinal cord injury: proof of concept; the results in 21 patients. World Neurosurg 110:e73\u2013e78. https:\/\/doi.org\/10.1016\/j.wneu.2017.10.080","journal-title":"World Neurosurg"},{"key":"4245_CR12","doi-asserted-by":"publisher","first-page":"5462694","DOI":"10.1155\/2019\/5462694","volume":"2019","author":"K Hyakutake","year":"2019","unstructured":"Hyakutake K, Morishita T, Saita K et al (2019) Effects of home-based robotic therapy involving the single-joint hybrid assistive limb robotic suit in the chronic phase of stroke: a pilot study. Biomed Res Int 2019:5462694. https:\/\/doi.org\/10.1155\/2019\/5462694","journal-title":"Biomed Res Int"},{"key":"4245_CR13","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1589\/jpts.32.192","volume":"32","author":"K Oga","year":"2020","unstructured":"Oga K, Yozu A, Kume Y et al (2020) Robotic rehabilitation of the paralyzed upper limb for a stroke patient using the single-joint hybrid assistive limb: a case study assessed by accelerometer on the wrist. J Phys Ther Sci 32:192\u2013196. https:\/\/doi.org\/10.1589\/jpts.32.192","journal-title":"J Phys Ther Sci"},{"key":"4245_CR14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229707","volume":"15","author":"A Wall","year":"2020","unstructured":"Wall A, Borg J, Vreede K et al (2020) A randomized controlled study incorporating an electromechanical gait machine, the Hybrid Assistive Limb, in gait training of patients with severe limitations in walking in the subacute phase after stroke. PLoS ONE 15:e0229707. https:\/\/doi.org\/10.1371\/journal.pone.0229707","journal-title":"PLoS ONE"},{"key":"4245_CR15","doi-asserted-by":"publisher","first-page":"5038","DOI":"10.1109\/IEMBS.2009.5333698","volume":"2009","author":"H Kawamoto","year":"2009","unstructured":"Kawamoto H, Hayashi T, Sakurai T et al (2009) Development of single leg version of HAL for hemiplegia. Annu Int Conf IEEE Eng Med Biol Soc 2009:5038\u20135043. https:\/\/doi.org\/10.1109\/IEMBS.2009.5333698","journal-title":"Annu Int Conf IEEE Eng Med Biol Soc"},{"key":"4245_CR16","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1159\/000500263","volume":"142","author":"H Watanabe","year":"2019","unstructured":"Watanabe H, Koike A, Wu L et al (2019) Efficacy of Cardiac Rehabilitation with Assistance from Hybrid Assistive Limb in Patients with Chronic Heart Failure: Protocol for a Randomized Controlled Study. Cardiology 142:213\u2013219. https:\/\/doi.org\/10.1159\/000500263","journal-title":"Cardiology"},{"key":"4245_CR17","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1080\/10400435.2016.1219883","volume":"29","author":"K Goto","year":"2017","unstructured":"Goto K, Morishita T, Kamada S et al (2017) Feasibility of rehabilitation using the single-joint hybrid assistive limb to facilitate early recovery following total knee arthroplasty: a pilot study. Assist Technol 29:197\u2013201. https:\/\/doi.org\/10.1080\/10400435.2016.1219883","journal-title":"Assist Technol"},{"key":"4245_CR18","doi-asserted-by":"publisher","first-page":"230949901877788","DOI":"10.1177\/2309499018777887","volume":"26","author":"S Kubota","year":"2018","unstructured":"Kubota S, Kadone H, Shimizu Y et al (2018) Robotic rehabilitation training with a newly developed upper limb single-joint Hybrid Assistive Limb (HAL-SJ) for elbow flexor reconstruction after brachial plexus injury: a report of two cases. J Orthop Surg (Hong Kong) 26:2309499018777887. https:\/\/doi.org\/10.1177\/2309499018777887","journal-title":"J Orthop Surg (Hong Kong)"},{"key":"4245_CR19","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1589\/jpts.31.206","volume":"31","author":"S Kubota","year":"2019","unstructured":"Kubota S, Mutsuzaki H, Yoshikawa K et al (2019) Safety and efficacy of robotic elbow training using the upper limb single-joint hybrid assistive limb combined with conventional rehabilitation for bilateral obstetric brachial plexus injury with co-contraction: a case report. J Phys Ther Sci 31:206\u2013210. https:\/\/doi.org\/10.1589\/jpts.31.206","journal-title":"J Phys Ther Sci"},{"key":"4245_CR20","doi-asserted-by":"publisher","first-page":"217","DOI":"10.2176\/nmc.oa.2019-0268","volume":"60","author":"K Saita","year":"2020","unstructured":"Saita K, Morishita T, Hyakutake K et al (2020) Feasibility of robot-assisted rehabilitation in poststroke recovery of upper limb function depending on the severity. Neurol Med Chir (Tokyo) 60:217\u2013222. https:\/\/doi.org\/10.2176\/nmc.oa.2019-0268","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"4245_CR21","doi-asserted-by":"publisher","first-page":"9610745","DOI":"10.1155\/2016\/9610745","volume":"2016","author":"T Yoshioka","year":"2016","unstructured":"Yoshioka T, Sugaya H, Kubota S et al (2016) Knee-extension training with a single-joint hybrid assistive limb during the early postoperative period after total knee arthroplasty in a patient with osteoarthritis. Case Rep Orthop 2016:9610745. https:\/\/doi.org\/10.1155\/2016\/9610745","journal-title":"Case Rep Orthop"},{"key":"4245_CR22","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1186\/s13256-017-1367-3","volume":"11","author":"T Yoshioka","year":"2017","unstructured":"Yoshioka T, Kubota S, Sugaya H et al (2017) Robotic device-assisted knee extension training during the early postoperative period after opening wedge high tibial osteotomy: a case report. J Med Case Rep 