Improved function from progressive strengthening interventions after total knee arthroplasty: A randomized clinical trial with an imbedded prospective cohort

The purpose of this study was to determine the effectiveness of progressive quadriceps strengthening with or without neuromuscular electrical stimulation (NMES) on quadriceps strength, activation, and functional recovery after total knee arthroplasty (TKA), and to compare progressive strengthening with conventional rehabilitation.  Two hundred patients who had undergone primary, unilateral TKA for knee osteoarthritis were randomized to 1 of 2 interventions 4 weeks after surgery, and 41 patients formed the 'standard of care' group. All randomized patients received 6 weeks of outpatient physical therapy 2 or 3 times per week through 1 of 2 intervention protocols: an exercise group (volitional strength training) or an exercise-NMES group (volitional strength training and NMES). The results showed that the standard of care group was weaker and exhibited worse function at 12 months compared with both treatment groups. 

Progressive quadriceps strengthening with or without NMES enhances clinical improvement after TKA, achieving similar short- and long-term functional recovery and approaching the functional level of healthy older adults. Conventional rehabilitation does not yield similar outcomes.

Arthritis Care & Research, 2009, 61(2), 174 - 183

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