Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty? A study protocol for a randomized trial

Abstract

BackgroundTotal knee arthroplasty (TKA) is effective in reducing pain and improving function for end-stage knee osteoarthritis. However, muscle weakness and functional limitations persist despite assistance from post-operative rehabilitation programs that traditionally focus on quadriceps strengthening and range of movement exercises. Hip abductor muscle weakness is evident in knee osteoarthritis and hip muscle strengthening reduces knee pain in this group. Following TKA, people with weak hip abductor strength perform more poorly on measures of physical function. However, very little is known of the effectiveness of including hip abductor strengthening exercises in post-operative rehabilitation. The aim of this trial is to compare the effects of targeted hip abductor strengthening to those of traditional care in a TKA rehabilitation program on muscle strength, patient reported outcomes and functional performance measures.Methods/designThis protocol describes a single-blinded randomized controlled trial, where 104 participants referred for inpatient rehabilitation following TKA will be recruited. Participants will be randomized using computer-generated numbers to one of two groups: usual care or usual care with additional hip strengthening exercises. Participants will attend physiotherapy daily during their inpatient length of stay, and will then attend between six and eight physiotherapy sessions as an outpatient. Primary outcomes are isometric hip abductor strength and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes are stair climb test, 6 min walk test, timed up and go, 40 m fast-paced walk test, 30 second chair stand test, isometric quadriceps strength, Lower Extremity Functional Scale (LEFS) and SF-12. Outcome measures will be recorded at baseline (admission to inpatient rehabilitation), and then 3 weeks, 6 weeks and 6 months post admission to rehabilitation.DiscussionThe findings of this study will determine whether the addition of targeted hip strengthening to usual care rehabilitation improves physical performance and patient reported outcomes following TKA when compared to usual care rehabilitation. This will then determine whether targeted hip strengthening exercises should be included in traditional rehabilitation programs to improve the outcomes following total knee arthroplasty.Trial registrationThe trial protocol was registered with the Australian Clinical Trial Registry (ACTRN12615000863538) on 18 August 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1104-x) contains supplementary material, which is available to authorized users.

Structure, function, and control of the human musculoskeletal network

“…Indeed, muscular changes in one part of the body are known to affect other muscle groups. For example, strengthening hip muscles can lead to improved knee function following knee replacement [ 67 ]. Alteration of muscular function in the ankle following sprains can cause altered hip muscle function [ 68 , 69 ], a result replicated by our model (which found the biceps femoris and vastus lateralis were most impacted by ankle injury), and injury to limb muscles can lead to secondary injury of the diaphragm [ 70 ].…”

The effect of intensive exercise program and kinesiotaping following total knee arthroplasty on functional recovery of patients

“…The strength of this muscle group in post-prosthetic patients has an important effect on the faster recovery of the knee function [ 34 ]. Therefore, it will be meaningful that exercise protocols for strengthening hip muscles take place in the routine rehabilitation programs following TKA [ 35 ]. Piva et al emphasized the importance of the hip circumference muscle strength for the functional recovery following TKA.…”

Pre-Conditioning and Post-Operative Photobiomodulation Therapy by a Novel Light Patch System for Knee Arthroplasty: A Protocol for a Phase 1 Study

“…38 Thus, it is sensitive to detecting early deterioration and improvement in the early post-TKA period. 45 Muscle strength. The lower limb muscle strength assessments are based on manual muscle testing.…”