Benefits of Early Proprioceptive Re-education Without Visual Information After Total Knee Arthroplasty (RAPPEL)

Osteoarthritis is a common and disabling joint disease, affecting 4.7% of men and 6.6% of women in France. It causes pain and impaired joint mobility, as well as a reduction in proprioception due to damage to intra-articular mechanoreceptors. In the long term, gonarthrosis can lead to limitations in activities of daily living and increase the risk of falls and institutionalisation.

Total knee arthroplasty is an effective treatment for reducing pain and improving functional capacity. However, 50% of patients operated on are not satisfied with the results obtained at 6 months, and between 37% and 55% experience no significant improvement in their functional mobility. It is therefore important to better define the modalities of rehabilitation interventions in order to improve their efficiency and the functional benefits for the patient.

Proprioception, the visual system and the vestibular system are the three major systems involved in posture and balance. Rehabilitation interventions aimed at improving balance involve these three inputs and their interaction. Studies have shown that proprioceptive rehabilitation can significantly improve balance and gait in patients who have undergone total knee arthroplasty. However, visual feedback may hinder the development of balance skills by limiting the use of other sensorimotor systems.

Study Overview

• Status: Not yet recruiting
• Conditions: Unilateral Primary Osteoarthritis, Left Knee
• Intervention / Treatment: Other: rehabilitation : eyes open; Other: rehabilitation : eyes closed

Detailed Description

The aim of this research project is to determine the benefits of visual deprivation and the methods of early proprioceptive exercises, right from the start of rehabilitation, on postural control in patients following total knee arthroplasty. Proprioceptive re-education with the eyes closed will be used from the very first rehabilitation sessions, evaluating its effect on proprioception. Currently, only one study has looked at the influence of the visual system in proprioceptive rehabilitation after total knee arthroplasty, seeking to assess the superiority of exercises with visual feedback compared with exercises without such feedback. The investigator presents an opposite and innovative questioning by proposing to evaluate on a larger scale the influence of visual deprivation rather than visual feedback.

• Study Type: Interventional
• Enrollment (Estimated): 66
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: déborah lebedieff; Phone Number: 0232888265; Email: deborah.lebedieff@chu-rouen.fr
• Study Contact Backup: Name: Timothée GILLOT, PhD, MKDE; Phone Number: 02 32 88 06 71; Email: timothee.gillot@chu-rouen.fr

Study Locations

• France
  • Bois-Guillaume, France, 76 230
    • CRMPR - les herbiers
    • Principal Investigator: Manon DANIEULOU
  • Rouen, France, 76 031
    • CHU Rouen
    • Principal Investigator: Eric Verin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patient aged between 60 and 85 having undergone primary total knee arthroplasty for gonarthrosis
• Patient admitted to a Continuing Care and Rehabilitation (CCR) department and having received a maximum of 1 functional re-education session
• Patient able to remain in bipodal support with eyes closed for 30 seconds on inclusion
• Weight below the limit accepted by the posturography platform (100 kg)
• Patient having read and understood the information letter and having signed the consent form
• Affiliation with the social security system

Exclusion Criteria:

• Blindness
• Diabetes with peripheral neuropathy
• Central or peripheral nerve pathology (cerebellar syndrome, stroke sequelae, etc.)
• Previously known ataxia
• Alcoholism not withdrawn
• Pre-existing gait disorders making assessment impossible
• Disorders of the vestibular system
• Inflammatory rheumatism
• Length of stay in surgery > 7 days
• Person deprived of liberty by administrative or judicial decision or person placed under court protection / sub-guardianship or guardianship

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: proprioceptive exercise with eyes open; 30 minutes of techniques to increase joint amplitude; 15 to 30 minutes of muscular strengthening of the hamstrings against resistance (elastic or pulley), of the quadriceps without resistance and then against a light weight (1 to 2 kg).; 15 to 30 minutes of proprioceptive exercises, eyes open.; 10 to 15 minutes of functional exercises: walking, overcoming obstacles, going up and down stairs; 20 minutes of pressure therapy	Other: rehabilitation : eyes open; proprioceptive exercise with eyes open
Experimental: proprioceptive exercise with eyes closed; 30 minutes of techniques to increase joint amplitude; 15 to 30 minutes of muscular strengthening of the hamstrings against resistance (elastic or pulley), of the quadriceps without resistance and then against a light weight (1 to 2 kg).; 15 to 30 minutes of proprioceptive exercises, eyes closed; 10 to 15 minutes of functional exercises: walking, overcoming obstacles, going up and down stairs; 20 minutes of pressure therapy	Other: rehabilitation : eyes closed; proprioceptive exercise with eyes closed

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the length of the projection of the centre of gravity on a posturography platform, in bipedal support, eyes closed, over 30 seconds	The main evaluation criterion is the length of the trace of the projection of the centre of gravity on a posturography platform, in bipedal support, eyes closed, over 30 seconds at 3 weeks (± 5 days) post-operatively or at discharge from the rehabilitation department, at the first intervening element. For this protocol, the posturographic analysis will be performed in the gait analysis laboratory of the Rouen Normandy University Hospital (Neurophysiology Department), by an investigator blinded to the treatment arm and trained in the use of the software.	3 weeks after randomization

Collaborators and Investigators

• Sponsor: University Hospital, Rouen
• Investigators: Principal Investigator: Timothée GILLOT, UH Rouen

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): April 1, 2027
• Study Completion (Estimated): April 1, 2027

Study Registration Dates

• First Submitted: April 4, 2025
• First Submitted That Met QC Criteria: April 11, 2025
• First Posted (Actual): April 20, 2025

Study Record Updates

• Last Update Posted (Actual): February 18, 2026
• Last Update Submitted That Met QC Criteria: February 17, 2026
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis
• Other Study ID Numbers: 2019/072/HP

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No