Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2010 | Research article

Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study

Authors: Raymond J Walls, Gavin McHugh, Donal J O'Gorman, Niall M Moyna, John M O'Byrne

Published in: BMC Musculoskeletal Disorders | Issue 1/2010

Abstract

Background

Supervised preoperative muscle strengthening programmes (prehabilitation) can improve recovery after total joint arthroplasty but are considered resource intensive. Neuromuscular electrical stimulation (NMES) has been shown to improve quadriceps femoris muscle (QFM) strength and clinical function in subjects with knee osteoarthritis (OA) however it has not been previously investigated as a prehabilitation modality.

Methods

This pilot study assessed the compliance of a home-based, NMES prehabilitation programme in patients undergoing total knee arthroplasty (TKA). We evaluated its effect on preoperative and postoperative isometric quadriceps femoris muscle (QFM) strength, QFM cross-sectional area (CSA) and clinical function (subjective and objective). Seventeen subjects were recruited with 14 completing the study (NMES group n = 9; Control group n = 5).

Results

Overall compliance with the programme was excellent (99%). Preoperative QFM strength increased by 28% (p > 0.05) with associated gains in walk, stair-climb and chair-rise times (p < 0.05). Early postoperative strength loss (approximately 50%) was similar in both groups. Only the NMES group demonstrated significant strength (53.3%, p = 0.011) and functional recovery (p < 0.05) from 6 to 12 weeks post-TKA. QFM CSA decreased by 4% in the NMES group compared to a reduction of 12% in the control group (P > 0.05) at 12 weeks postoperatively compared to baseline. There were only limited associations found between objective and subjective functional outcome instruments.

Conclusions

This pilot study has shown that preoperative NMES may improve recovery of quadriceps muscle strength and expedite a return to normal activities in patients undergoing TKA for OA. Recommendations for appropriate outcome instruments in future studies of prehabilitation in TKA have been provided.

Available only for authorised users

Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L: Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc. 2008, 40: 422-427. 10.1249/MSS.0b013e31815ef285.CrossRefPubMedPubMedCentral

Fitzgerald GK, Piva SR, Irrgang JJ, Bouzubar F, Starz TW: Quadriceps activation failure as a moderator of the relationship between quadriceps strength and physical function in individuals with knee osteoarthritis. Arthritis Rheum. 2004, 51: 40-48. 10.1002/art.20084.CrossRefPubMed

Mizner RL, Petterson SC, Stevens JE, Axe MJ, Snyder-Mackler L: Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. J Rheumatol. 2005, 32: 1533-1539.PubMed

Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L: Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005, 87: 1047-1053. 10.2106/JBJS.D.01992.CrossRefPubMedPubMedCentral

Mizner RL, Petterson SC, Snyder-Mackler L: Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005, 35: 424-436.CrossRefPubMed

Stevens JE, Mizner RL, Snyder-Mackler L: Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. J Orthop Res. 2003, 21: 775-779. 10.1016/S0736-0266(03)00052-4.CrossRefPubMed

Felson DT, Lawrence RC, Hochberg MC, McAlindon T, Dieppe PA, Minor MA, et al.: Osteoarthritis: new insights. Part 2: treatment approaches. Ann Intern Med. 2000, 133: 726-737.CrossRefPubMed

Petrella RJ: Is exercise effective treatment for osteoarthritis of the knee?. Br J Sports Med. 2000, 34: 326-331. 10.1136/bjsm.34.5.326.CrossRefPubMedPubMedCentral

Beaupre LA, Lier D, Davies DM, Johnston DB: The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. J Rheumatol. 2004, 31: 1166-1173.PubMed

10.

D'Lima DD, Colwell CW, Morris BA, Hardwick ME, Kozin F: The effect of preoperative exercise on total knee replacement outcomes. Clin Orthop Relat Res. 1996, 174-182. 10.1097/00003086-199605000-00020.

11.

Rodgers JA, Garvin KL, Walker CW, Morford D, Urban J, Bedard J: Preoperative physical therapy in primary total knee arthroplasty. J Arthroplasty. 1998, 13: 414-421. 10.1016/S0883-5403(98)90007-9.CrossRefPubMed

12.

Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, et al.: Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum. 2006, 55: 700-708. 10.1002/art.22223.CrossRefPubMed

13.

