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Improved early outcome after TKA through an app-based active muscle training programme—a randomized-controlled trial

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this prospective randomized-controlled trial (RCT) was to evaluate if an app-based feedback-controlled active muscle training programme can be used to improve the outcome in the immediate postoperative period after total knee arthroplasty (TKA).

Methods

Sixty patients, with a median age of 65.9 years (range 45–84), awaiting primary TKA were randomized into a control and training group. Both groups followed an identical postoperative protocol. In addition, the training group postoperatively performed an app-based feedback-controlled active muscle training programme multiple times daily. Outcome measures were active and passive range of motion (ROM), pain at rest and in motion, knee extension strength, the timed “Up and Go”, 10-m Walk Test, 30-s Chair Stand Test, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), and clinical data.

Results

The training group performed an average of 18.4 training sessions, which led to significantly higher ROM, less pain at rest and in motion, higher strength, and significantly higher functional scores. More training correlated with a better outcome.

Conclusions

The use of an app-based feedback-controlled active muscle training programme can improve the clinical outcome after TKA, especially ROM and reduce pain. Clinically relevant is that the training programme could be considered an alternative to continuous passive motion after total knee arthroplasty.

Level of evidence

II.

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Abbreviations

BMI:

Body mass index

ERAS:

Enhanced recovery after surgery

ITT:

Intention-to-treat

KOOS:

Knee Injury and Osteoarthritis Outcome Score

KSS:

Knee Society Score

NRS:

Numeric rating scale

n.s.:

Not significant

PP:

Per protocol

RCT:

Randomized-controlled trial

ROM:

Range of motion

SD:

Standard deviation

TKA:

Total knee arthroplasty

References

  1. Andersen SH, Husted H, Kehlet H (2009) Economic consequences of accelerated care pathways in total knee-arthroplasty. Ugeskr Laeger 171:3276–3280

    PubMed  Google Scholar 

  2. Bade MJ, Kohrt WM, Stevens-Lapsley JE (2010) Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther 40:559–567

    Article  Google Scholar 

  3. Bade MJ, Stevens-Lapsley JE (2012) Restoration of physical function in patients following total knee arthroplasty: an update on rehabilitation practices. Curr Opin Rheumatol 24:208–214

    Article  Google Scholar 

  4. Bandholm T, Kehlet H (2012) Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Arch Phys Med Rehabil 93:1292–1294

    Article  Google Scholar 

  5. Carroll TJ (2012) Emerging evidence that exercise-induced improvements in muscular strength are partly due to adaptations in the brain. Acta Physiol (Oxf) 206:96–97

    Article  CAS  Google Scholar 

  6. Carroll TJ, Selvanayagam VS, Riek S, Semmler JG (2011) Neural adaptations to strength training: moving beyond transcranial magnetic stimulation and reflex studies. Acta Physiol (Oxf) 202:119–140

    Article  CAS  Google Scholar 

  7. Catarinella FS, Bos WH (2016) Digital health assessment in rheumatology: current and future possibilities. Clin Exp Rheumatol 34:2–4

    Google Scholar 

  8. Christie A, Kamen G (2010) Short-term training adaptations in maximal motor unit firing rates and afterhyperpolarization duration. Muscle Nerve 41:651–660

    PubMed  Google Scholar 

  9. Greene KA, Schurman JR 2nd (2008) Quadriceps muscle function in primary total knee arthroplasty. J Arthroplasty 23:15–19

    Article  Google Scholar 

  10. Harvey LA, Brosseau L, Herbert RD (2014) Continuous passive motion following total knee arthroplasty in people with arthritis. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004260.pub3

    Article  PubMed  Google Scholar 

  11. Herbold JA, Bonistall K, Blackburn M, Agolli J, Gaston S, Gross C et al (2014) Randomized controlled trial of the effectiveness of continuous passive motion after total knee replacement. Arch Phys Med Rehabil 95:1240–1245

    Article  Google Scholar 

  12. Horstmann H, Colcuc C, Lobenhoffer P, Krettek C, Weber-Spickschen TS (2017) Evaluation of the acceptability of a sphygmomanometer device in knee extension training following surgical procedures of the knee. Int J Orthop Trauma Nurs 25:42–47

    Article  Google Scholar 

  13. Kamen G, Knight CA (2004) Training-related adaptations in motor unit discharge rate in young and older adults. J Gerontol A Biol Sci Med Sci 59:1334–1338

    Article  Google Scholar 

  14. Ljungqvist O (2014) ERAS–enhanced recovery after surgery: moving evidence-based perioperative care to practice. JPEN J Parenter Enteral Nutr 38:559–566

    Article  Google Scholar 

  15. Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery: a review. JAMA Surg 152:292–298

