Effects of preoperative low-intensity training with slow movement on early quadriceps weakness after total knee arthroplasty in patients with knee osteoarthritis: a retrospective propensity score-matched study

Abstract

Background Severe and early quadriceps weakness (QW) after total knee arthroplasty (TKA), which is caused by acute inflammation resulting from surgical trauma and tourniquet-induced ischemia-reperfusion (IR) injury, can be especially problematic. We focused on tourniquet-induced IR injury, because it has been shown to be preventable through ischemic and exercise preconditioning. Low-intensity resistance exercise with slow movement and tonic force generation (LST) share some similarities with ischemic and exercise preconditioning. The present study primarily aimed to clarify the efficacy of preoperative LST program as prehabilitation for early QW among patients with TKA using propensity score matching analysis. Methods This single-center retrospective observational study used data from patients with knee osteoarthritis (n = 277) who were scheduled to undergo unilateral TKA between August 2015 and January 2017. Those with missing outcome data due to their inability to perform tests were excluded. The LST group included participants who performed LST and aerobic exercise (LST session) more than seven times for three months prior to surgery. The control group included participants who performed less than eight LST sessions, a general and light exercise or had no exercise for three months prior to surgery. Knee circumference, thigh volume, knee pain during quadriceps strength test (QST) and timed up and go test (TUG), quadriceps strength, and TUG were measured before and 4 days after surgery. Knee swelling, thigh swelling, Δknee pain, QW, and ΔTUG were determined by comparing pre- and postoperative measurements. Results Propensity score matching generated 41 matched pairs who had nearly balanced characteristics. The LST group had a significantly lower knee and thigh swelling, QW, and ΔTUG compared to the control group (all, p < 0.05). No significant differences in Δknee pain during the QST and TUG were observed between both groups (both, p > 0.05). Conclusions The present study demonstrated the beneficial effects of preoperative LST program on knee swelling, thigh swelling, QW, and walking disability immediately after TKA.

Effects of n-3 polyunsaturated fatty acid supplementation on quadriceps weakness immediately after total knee arthroplasty: a pilot, randomized, open-label clinical trial

“…However, no significant differences in increased oxidative stress, knee and thigh swelling, and knee pain during the QST performed immediately after TKA were observed between the groups. Several studies on human models have shown that QW can be caused by knee swelling, knee pain, and quadriceps muscle atrophy 3,5,6) , which are partially induced by tourniquet application during TKA 7,8) . Tourniquet application and its subsequent release can induce IR injuries 28) .…”

“…Pre-and postoperative evaluations, which were performed at 1 month before surgery and again on postoperative day 4, included measurements of serum d-ROM levels, knee circumference at 1 and 10 cm proximal to the upper edge of the patella, knee pain during the QST, and quadriceps strength. The thigh volume was calculated via the truncated cone method, as previously described 6) . This method has shown to be excellent criterion-related validity, intra-rater reliability, and good inter-rater reliability 20) .…”

“…The sample size calculation was based on a previous study 6) with similar methods, and we used 14% as the standard deviation and 12% as the distinction in the mean (d) of the early QW after TKA. A sample size of 23 participants in each group was adequate to reject the null hypothesis with a statistical power of 80% and a significance level of p<0.05.…”

“…Earlier studies have demonstrated that early QW is caused by knee swelling, knee pain during the quadriceps strength test (QST), and quadriceps muscle atrophy after TKA 3,5,6) . These factors can be induced by surgical trauma and/or ischemiareperfusion (IR) injury caused by tourniquet application 7,8) .…”