Jaggers JR, Simpson CD, Frost KL, Quesada PM, Topp RV, Swank AM, et al.: Prehabilitation before knee arthroplasty increases postsurgical function: a case study. J Strength Cond Res. 2007, 21: 632-634. 10.1519/R-19465.1.PubMed

14.

Hultman E, Sjoholm H, Jaderholm-Ek I, Krynicki J: Evaluation of methods for electrical stimulation of human skeletal muscle in situ. Pflugers Arch. 1983, 398: 139-141. 10.1007/BF00581062.CrossRefPubMed

15.

Talbot LA, Gaines JM, Ling SM, Metter EJ: A home-based protocol of electrical muscle stimulation for quadriceps muscle strength in older adults with osteoarthritis of the knee. J Rheumatol. 2003, 30: 1571-1578.PubMed

16.

Durmus D, Alayli G, Canturk F: Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clin Rheumatol. 2007, 26: 674-678. 10.1007/s10067-006-0358-3.CrossRefPubMed

17.

Avramidis K, Strike PW, Taylor PN, Swain ID: Effectiveness of electric stimulation of the vastus medialis muscle in the rehabilitation of patients after total knee arthroplasty. Arch Phys Med Rehabil. 2003, 84: 1850-1853. 10.1016/S0003-9993(03)00429-5.CrossRefPubMed

18.

Petterson S, Snyder-Mackler L: The use of neuromuscular electrical stimulation to improve activation deficits in a patient with chronic quadriceps strength impairments following total knee arthroplasty. J Orthop Sports Phys Ther. 2006, 36: 678-685.CrossRefPubMed

19.

Akima H, Kano Y, Enomoto Y, Ishizu M, Okada M, Oishi Y, et al.: Muscle function in 164 men and women aged 20--84 yr. Med Sci Sports Exerc. 2001, 33: 220-226. 10.1097/00005768-200105001-01223.CrossRefPubMed

20.

Lyons CL, Robb JB, Irrgang JJ, Fitzgerald GK: Differences in quadriceps femoris muscle torque when using a clinical electrical stimulator versus a portable electrical stimulator. Phys Ther. 2005, 85: 44-51.PubMed

21.

Murray MP, Gardner GM, Mollinger LA, Sepic SB: Strength of isometric and isokinetic contractions: knee muscles of men aged 20 to 86. Phys Ther. 1980, 60: 412-419.PubMed

22.

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW: Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988, 15: 1833-1840.PubMed

23.

Lyons RA, Perry HM, Littlepage BN: Evidence for the validity of the Short-form 36 Questionnaire (SF-36) in an elderly population. Age Ageing. 1994, 23: 182-184. 10.1093/ageing/23.3.182.CrossRefPubMed

24.

McHorney CA, Ware JE, Lu JF, Sherbourne CD: The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994, 32: 40-66. 10.1097/00005650-199401000-00004.CrossRefPubMed

25.

Buchner DM, Larson EB, Wagner EH, Koepsell TD, de Lateur BJ: Evidence for a non-linear relationship between leg strength and gait speed. Age Ageing. 1996, 25: 386-391. 10.1093/ageing/25.5.386.CrossRefPubMed

26.

Maly MR, Costigan PA, Olney SJ: Determinants of self-report outcome measures in people with knee osteoarthritis. Arch Phys Med Rehabil. 2006, 87: 96-104. 10.1016/j.apmr.2005.08.110.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/11/119/prepub

Title: Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study
Authors: Raymond J Walls
Gavin McHugh
Donal J O'Gorman
Niall M Moyna
John M O'Byrne
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2010
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/1471-2474-11-119

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2010

Predicting growth and curve progression in the individual patient with adolescent idiopathic scoliosis: design of a prospective longitudinal cohort study

Depressive symptoms during rehabilitation period predict poor outcome of lumbar spinal stenosis surgery: A two-year perspective

Extending conceptual frameworks: life course epidemiology for the study of back pain

Predictors of Shoulder Pain and Disability Index (SPADI) and work status after 1 year in patients with subacromial shoulder pain

Effectiveness of diclofenac versus acetaminophen in primary care patients with knee osteoarthritis: [NTR1485], DIPA-Trial: design of a randomized clinical trial

Validity of self-assessment of hallux valgus using the Manchester scale