    Article  Google Scholar 

  16. Maeo S, Yoshitake Y, Takai Y, Fukunaga T, Kanehisa H (2014) Effect of short-term maximal voluntary co-contraction training on neuromuscular function. Int J Sports Med 35:125–134

    CAS  PubMed  Google Scholar 

  17. Meier W, Mizner RL, Marcus RL, Dibble LE, Peters C, Lastayo PC (2008) Total knee arthroplasty: muscle impairments, functional limitations, and recommended rehabilitation approaches. J Orthop Sports Phys Ther 38:246–256

    Article  Google Scholar 

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

    Article  Google Scholar 

  19. Paul A, Anwer S, Rau S, Alghadir A (2016) Comparison of the combined effects of hip and knee muscle strengthening vs. knee muscle strengthening alone on pain, function and gait parameters in knee osteoarthritis. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin 26:118–123

    Article  Google Scholar 

  20. Petterson SC, Mizner RL, Stevens JE, Raisis L, Bodenstab A, Newcomb W et al (2009) Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum 61:174–183

    Article  Google Scholar 

  21. Quack V, Ippendorf AV, Betsch M, Schenker H, Nebelung S, Rath B et al (2015) Multidisciplinary rehabilitation and fast-track rehabilitation after knee replacement: faster, better, cheaper? A survey and systematic review of literature. Rehabilitation (Stuttg) 54:245–251

    Article  CAS  Google Scholar 

  22. Reimers N, Reimers C (2012) Sportliches Training bei Lumbalgien, Kox- und Gonarthrose sowie Fibromyalgie-Syndrom: Effekt auf die Schmerzen—Eine Literaturübersicht. Aktuelle Rheumatologie 37:174–188

    Article  Google Scholar 

  23. Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64

    Article  Google Scholar 

  24. Scanlon TC, Fragala MS, Stout JR, Emerson NS, Beyer KS, Oliveira LP et al (2014) Muscle architecture and strength: adaptations to short-term resistance training in older adults. Muscle Nerve 49:584–592

    Article  Google Scholar 

  25. Stevens-Lapsley JE, Balter JE, Kohrt WM, Eckhoff DG (2010) Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clin Orthop Relat Res 468:2460–2468

    Article  Google Scholar 

  26. Stowers MD, Lemanu DP, Coleman B, Hill AG, Munro JT (2014) Review article: perioperative care in enhanced recovery for total hip and knee arthroplasty. J Orthop Surg (Hong Kong) 22:383–392

    Article  Google Scholar 

  27. Tanner SM, Dainty KN, Marx RG, Kirkley A (2007) Knee-specific quality-of-life instruments: which ones measure symptoms and disabilities most important to patients? Am J Sports Med 35:1450–1458

    Article  Google Scholar 

  28. Weier AT, Pearce AJ, Kidgell DJ (2012) Strength training reduces intracortical inhibition. Acta Physiol (Oxf) 206:109–119

    Article  CAS  Google Scholar 

  29. Wolk S, Meissner T, Linke S, Mussle B, Wierick A, Bogner A et al (2017) Use of activity tracking in major visceral surgery—the enhanced perioperative mobilization (EPM) trial: study protocol for a randomized controlled trial. Trials 18:77

    Article  Google Scholar 

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Funding

This research received no funding.

Author information

Authors and Affiliations

Authors

Contributions

SH and MRGS contributed equally to this study. All authors made substantial contributions. Conception and Design: SH, MRGS, TP, HH, and TSWS. Acquisition or Analysis and Interpretation of Data: SH, MRGS, GW, EL, and TSWS. Drafting or Revising the Manuscript: SH, MRGS, TP, GW, HH, EL, and TSWS. Final Approval of the Submission: SH, MRGS, TP, GW, HH, EL, and TSWS.

Corresponding author

Correspondence to Sebastian Hardt.

Ethics declarations

Conflict of interest

Author TP has received payment by Depuy Synthes for consultancy and by Depuy Synthes and Link for development of educational presentations, but not related to this study. Author TSWS is the inventor of GenuSport and has a patent pending. The rest of the authors declare that they have no conflict of interest in relation to this manuscript.

Ethical approval

The study protocol was reviewed and approved by the institutional ethics committee (Hannover Medical School, No. 300-20016). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Sebastian Hardt and Matthias R. G. Schulz shared first authorship.

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Hardt, S., Schulz, M.R.G., Pfitzner, T. et al. Improved early outcome after TKA through an app-based active muscle training programme—a randomized-controlled trial. Knee Surg Sports Traumatol Arthrosc 26, 3429–3437 (2018). https://doi.org/10.1007/s00167-018-4918-2

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  • DOI: https://doi.org/10.1007/s00167-018-4918-2

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