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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2018

01-11-2018 | Knee

Improved early outcome after TKA through an app-based active muscle training programme—a randomized-controlled trial

Authors: Sebastian Hardt, Matthias R. G. Schulz, Tilman Pfitzner, Georgi Wassilew, Hauke Horstmann, Emmanouil Liodakis, Thomas Sanjay Weber-Spickschen

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2018

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Abstract

Purpose

The purpose of this prospective randomized-controlled trial (RCT) was to evaluate if an app-based feedback-controlled active muscle training programme can be used to improve the outcome in the immediate postoperative period after total knee arthroplasty (TKA).

Methods

Sixty patients, with a median age of 65.9 years (range 45–84), awaiting primary TKA were randomized into a control and training group. Both groups followed an identical postoperative protocol. In addition, the training group postoperatively performed an app-based feedback-controlled active muscle training programme multiple times daily. Outcome measures were active and passive range of motion (ROM), pain at rest and in motion, knee extension strength, the timed “Up and Go”, 10-m Walk Test, 30-s Chair Stand Test, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), and clinical data.

Results

The training group performed an average of 18.4 training sessions, which led to significantly higher ROM, less pain at rest and in motion, higher strength, and significantly higher functional scores. More training correlated with a better outcome.

Conclusions

The use of an app-based feedback-controlled active muscle training programme can improve the clinical outcome after TKA, especially ROM and reduce pain. Clinically relevant is that the training programme could be considered an alternative to continuous passive motion after total knee arthroplasty.

Level of evidence

II.
Literature
1.
Andersen SH, Husted H, Kehlet H (2009) Economic consequences of accelerated care pathways in total knee-arthroplasty. Ugeskr Laeger 171:3276–3280PubMed
2.
Bade MJ, Kohrt WM, Stevens-Lapsley JE (2010) Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 40:559–567CrossRef
3.
Bade MJ, Stevens-Lapsley JE (2012) Restoration of physical function in patients following total knee arthroplasty: an update on rehabilitation practices. Curr Opin Rheumatol 24:208–214CrossRef
4.
Bandholm T, Kehlet H (2012) Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Arch Phys Med Rehabil 93:1292–1294CrossRef
5.
Carroll TJ (2012) Emerging evidence that exercise-induced improvements in muscular strength are partly due to adaptations in the brain. Acta Physiol (Oxf) 206:96–97CrossRef
6.
Carroll TJ, Selvanayagam VS, Riek S, Semmler JG (2011) Neural adaptations to strength training: moving beyond transcranial magnetic stimulation and reflex studies. Acta Physiol (Oxf) 202:119–140CrossRef
7.
Catarinella FS, Bos WH (2016) Digital health assessment in rheumatology: current and future possibilities. Clin Exp Rheumatol 34:2–4
8.
Christie A, Kamen G (2010) Short-term training adaptations in maximal motor unit firing rates and afterhyperpolarization duration. Muscle Nerve 41:651–660PubMed
9.
Greene KA, Schurman JR 2nd (2008) Quadriceps muscle function in primary total knee arthroplasty. J Arthroplasty 23:15–19CrossRef
10.
11.
Herbold JA, Bonistall K, Blackburn M, Agolli J, Gaston S, Gross C et al (2014) Randomized controlled trial of the effectiveness of continuous passive motion after total knee replacement. Arch Phys Med Rehabil 95:1240–1245CrossRef
12.
Horstmann H, Colcuc C, Lobenhoffer P, Krettek C, Weber-Spickschen TS (2017) Evaluation of the acceptability of a sphygmomanometer device in knee extension training following surgical procedures of the knee. Int J Orthop Trauma Nurs 25:42–47CrossRef
13.
Kamen G, Knight CA (2004) Training-related adaptations in motor unit discharge rate in young and older adults. J Gerontol A Biol Sci Med Sci 59:1334–1338CrossRef
14.
Ljungqvist O (2014) ERAS–enhanced recovery after surgery: moving evidence-based perioperative care to practice. JPEN J Parenter Enteral Nutr 38:559–566CrossRef
15.
Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298CrossRef
16.
Maeo S, Yoshitake Y, Takai Y, Fukunaga T, Kanehisa H (2014) Effect of short-term maximal voluntary co-contraction training on neuromuscular function. Int J Sports Med 35:125–134PubMed
17.
Meier W, Mizner RL, Marcus RL, Dibble LE, Peters C, Lastayo PC (2008) Total knee arthroplasty: muscle impairments, functional limitations, and recommended rehabilitation approaches. J Orthop Sports Phys Ther 38:246–256CrossRef
18.
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 35:424–436CrossRef
19.
Paul A, Anwer S, Rau S, Alghadir A (2016) Comparison of the combined effects of hip and knee muscle strengthening vs. knee muscle strengthening alone on pain, function and gait parameters in knee osteoarthritis. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin 26:118–123CrossRef
20.
Petterson SC, Mizner RL, Stevens JE, Raisis L, Bodenstab A, Newcomb W et al (2009) Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum 61:174–183CrossRef
21.
Quack V, Ippendorf AV, Betsch M, Schenker H, Nebelung S, Rath B et al (2015) Multidisciplinary rehabilitation and fast-track rehabilitation after knee replacement: faster, better, cheaper? A survey and systematic review of literature. Rehabilitation (Stuttg) 54:245–251CrossRef
22.
Reimers N, Reimers C (2012) Sportliches Training bei Lumbalgien, Kox- und Gonarthrose sowie Fibromyalgie-Syndrom: Effekt auf die Schmerzen—Eine Literaturübersicht. Aktuelle Rheumatologie 37:174–188CrossRef
23.
Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64CrossRef
24.
Scanlon TC, Fragala MS, Stout JR, Emerson NS, Beyer KS, Oliveira LP et al (2014) Muscle architecture and strength: adaptations to short-term resistance training in older adults. Muscle Nerve 49:584–592CrossRef
25.
Stevens-Lapsley JE, Balter JE, Kohrt WM, Eckhoff DG (2010) Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clin Orthop Relat Res 468:2460–2468CrossRef
26.
Stowers MD, Lemanu DP, Coleman B, Hill AG, Munro JT (2014) Review article: perioperative care in enhanced recovery for total hip and knee arthroplasty. J Orthop Surg (Hong Kong) 22:383–392CrossRef
27.
Tanner SM, Dainty KN, Marx RG, Kirkley A (2007) Knee-specific quality-of-life instruments: which ones measure symptoms and disabilities most important to patients? Am J Sports Med 35:1450–1458CrossRef
28.
Weier AT, Pearce AJ, Kidgell DJ (2012) Strength training reduces intracortical inhibition. Acta Physiol (Oxf) 206:109–119CrossRef
29.
Wolk S, Meissner T, Linke S, Mussle B, Wierick A, Bogner A et al (2017) Use of activity tracking in major visceral surgery—the enhanced perioperative mobilization (EPM) trial: study protocol for a randomized controlled trial. Trials 18:77CrossRef
Metadata
Title
Improved early outcome after TKA through an app-based active muscle training programme—a randomized-controlled trial
Authors
Sebastian Hardt
Matthias R. G. Schulz
Tilman Pfitzner
Georgi Wassilew
Hauke Horstmann
Emmanouil Liodakis
Thomas Sanjay Weber-Spickschen
Publication date
01-11-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-4918-2

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