Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study

Raymond J Walls, Gavin McHugh, Donal J O'Gorman, Niall M Moyna, John M O'Byrne, Raymond J Walls, Gavin McHugh, Donal J O'Gorman, Niall M Moyna, John M O'Byrne

Abstract

Background: Supervised preoperative muscle strengthening programmes (prehabilitation) can improve recovery after total joint arthroplasty but are considered resource intensive. Neuromuscular electrical stimulation (NMES) has been shown to improve quadriceps femoris muscle (QFM) strength and clinical function in subjects with knee osteoarthritis (OA) however it has not been previously investigated as a prehabilitation modality.

Methods: This pilot study assessed the compliance of a home-based, NMES prehabilitation programme in patients undergoing total knee arthroplasty (TKA). We evaluated its effect on preoperative and postoperative isometric quadriceps femoris muscle (QFM) strength, QFM cross-sectional area (CSA) and clinical function (subjective and objective). Seventeen subjects were recruited with 14 completing the study (NMES group n = 9; Control group n = 5).

Results: Overall compliance with the programme was excellent (99%). Preoperative QFM strength increased by 28% (p > 0.05) with associated gains in walk, stair-climb and chair-rise times (p < 0.05). Early postoperative strength loss (approximately 50%) was similar in both groups. Only the NMES group demonstrated significant strength (53.3%, p = 0.011) and functional recovery (p < 0.05) from 6 to 12 weeks post-TKA. QFM CSA decreased by 4% in the NMES group compared to a reduction of 12% in the control group (P > 0.05) at 12 weeks postoperatively compared to baseline. There were only limited associations found between objective and subjective functional outcome instruments.

Conclusions: This pilot study has shown that preoperative NMES may improve recovery of quadriceps muscle strength and expedite a return to normal activities in patients undergoing TKA for OA. Recommendations for appropriate outcome instruments in future studies of prehabilitation in TKA have been provided.

Figures

Figure 1
Figure 1
Quadriceps Femoris Muscle Strength. ap < 0.05 vs. Preoperative; bp < 0.05 vs. + 6 Weeks; Error Bars represent Standard Error
Figure 2
Figure 2
Quadriceps Femoris Muscle Cross-sectional Area. ap < 0.05 vs. Preoperative; Error Bars represent Standard Error
Figure 3
Figure 3
Objective Functional Capacity. ap < 0.05 vs. Baseline; bp < 0.05 vs. Preoperative; cp < 0.05 vs. + 6 Weeks; *p < 0.05 vs. Control; Error Bars represent Standard Error a) Timed Stair-Climb Test. b) Timed Chair-Rise Test. c) 25 metre Timed Walk Test.

