Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?

Abstract

Purpose: To explore the feasibility of progressive strength training commenced immediately after total knee arthroplasty (TKA). Methods: A pilot study was conducted at an outpatient training facility. Fourteen patients with unilateral TKA were included from a fast-track orthopedic arthroplasty unit. They received rehabilitation including progressive strength training of the operated leg (leg press and knee-extension), using relative loads of 10 repetition maximum with three training sessions per week for 2 weeks. Rehabilitation was commenced 1 or 2 days after TKA. At each training session, knee pain, knee joint effusion and training load were recorded. Isometric knee-extension strength and maximal walking speed were measured before the first and last session. Results: The training load increased progressively (p < 0.0001). Patients experienced only moderate knee pain during the strength training exercises, but knee pain at rest and knee joint effusion (p < 0.0001) were unchanged or decreased over the six training sessions. Isometric knee-extension strength and maximal walking speed increased by 147 and 112%, respectively. Conclusion: Progressive strength training initiated immediately after TKA seems feasible, and increases knee-extension strength and functional performance without increasing knee joint effusion or knee pain.

Implications for Rehabilitation

• Rehabilitation with progressive strength training initiated early after total knee arthroplasty (TKA) seems feasible.

• Rehabilitation with progressive strength training increases knee-extension strength and maximal walking speed without increasing knee joint effusion and knee pain during the first 2 weeks after TKA.

• During the progressive strength training exercises, patients with TKA may experience moderate knee pain, which seems to decrease over time. Resting knee pain before and after each training session is none to mild.

• The results of this pilot study are encouraging, but a larger randomized controlled trial, which compares rehabilitation with or without progressive strength training, is needed to confirm our findings.

Keywords::

• Arthroplasty
• osteoarthritis
• physical function
• physical therapy
• resistance training

Acknowledgements

We thank the physical therapists and nurses working at the Department of Orthopaedic Surgery at Copenhagen University Hospital, Hvidovre for assistance related to performing this study, Bente Holm, PT, MSc, for valuable discussions about the project, Mathilde Kofoed-Hansen, BSc student, for assistance in recording the outcome measures, and Janne Petersen, PhD, for statistical help.

Declaration of Interest: We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated. The study was supported in part by grants from The Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty, The Danish Foundation for Research in Physical Therapy and The Department of Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark.