ORIGINAL ARTICLE   Free access

European Journal of Physical and Rehabilitation Medicine 2018 June;54(3):371-9

DOI: 10.23736/S1973-9087.17.04712-8

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Randomized controlled trial of maximal strength training vs. standard rehabilitation following total knee arthroplasty

Vigdis S. HUSBY ¹ ✉, Olav A. FOSS ², Otto S. HUSBY ^{3, 4}, Siri B. WINTHER ^{2, 3}

¹ Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; ² Orthopedic Research Center, Orthopedic Department, Trondheim University Hospital, Trondheim, Norway; ³ Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; ⁴ Department of Orthopedics, Trondheim University Hospital, Trondheim, Norway

BACKGROUND: Total knee arthroplasty (TKA) alleviates pain, but muscle strength and function is reduced for a long period postoperatively.
AIM: To investigate whether maximal strength training (MST) is more effective in improving muscle strength than standard rehabilitation (SR) after TKA.
DESIGN: A randomized, controlled study.
SETTING: Community physical therapy centers and University hospital research department.
POPULATION: Forty-one adults <75 years with primary, unilateral osteoarthritis of the knee scheduled for TKA.
METHODS: Participants were randomized to supervised MST of the lower extremities 3 times/week for 8 weeks and physiotherapy session1/week (N.=21) or to SR, including physiotherapy sessions/telephone contact 1/week and writing home exercise logs (N.=20). Maximal strength in leg press and knee extension, 6-minute walk test, patient-reported functional outcome score and pain were assessed preoperatively, 7 days, 10 weeks and 12 months postoperatively.
RESULTS: The MST group exceeded preoperative levels of muscle strength in leg press and knee extension by 37% and 43%, respectively at 10 weeks’ follow-up, and the increase was higher than in the SR group (P≤0.001). Strength differences persisted up to 12-months follow-up. At 12 months, both groups recovered to normative levels in the 6-Minute Walk Test, with no statistically significantly difference between the groups.
CONCLUSIONS: Participants undergoing MST experienced superior increases in leg press and knee extension muscle strength compared with those managed with SR from 7-day to 10-week follow-up. The difference in muscle strength was maintained at 12-month follow-up. No differences in functional performance were found at any time-point.
CLINICAL REHABILITATION IMPACT: Exercises after TKA should be performed with high intensity and target the operated leg specifically.

KEY WORDS: Arthroplasty, replacement, knee - Resistance training - Osteoarthritis