DOS Kongressen 2014 ·
117
Early progressive strength training to enhance
recovery after fast-track total knee arthroplasty.
A randomized controlled trial
Thomas Linding Jakobsen, Henrik Kehlet, Henrik Husted, Janne Petersen,
Thomas Bandholm
Lundbeck Foundation Centre for Fast-track Hip and Knee Arthroplasty, Clinical
Research Centre, Physi, Hvidovre Hospital, University of Copenhagen; Section
for Surgical Pathophysiology 4074, Lundbeck Foundation Centre for Fast-
track Hip and Knee Ar, Rigshospitalet, University of Copenhagen; Department
of Orthopaedic Surgery, Hvidovre Hospital, University of Copenhagen; Clinical
Research Centre, Hvidovre Hospital, University of Copenhagen; Physical
Medicine and Rehabilitation Research - Copenhagen (PMR-C), Department of
Physical Therapy, , Hvidovre Hospital, University of Copenhagen
Background:
A pronounced loss of muscle strength and functional perfor-
mance has been found after total knee arthroplasty (TKA). A rehabilitation
modality known to increase muscle strength and functional performance over
time - such as progressive strength training (PST) - seems rational to enhance
recovery after TKA. However, the effect of rehabilitation with PST has not been
investigated in a large assessor-blinded randomized controlled trial.
Purpose / Aim of Study:
To compare 7 weeks of supervised rehabilitation
with or without PST commenced early after fast-track TKA on functional per-
formance.
Materials andMethods:
Eighty-two patients with a unilateral primary TKA were
randomized to 7 weeks of supervised rehabilitation with (PST-group) and without
(CON-group) PST commenced early after fast-track TKA. The primary outcome
was the maximal distance walked in 6 minutes (6- minute walk test). Secondary
outcomes were lower limb strength and power, knee joint effusion and range of
motion, knee pain and self-reported disability and quality of life. All outcome mea-
sures were assessed before (baseline) and 4, 8 and 26 weeks after TKA.
Findings / Results:
There was no statistically significant difference between
the PST- and CON- group 8-week postoperatively (primary endpoint) for the
6-minute walk test (mean difference between groups: -11.3 meters, 95% con-
fidence interval -45.4 to 22.7 meters; analysis of variance , p=0.51). There
were no statistically significant or clinically meaningful differences between
groups in change scores from baseline to any other time point for all secondary
outcomes.
Conclusions:
Seven weeks of supervised rehabilitation with PST was not supe-
rior to 7 weeks of supervised rehabilitation without PST in improving functional
performance, measured as the maximal walking distance in 6 minutes, at the
primary endpoint 8 weeks after fast-track TKA.
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