Efficacy of pre-operative quadriceps strength training on knee-extensor strength before and shortly following total knee arthroplasty: protocol for a randomized, dose-response trial (The QUADX-1 trial)

AbstractThe present study aims to examine (1) the preoperative factors that can predict postoperative falls, (2) whether postoperative physical activity (PA) mediates the relationship between fall incidence and gait function, and (3) whether postoperative PA levels are associated with fall risk in total knee arthroplasty (TKA) patients. Ninety-six patients (mean age: 72.0 ± 6.1 years) who were observed postoperatively for 6 months were selected. Timed up and go (TUG) was assessed as an indicator of gait function. Fall incidence and PA were investigated for 6 months post-TKA. The body mass index, history of preoperative falls, knee pain, knee extensor strength, range of motion in knee flexion, and modified gait efficacy scale were evaluated. Additionally, postoperative PA levels were categorized into three groups—low: <3,000, moderate: 3,000 to 4,000, and high: ≥4,000 steps/day. The relative fall incidence rate was calculated according to the total number of falls normalized for every 1,000 steps/day for 6 months postoperatively. Twenty-five (26.0%) of the 96 patients had at least one fall. The TUG, knee pain, and knee extensor strength were identified preoperatively as significant variables affecting postoperative falls. The mediated effects model revealed that postoperative fall incidence was predicted by preoperative TUG and postoperative PA. Postoperative PA was significantly associated with preoperative TUG. Moreover, both the preoperative TUG and postoperative PA were selected as significant variables for predicting fall incidence. Thus, postoperative PA mediates the relationship between gait function and fall incidence after TKA. Furthermore, the relative fall incidence rate associated with a low PA level was significantly higher than that associated with moderate and high PA levels. In conclusion, preoperative assessments of TUG performance, muscle strength, and knee pain were effective in predicting fall risk. Additionally, an increase in PA could contribute to reducing fall risk in TKA patients. Therefore, our results suggest that preoperative screening for fall predictors and managing postoperative PA could reduce the fall incidence in TKA patients.

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Early Post-Operative Intervention of Whole-Body Vibration in Patients After Total Knee Arthroplasty: A Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm8111902 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1902 ◽

Cited By ~ 2

Author(s):

Yu-Hsuan Hsiao ◽

Song-Hsiung Chien ◽

Hung-Pin Tu ◽

Jimmy Chun-Ming Fu ◽

Shih-Ting Tsai ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Whole Body Vibration ◽

Knee Extensor ◽

Whole Body ◽

Body Vibration ◽

Knee Extensor Strength ◽

Significant Difference ◽

Total Knee

(1) Background: Knee osteoarthritis causes pain, weakness, muscle atrophy, and disability. The application of whole-body vibration in patients with knee osteoarthritis can improve strength, balance, and functional activities. The purpose of the study is to evaluate the effects of early whole-body vibration intervention in patients after total knee arthroplasty. (2) Method: A single-blinded randomized control trial. Fifty-two patients with knee osteoarthritis post total knee replacement from a medical center in southern Taiwan were randomly assigned to either a whole-body vibration group or control group. Main outcome measures included pain severity, leg circumference, knee range of motion, knee extensor strength, a five-times sit to stand test, and a timed up and go test. (3) Results: Immediately post treatment, the patients in the vibration group showed a significant increase in knee extensor strength and improvement in calf swelling compared to the control group. A trend toward decrease in pain severity and improvement in functional performance were observed in both groups without a significant difference between the groups. There was no significant difference in knee range of motion (ROM) and functional performance between the groups. (4) Conclusions: The whole-body vibration intervention in patients early post total knee arthroplasty showed significant immediate effect in increasing knee extensor strength and decreasing calf swelling.

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Preoperative Strength Training for Elderly Patients Awaiting Total Knee Arthroplasty

Rehabilitation Research and Practice ◽

10.1155/2014/462750 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 7

Author(s):

D. M. van Leeuwen ◽

C. J. de Ruiter ◽

P. A. Nolte ◽

A. de Haan

Keyword(s):

