Early High‐Intensity Versus Low‐Intensity Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract

Objective The purpose of this study was to examine the safety and efficacy of a high-intensity progressive rehabilitation protocol (HI) beginning 4 days after total knee arthroplasty (TKA) compared to a low-intensity (LI) rehabilitation protocol. Methods One hundred sixty-two participants (aged 63±7 years; 89 females) were randomized to either the HI group or LI group after TKA. Key components of the HI intervention were the utilization of progressive resistance exercises and a rapid progression to weight-bearing exercises and activities. Both groups were treated in an outpatient setting 2-3 times per week for 11 weeks (26 total sessions). Outcomes included the stair climbing test (SCT) (primary outcome), timed-up-and-go (TUG) test, 6-minute walk (6MW) test, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form 12 (SF-12), knee ROM, quadriceps and hamstring strength, and quadriceps activation. Outcomes were assessed preoperatively and at 1, 2, 3 (primary end point), 6, and 12 months postoperatively. Results There were no significant differences between groups at 3 or 12 months in SCT, TUG, 6MW, WOMAC scores, knee ROM, quadriceps and hamstrings strength, quadriceps activation, or adverse event rates. By 12 months, outcomes on the 6MW, TUG, WOMAC, SF-12, quadriceps and hamstring strength, and quadriceps activation had improved beyond baseline performance in both groups. Conclusion Both the HI and LI interventions were effective in improving strength and function after TKA. High-intensity progressive rehabilitation is safe for individuals after TKA. However, its effectiveness may be limited by arthrogenic muscular inhibition in the early postoperative period.

Men and Women Demonstrate Differences in Early Functional Recovery After Total Knee Arthroplasty

“…31–33 Recruitment across all studies was restricted to patients who underwent an elective unilateral TKA for the treatment of OA and were between 50–85 years of age. Exclusion criteria in all studies included uncontrolled hypertension, uncontrolled diabetes, significant neurologic impairments, contralateral knee osteoarthritis (as defined by a pain level of greater than 4/10 with activity), the presence of other unstable lower-extremity orthopedic conditions, and a body mass index (BMI) greater than >40 kg/m 2 .…”

Effects of Phased Rehabilitation Programs after Total Knee Arthroplasty: A Randomized Controlled Trial

“…Between 2003 and 2012, the incidence of TKA increased from 145.4 to 223.0 per 100,000 people in Australia [4]. Over 700,000 TKAs are performed each year in America to alleviate the pain and disabilities associated with knee osteoarthritis [5].…”

Comparison of the Effectiveness of Ultrasound‐Guided Steroid Injections and Blind Steroid Injections in the Treatment of Carpal Tunnel Syndrome: Comment on the Article by Evers et al

“…In their recent article published in Arthritis Care & Research, Bade et al examined the safety and efficacy of high-intensity versus low-intensity rehabilitation protocols (1). We read the article with interest and noted that the study showed essentially no differences at either 3 or 12 months between the training groups in functional performance, patient-reported outcomes, and muscle strength.…”

“…We have previously published a systematic review on progressive resistance training before and after total knee arthroplasty (2). We found that the methodologic quality of existing evidence did not permit us to reach a conclusion on the effectiveness of progressive resistance training before and/or after total knee arthroplasty, and we are therefore encouraged that studies on this topic are now emerging (1,3). There seems to be a growing body of evidence suggesting that high-intensity training initiated in the early postoperative phase after total knee arthroplasty, does not result in better outcomes (1,3).…”

“…We found that the methodologic quality of existing evidence did not permit us to reach a conclusion on the effectiveness of progressive resistance training before and/or after total knee arthroplasty, and we are therefore encouraged that studies on this topic are now emerging (1,3). There seems to be a growing body of evidence suggesting that high-intensity training initiated in the early postoperative phase after total knee arthroplasty, does not result in better outcomes (1,3). The mechanisms underlying this are not fully clear, although they may involve arthrogenic muscular inhibition limiting full muscular activation during resistance training and/or impaired recovery following exercise.…”