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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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European Journal of Physical and Rehabilitation Medicine 2017 Sep 13

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 Orthopaedic Research Centre, Orthopaedic Department, Trondheim University Hospital, Trondheim, Norway; 3 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; 4 Orthopaedic Department, Trondheim University Hospital, Trondheim, Norway


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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 days’ to 10 weeks’ follow-up. The difference in muscle strength was maintained at 12 months’ 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: Total knee replacement - Resistance training - Fast-track - Osteoarthritis

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Publication History

Article first published online: September 13, 2017
Manuscript accepted: September 12, 2017
Manuscript revised: September 4, 2017
Manuscript received: March 2, 2017

Cite this article as

Husby VS, Foss OA, Husby OS, Winther SB. Randomized controlled trial of maximal strength training vs standard rehabilitation following total knee arthroplasty. Eur J Phys Rehabil Med 2017 Sep 13. DOI: 10.23736/S1973-9087.17.04712-8

Corresponding author e-mail

vigdis.schnell.husby@ntnu.no