Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement

Improving functional status preoperatively with exercise could improve postoperative outcome. Previous knowledge on preoperative exercise in knee osteoarthritis is not adequate. The goal of the study was to compare the difference in change between groups in lower extremity function from baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone. After intervention before surgery a small improvement for primary and secondary endpoints was seen in both groups, which did not differ significantly between groups: comparing the exercise to the control group the treatment effect for the CST was -1.5 seconds (95% CI: -5.3, 2.2), for KOOS ADL and KOOS pain the treatment effect was 1.3 points (-10.1, 12.8) and -2.3 (-12.4, 7.9) respectively. At 3 months post surgery a small improvement in the primary endpoint was seen in the control group and a significant improvement in the secondary endpoints in both exercise and control groups, which did not differ significantly between groups: comparing the exercise group to the control group the treatment effect in the CST was 2.0 seconds (-1.8, 5.8), for KOOS ADL and KOOS pain the treatment effect was -4.9 points (-16.3, 6.5) and -3.3 points (-13.5, 6.8) respectively.

A median (IQR) of 10 (8, 14) exercise sessions before surgery exhibited an additional small but non-significant improvement in all functional assessments compared to patient education alone. These benefits were not sustained after TKR. This trial doesn’t give a conclusive answer to whether additional preoperative exercise has any benefit on postoperative functional outcomes.

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