Total Knee Arthroplasty ◽

Strength Training ◽

Knee Extensor ◽

Voluntary Activation ◽

Chair Stand ◽

Knee Extensor Strength ◽

Before And After ◽

Total Knee ◽

Standard Training ◽

Minute Walk

Objective. To investigate the feasibility and effects of additional preoperative high intensity strength training for patients awaiting total knee arthroplasty (TKA).Design. Clinical controlled trial.Patients. Twenty-two patients awaiting TKA.Methods. Patients were allocated to a standard training group or a group receiving standard training with additional progressive strength training for 6 weeks. Isometric knee extensor strength, voluntary activation, chair stand, 6-minute walk test (6MWT), and stair climbing were assessed before and after 6 weeks of training and 6 and 12 weeks after TKA.Results. For 3 of the 11 patients in the intensive strength group, training load had to be adjusted because of pain. For both groups combined, improvements in chair stand and 6MWT were observed before surgery, but intensive strength training was not more effective than standard training. Voluntary activation did not change before and after surgery, and postoperative recovery was not different between groups (P>0.05). Knee extensor strength of the affected leg before surgery was significantly associated with 6-minute walk (r=0.50) and the stair climb (r−=0.58,P<0.05).Conclusion. Intensive strength training was feasible for the majority of patients, but there were no indications that it is more effective than standard training to increase preoperative physical performance. This trial was registered withNTR2278.

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The Effect of a Prehabilitation Exercise Program on Quadriceps Strength for Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Pilot Study

PM&R ◽

10.1016/j.pmrj.2012.04.012 ◽

2012 ◽

Vol 4 (9) ◽

pp. 647-656 ◽

Cited By ~ 57

Author(s):

Carly McKay ◽

Harry Prapavessis ◽

Timothy Doherty

Keyword(s):

Total Knee Arthroplasty ◽

Pilot Study ◽

Knee Arthroplasty ◽

Exercise Program ◽

Quadriceps Strength ◽

Randomized Controlled ◽

Total Knee

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Comparative performance of isometric and isotonic quadriceps strength testing in total knee arthroplasty

Musculoskeletal Science and Practice ◽

10.1016/j.msksp.2018.06.008 ◽

2018 ◽

Vol 37 ◽

pp. 17-19 ◽

Cited By ~ 1

Author(s):

Yong-Hao Pua ◽

Cheryl Lian-Li Poon ◽

Felicia Jie-Ting Seah ◽

Benjamin F. Mentiplay ◽

Choo-Lye Ho ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Quadriceps Strength ◽

Strength Testing ◽

Comparative Performance ◽

Total Knee

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How co-activation is affected by differences in contraction intensity of knee extensor in total knee arthroplasty patients

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2019.02.491 ◽

2019 ◽

Vol 27 ◽

pp. S452-S453

Author(s):

K. Nojin ◽

T. Kobayashi ◽

T. Kannnari ◽

H. Horiuchi ◽

N. Matsui ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Extensor ◽

Co Activation ◽

Total Knee

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Neuromuscular Electrical Stimulation Use after Total Knee Arthroplasty Improves Early Return to Function: A Randomized Trial

The Journal of Knee Surgery ◽

10.1055/s-0040-1713420 ◽

2020 ◽

Author(s):

Alison K. Klika ◽

George Yakubek ◽

Nicholas Piuzzi ◽

Gary Calabrese ◽

Wael K. Barsoum ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Electrical Stimulation ◽

Knee Arthroplasty ◽

Academic Medical Center ◽

Recovery Period ◽

Neuromuscular Electrical Stimulation ◽

Quadriceps Strength ◽

Randomized Controlled ◽

Early Return ◽

Total Knee

AbstractNeuromuscular electrical stimulation (NMES) has been reported as an effective method for quadriceps strengthening which could attenuate muscle loss in the early total knee arthroplasty (TKA) postoperative recovery period. The purpose of this randomized controlled trial was to test whether postoperative use of NMES on TKA patients results in increased quadriceps strength and ultimately improved functional outcomes. This randomized controlled clinical trial of 66 primary TKA patients was conducted at a large academic medical center. Patients were randomized 2:1 into treatment (NMES use, n = 44) or control arm (no NMES, n = 22). Patients who used the device for an average of 200 minutes/week or more (starting 1 week postoperative and continuing through week 12) were considered compliant. Baseline measurements and outcomes were recorded at 3, 6, and 12 weeks postoperatively, and included quadriceps strength, range of motion (ROM), resting pain, functional timed up and go (TUG), stair climb test, and knee injury and osteoarthritis outcome score (KOOS) and veterans rand 12-item health survey (VR-12) scores. Patients in the treatment arm (NMES use) experienced quadriceps strength gains over baseline at 3, 6, and 12 weeks following surgery, which were statistically significant compared with controls with quadriceps strength losses at 3 (p = 0.050) and 6 weeks (p = 0.015). The TUG improvements for patients treated with NMES showed significant improvements at 6 (p = 0.018) and 12 weeks (p = 0.003) postoperatively. Use of a home-based application-controlled NMES therapy system added to standard of care treatment showed statistically significant improvements in quadriceps strength and TUG following TKA, supporting a quicker return to function.

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