11:213. https:\/\/doi.org\/10.1186\/s13256-017-1367-3","journal-title":"J Med Case Rep"},{"key":"4245_CR23","doi-asserted-by":"publisher","first-page":"22","DOI":"10.2185\/jrm.2020-024","volume":"16","author":"T Yoshioka","year":"2021","unstructured":"Yoshioka T, Kubota S, Sugaya H et al (2021) Feasibility and efficacy of knee extension training using a single-joint hybrid assistive limb, versus conventional rehabilitation during the early postoperative period after total knee arthroplasty. J Rural Med 16:22\u201328. https:\/\/doi.org\/10.2185\/jrm.2020-024","journal-title":"J Rural Med"},{"key":"4245_CR24","unstructured":"Hermens HJ (1999) European recommendations for surface ElectroMyoGraphy: results of the SENIAM project. SENIAM, vol 8. In: Roessingh Research and Development, Enschede"},{"key":"4245_CR25","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1302\/0301-620x.80b1.7859","volume":"80","author":"J Dawson","year":"1998","unstructured":"Dawson J, Fitzpatrick R, Murray D et al (1998) Questionnaire on the perceptions of patients about total knee replacement. J Bone Joint Surg Br 80:63\u201369. https:\/\/doi.org\/10.1302\/0301-620x.80b1.7859","journal-title":"J Bone Joint Surg Br"},{"key":"4245_CR26","doi-asserted-by":"publisher","first-page":"5225","DOI":"10.1038\/s41598-021-84710-y","volume":"11","author":"M Worlicek","year":"2021","unstructured":"Worlicek M, Koch M, Daniel P et al (2021) A retrospective analysis of trends in primary knee arthroplasty in Germany from 2008 to 2018. Sci Rep 11:5225. https:\/\/doi.org\/10.1038\/s41598-021-84710-y","journal-title":"Sci Rep"},{"key":"4245_CR27","doi-asserted-by":"publisher","first-page":"413","DOI":"10.3233\/BMR-181482","volume":"33","author":"N Kotani","year":"2020","unstructured":"Kotani N, Morishita T, Saita K et al (2020) Feasibility of supplemental robot-assisted knee flexion exercise following total knee arthroplasty. J Back Musculoskelet Rehabil 33:413\u2013421. https:\/\/doi.org\/10.3233\/BMR-181482","journal-title":"J Back Musculoskelet Rehabil"},{"key":"4245_CR28","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1097\/ACO.0000000000000115","volume":"27","author":"MCR Bauer","year":"2014","unstructured":"Bauer MCR, Pogatzki-Zahn EM, Zahn PK (2014) Regional analgesia techniques for total knee replacement. Curr Opin Anaesthesiol 27:501\u2013506. https:\/\/doi.org\/10.1097\/ACO.0000000000000115","journal-title":"Curr Opin Anaesthesiol"},{"key":"4245_CR29","doi-asserted-by":"publisher","first-page":"3355","DOI":"10.2147\/JPR.S217283","volume":"12","author":"X Yang","year":"2019","unstructured":"Yang X, Kang W, Xiong W et al (2019) The effect of dexmedetomidine as adjuvant to ropivacaine 0.1% for femoral nerve block on strength of quadriceps muscle in patients undergoing total knee arthroplasty: a double-blinded randomized controlled trial. J Pain Res 12:3355\u20133363. https:\/\/doi.org\/10.2147\/JPR.S217283","journal-title":"J Pain Res"},{"key":"4245_CR30","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/00000539-199807000-00019","volume":"87","author":"FJ Singelyn","year":"1998","unstructured":"Singelyn FJ, Deyaert M, Joris D et al (1998) Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg 87:88\u201392. https:\/\/doi.org\/10.1097\/00000539-199807000-00019","journal-title":"Anesth Analg"},{"key":"4245_CR31","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/0304-3959(89)90069-9","volume":"38","author":"MEH Boeckstyns","year":"1989","unstructured":"Boeckstyns MEH, Backer M (1989) Reliability and validity of the evaluation of pain in patients with total knee replacement. Pain 38:29\u201333. https:\/\/doi.org\/10.1016\/0304-3959(89)90069-9","journal-title":"Pain"},{"key":"4245_CR32","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/S0883-5403(87)80015-3","volume":"2","author":"MA Ritter","year":"1987","unstructured":"Ritter MA, Campbell ED (1987) Effect of range of motion on the success of a total knee arthroplasty. J Arthroplasty 2:95\u201397. https:\/\/doi.org\/10.1016\/S0883-5403(87)80015-3","journal-title":"J Arthroplasty"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-021-04245-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-021-04245-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-021-04245-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T13:23:33Z","timestamp":1666704213000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-021-04245-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,16]]},"references-count":32,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["4245"],"URL":"https:\/\/doi.org\/10.1007\/s00402-021-04245-9","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,16]]},"assertion":[{"value":"13 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest. We got financial support from Cyberdyne Care robotics (payment of fees for the ethical board and for patient insurance) which produces the HAL. Cyberdyne was neither involved in study design, data collection and analysis, nor writing or submitting this article, therefore, concluding in no specific influence on the trial.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved and authorized by the Institutional Review Board of the Ruhr University Bochum (Register Number 16-5979) and patients consented to participate.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent has been obtained.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}