References

    1. Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L. Mechanisms underlying quadriceps weakness in knee osteoarthritis. Med Sci Sports Exerc. 2008;40:422–427. doi: 10.1249/MSS.0b013e31815ef285.
    1. Fitzgerald GK, Piva SR, Irrgang JJ, Bouzubar F, Starz TW. Quadriceps activation failure as a moderator of the relationship between quadriceps strength and physical function in individuals with knee osteoarthritis. Arthritis Rheum. 2004;51:40–48. doi: 10.1002/art.20084.
    1. Mizner RL, Petterson SC, Stevens JE, Axe MJ, Snyder-Mackler L. Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. J Rheumatol. 2005;32:1533–1539.
    1. Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005;87:1047–1053. doi: 10.2106/JBJS.D.01992.
    1. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005;35:424–436.
    1. Stevens JE, Mizner RL, Snyder-Mackler L. Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. J Orthop Res. 2003;21:775–779. doi: 10.1016/S0736-0266(03)00052-4.
    1. Felson DT, Lawrence RC, Hochberg MC, McAlindon T, Dieppe PA, Minor MA. Osteoarthritis: new insights. Part 2: treatment approaches. Ann Intern Med. 2000;133:726–737.
    1. Petrella RJ. Is exercise effective treatment for osteoarthritis of the knee? Br J Sports Med. 2000;34:326–331. doi: 10.1136/bjsm.34.5.326.
    1. Beaupre LA, Lier D, Davies DM, Johnston DB. The effect of a preoperative exercise and education program on functional recovery, health related quality of life, and health service utilization following primary total knee arthroplasty. J Rheumatol. 2004;31:1166–1173.
    1. D'Lima DD, Colwell CW, Jr, Morris BA, Hardwick ME, Kozin F. The effect of preoperative exercise on total knee replacement outcomes. Clin Orthop Relat Res. 1996. pp. 174–182.
    1. Rodgers JA, Garvin KL, Walker CW, Morford D, Urban J, Bedard J. Preoperative physical therapy in primary total knee arthroplasty. J Arthroplasty. 1998;13:414–421. doi: 10.1016/S0883-5403(98)90007-9.
    1. Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum. 2006;55:700–708. doi: 10.1002/art.22223.
    1. Jaggers JR, Simpson CD, Frost KL, Quesada PM, Topp RV, Swank AM. Prehabilitation before knee arthroplasty increases postsurgical function: a case study. J Strength Cond Res. 2007;21:632–634. doi: 10.1519/R-19465.1.
    1. Hultman E, Sjoholm H, Jaderholm-Ek I, Krynicki J. Evaluation of methods for electrical stimulation of human skeletal muscle in situ. Pflugers Arch. 1983;398:139–141. doi: 10.1007/BF00581062.
    1. Talbot LA, Gaines JM, Ling SM, Metter EJ. A home-based protocol of electrical muscle stimulation for quadriceps muscle strength in older adults with osteoarthritis of the knee. J Rheumatol. 2003;30:1571–1578.
    1. Durmus D, Alayli G, Canturk F. Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clin Rheumatol. 2007;26:674–678. doi: 10.1007/s10067-006-0358-3.
    1. Avramidis K, Strike PW, Taylor PN, Swain ID. Effectiveness of electric stimulation of the vastus medialis muscle in the rehabilitation of patients after total knee arthroplasty. Arch Phys Med Rehabil. 2003;84:1850–1853. doi: 10.1016/S0003-9993(03)00429-5.
    1. Petterson S, Snyder-Mackler L. The use of neuromuscular electrical stimulation to improve activation deficits in a patient with chronic quadriceps strength impairments following total knee arthroplasty. J Orthop Sports Phys Ther. 2006;36:678–685.
    1. Akima H, Kano Y, Enomoto Y, Ishizu M, Okada M, Oishi Y. Muscle function in 164 men and women aged 20--84 yr. Med Sci Sports Exerc. 2001;33:220–226. doi: 10.1097/00005768-200105001-01223.
    1. Lyons CL, Robb JB, Irrgang JJ, Fitzgerald GK. Differences in quadriceps femoris muscle torque when using a clinical electrical stimulator versus a portable electrical stimulator. Phys Ther. 2005;85:44–51.
    1. Murray MP, Gardner GM, Mollinger LA, Sepic SB. Strength of isometric and isokinetic contractions: knee muscles of men aged 20 to 86. Phys Ther. 1980;60:412–419.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
    1. Lyons RA, Perry HM, Littlepage BN. Evidence for the validity of the Short-form 36 Questionnaire (SF-36) in an elderly population. Age Ageing. 1994;23:182–184. doi: 10.1093/ageing/23.3.182.
    1. McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66. doi: 10.1097/00005650-199401000-00004.
    1. Buchner DM, Larson EB, Wagner EH, Koepsell TD, de Lateur BJ. Evidence for a non-linear relationship between leg strength and gait speed. Age Ageing. 1996;25:386–391. doi: 10.1093/ageing/25.5.386.
    1. Maly MR, Costigan PA, Olney SJ. Determinants of self-report outcome measures in people with knee osteoarthritis. Arch Phys Med Rehabil. 2006;87:96–104. doi: 10.1016/j.apmr.2005.08.110.

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