DOS 2020

DOS Kongressen 2020 · 93 The relationship between pre-operative knee- extensor exercise dosage and effect on knee- extensor strength prior to and following total knee arthroplasty: A systematic review and meta-regression analysis of randomized controlled trials Rasmus Skov Husted, Carsten Juhl, Anders Troelsen, Kristian Thorborg, Thomas Kallemose, Michael Skovdal Rathleff, Thomas Bandholm Clinical Research Centre, Copenhagen University Hospital Hvidovre; Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte; Clinical Orthopedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre; Sports Orthopaedic Research Center – Copenhagen (SORC-C), Copenhagen University Hospital Hvidovre; Clinical Research Centre, Copenhagen University Hospital Hvidovre; Center for General Practice , Aalborg University; Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C); Department of Physical and Occupational Therapy; Clinical Research Centre; Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre Background: Patients with knee osteoarthritis have decreased knee-extensor muscle strength and may ultimately receive total knee arthroplasty (TKA). Recent trials with large pre-operative knee-extensor exercise dosages report positive effects on clinical outcomes before and after TKA – indicating a dose-response relationship. Purpose / Aim of Study: The aim of this systematic review was therefore to evaluate the relationship between knee-extensor strength exercise dosage in pre-operative exer- cise intervention and the effect on knee-extensor muscle strength before and after TKA. Materials and Methods: A systematic literature search was performed including RCT´s evaluating the effect of pre- operative exercise before and after TKA. Meta- regres- sion analysis was performed to evaluate the dose-response relationship between ex- ercise dose and the pooled effect, measured as standardized mean difference (SMD). PROSPERO-ID: CRD42018076308. Findings / Results: Twelve trials with 616 patients were included. Meta- regression analyses showed no relationship between pre-operative knee-extensor exercise dosage and change in knee-extensor strength neither before (slope 0.0005 [95%CI -0.007 to 0.008]) or three months after TKA (slope 0.0014 [95%CI -0.006 to 0.009]). Before TKA, a moderate effect favoring pre-operative exercise for increase in knee-extensor strength was found (SMD 0.50 [95%CI 0.12 to 0.88]), but not three months after TKA (SMD -0.01 [95%CI -0.45 to 0.43]). Conclusions: We found no relationship between pre-operative knee-extensor exercise dosage and change in knee-extensor strength. Pre-operative exercise including knee- extensor muscle strength exercise increased knee-extensor strength moderately before but not three months after TKA. The results suggest changing focus from pre-operative exercise to enhance post-operative recovery – to “pre-evaluation” – including pre- op- erative exercise to enhance shared surgical decision-making – as part of an enhanced recovery program after TKA. 79.