Preoperative Strength Training in Patients With Total Knee Arthroplasty

Effect of Preoperative Strength Training on Postoperative Quadriceps Strength and Ability of Function in Patients With Total Knee Arthroplasty in Fast Track Regi

The purpose of this study is to investigate if preoperative strength training will result in faster recovery and higher level of function six weeks after total knee arthroplasty (TKA).

Study Overview

• Status: Unknown
• Conditions: Osteoarthritis, Knee
• Intervention / Treatment: Other: Preoperative strength training

Detailed Description

Reduced strength of the quadriceps muscle is a common clinical finding in patients with Knee Osteoarthritis and this seems to play a central role in the development of the disease. The strength of the quadriceps muscle have been shown to be reduced by 20-40% as compared to age-matched healthy controls and this decrease in muscle strength have been closely associated with a reduced level of function and increase of pain. Furthermore, it has been demonstrated that the preoperative strength of the quadriceps muscle in patients undergoing TKA, is associated with the level of function one year after surgery. Compared to the level before the operation, an additional operation-induced reduction of the strength of the quadriceps muscle up to 60% as has been demonstrated. Presumably, an optimizing of the strength of the quadriceps muscle could counteract the impact of the expected postoperative loss of muscle strength to such an extent that the loss will be of less clinical significance. It is hypothesized that an optimizing of the strength of the quadriceps muscle may have a favorable effect on the postoperative rehabilitation program and shorten the period of convalescence.

• Study Type: Interventional
• Enrollment (Anticipated): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Denmark
  • Aarhus, Denmark, 8000
    • Recruiting
    • Aarhus University Hospital
    • Contact: Birgit Sørensen Skoffer, MPH; Phone Number: +45 50 42 28 30; Email: BSkoffer@dadlnet.dk
    • Principal Investigator: Birgit Sørensen Skoffer, MPH

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Planned TKA at the Aarhus University Hospital or Region Hospital Silkeborg,
• Living in Aarhus Municipality,
• Primary knee osteoarthritis or secondary osteoarthritis after meniscectomy or ligament injury

Exclusion Criteria:

• Unstable blood pressure,
• Neuromuscular or neurodegenerative disease,
• Comprehension or dementia problems

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Preoperative strength training; Progressive strength training on group basis four weeks before the operation and progressive strength training on group basis four weeks after the operation	Other: Preoperative strength training; Progressive strength training on group basis (not more than 3 subjects) 3 sessions weekly starting 4 weeks before the operation, in total 12 sessions Strength training 3 sessions weekly 4 weeks postsurgery; Other Names: Strength training; Preoperative training
NO_INTERVENTION: Living as usual; The patients are living as usual the last 4 weeks before operation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary outcome: Sit-to-stand test	Ability of function test	Change from Baseline 6 weeks preoperative in Sit-to-Stand at 6 weeks postoperative

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Isokinetic: Quadriceps 60 gr./sek	Muscle strength test in dynamometer	6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
Isokinetic: Hamstrings 60 gr./sek	Muscle strength test in dynamometer	6 weeks and 1 week before the operation, 1 week, 6 weeks 12 weeks and 1 year after the operation
Isometric: Quadriceps (70 gr. flexion)	Muscle strength test in dynamometer	6 weeks and 1 week before the operation and 11 week, 6 weeks, 12 weeks and 1 year after the operation
Isometric: Hamstrings (20 gr. flexion)	Muscle strength test in dynamometer	6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
Rate of force development (flexion and extension)	Muscle test in dynamometer	6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
Timed Up and Go	Ability of function test	6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
10 meter walk test	Ability of function test	6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
6 minute walk test	Ability of function test	6 weeks and 1 week before operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
Knee injury and Osteoarthritis Outcome Score (KOOS)	Disease-specific questionnaire	6 weeks and 1 week before operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
Oxford Knee Score (OKS)	Disease-specific questionnaire	6 weeks before the operation and 6 weeks after
EuroQol-5 dimensions (EQ-5D)	Generic questionnaire for self-rated health	6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
Short-Form Health Survey (SF 12)	Generic questionnaire for self-rated health	6 weeks before the operation and 1 year after
Background data questionnaire	Questionnaire about pain, medicine use, alcohol intake, smoking, education, job	6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
Range of motion of the knee	Extension of the knee Flexion of the knee	6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation
Body mass index	Weight/height2	6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation

Collaborators and Investigators

• Sponsor: University of Aarhus
• Investigators: Study Chair: Kjeld Soeballe, Professor, Aarhus University Hospital, Department of orthopaedic, Tage Hansensgade 2, 8000 Aarhus C

Publications and helpful links

General Publications

• Skoffer B, Dalgas U, Maribo T, Soballe K, Mechlenburg I. No Exacerbation of Knee Joint Pain and Effusion Following Preoperative Progressive Resistance Training in Patients Scheduled for Total Knee Arthroplasty: Secondary Analyses From a Randomized Controlled Trial. PM R. 2018 Jul;10(7):687-692. doi: 10.1016/j.pmrj.2017.11.002. Epub 2017 Nov 9.
• Skoffer B, Maribo T, Mechlenburg I, Hansen PM, Soballe K, Dalgas U. Efficacy of Preoperative Progressive Resistance Training on Postoperative Outcomes in Patients Undergoing Total Knee Arthroplasty. Arthritis Care Res (Hoboken). 2016 Sep;68(9):1239-51. doi: 10.1002/acr.22825. Epub 2016 Jul 28.

Study record dates

Study Major Dates

• Study Start: January 1, 2012
• Primary Completion (ANTICIPATED): October 1, 2013
• Study Completion (ANTICIPATED): December 1, 2013

Study Registration Dates

• First Submitted: July 13, 2012
• First Submitted That Met QC Criteria: July 20, 2012
• First Posted (ESTIMATE): July 23, 2012

Study Record Updates

• Last Update Posted (ESTIMATE): July 23, 2012
• Last Update Submitted That Met QC Criteria: July 20, 2012
• Last Verified: July 1, 2012

More Information

Terms related to this study

• Keywords: Knee osteoarthritis; Total knee arthroplasty; Strength training; Preoperative training
• Additional Relevant MeSH Terms: Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Arthritis; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: M-20110181