Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength After Total Knee Arthroplasty: A Randomized Controlled Trial

Stevens‐Lapsley, Jennifer E.; Balter, Jaclyn E.; Wolfe, Pamela; Eckhoff, Donald G.; Kohrt, Wendy M.

doi:10.2522/ptj.20110124

Cited by 218 publications

(398 citation statements)

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“…Previous work performed by the authors [51,53] suggested that 25 patients (50 knees) would be required to achieve 90% power to detect a small to moderate effect of tourniquet use on quadriceps strength at 3 weeks postoperatively, the primary variable of this report. Because leg dominance was not formally assessed in this study, it is conceivable that-by chance-the tourniquet could have been applied to the nondominant leg a greater proportion of the time, thus confounding outcomes in favor of the notourniquet group.…”

Section: Discussionmentioning

confidence: 99%

“…Early postoperative deficits in quadriceps strength may be particularly problematic because there is reason to believe that early strength loss, occurring primarily through deficits in voluntary muscle activation [36], may actually exacerbate long-term weakness [24]. In fact, there is a growing body of research focused on improving TKA rehabilitation specifically to limit early postoperative loss of quadriceps strength [31,53]. Moreover, for patients undergoing TKA, quadriceps strength is one of the most robust predictors of long-term function in tasks such as chair-rise and stairclimbing ability [35,64].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we chose to base our estimate of sample size on our desire to detect a small to medium effect (Cohen's d \ 0.4) on quadriceps strength at our primary endpoint (3 weeks after surgery). Based on our previous work [51,53], we assumed a standard deviation in quadriceps strength of 29.8 Nm at 3 weeks after surgery and estimated that 25 patients (50 knees) would be required to achieve 90% power to detect a small to medium effect (approximately 12 Nm) at this time point. Sample size estimates were performed using Statistical Analysis Software (SAS Institute Inc, Cary, NC, USA).…”

Section: Methodsmentioning

confidence: 99%

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Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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169

148

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Background Tourniquet use during total knee arthroplasty (TKA) improves visibility and reduces intraoperative blood loss. However, tourniquet use may also have a negative impact on early recovery of muscle strength and lower extremity function after TKA. Questions/purposes The purpose of this study was (1) to determine whether tourniquet use affects recovery of quadriceps strength (primary outcome) during the first 3 postoperative months; and (2) to examine the effects of tourniquet application on secondary outcomes: voluntary quadriceps activation, hamstring strength, unilateral limb balance as well as the effect on operative time and blood loss.Methods Twenty-eight patients (mean age 62 ± 6 years; 16 men) undergoing same-day bilateral TKA (56 lower extremities) were enrolled in a prospective, randomized study. Subjects were randomized to receive a tourniquetassisted knee arthroplasty on one lower extremity while the contralateral limb underwent knee arthroplasty without extended tourniquet use. In the former group, the tourniquet was inflated just before the incision was made and released after cementation; in the latter group, a tourniquet was not used (10 of 28 [36%]) or inflated only during component cementation (18 of 28 [64%]). The choice of no tourniquet or use just during cementation was based on surgeon choice, because some surgeons felt a tourniquet during cementation was necessary to achieve a dry surgical field to maximize cement fixation. A median parapatellar approach and the One or more of the authors (DAD, CCY, TMM, RHK) has received funding from Porter Adventist Hospital, during the study period, in the amount of USD 10,000 to USD 100,000. One of the authors (DAD) has or may receive payments or benefits from DePuy (Warsaw, IN, USA) in the amount of USD more than USD 1,000,001 not related to this work. One of the authors certifies that he (RHK) has or may receive payments or benefits from Stryker (Kalamazoo, MI, USA) and Innomed (Savannah, GA, USA) in the amount of USD 100,001 to USD 1,000,001 not related to this work. One of the authors (TMM) has or may receive payments or benefits from Zimmer (Warsaw, IN, USA) in the amount of less than USD 10,000 not related to this work. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.The surgeries for this study were performed at Porter Adventist Hospital, Denver, CO, USA, and the postoperative patient te...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

Self Cite

169

148

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“…All patients were given visual targets from the dynamometer's output and strong verbal encouragement during each trial. Maximal voluntary isometric contractions for all muscle groups were performed twice; however, if maximal torque during the first two trials differed by more than 5%, a third trial was performed, as previously described [18,[46][47][48]. The trial with the highest torque was normalized to body mass (kg) and used for analysis [1].…”

Section: Strength Testing Proceduresmentioning

confidence: 99%

Muscle Strength and Functional Recovery During the First Year After THA

Judd¹,

Dennis

Thomas³

et al. 2013

Clin Orthop Relat Res

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Background Patients undergoing total hip arthroplasty (THA) often are satisfied with the decrease in pain and improvement in function they achieve after surgery. Even so, strength and functional performance deficits persist after recovery, but these remain poorly characterized; knowledge about any ongoing strength or functional deficits may allow therapists to design rehabilitation programs to optimize recovery after THA. Questions/purposes The purposes of this study were to (1) evaluate postoperative muscle strength, function, and quality of life during the first year after THA; and (2) compare strength and function in patients 1 year after THA with a cohort of healthy peers. Methods Twenty-six patients undergoing THA were assessed 1, 3, 6, and 12 months postoperatively, and 19 adults with no hip pathology were tested as a control group. Isometric muscle strength (hip flexors, extensors, abductors, knee extensors, and flexors), functional performance (stair climbing, five times sit-to-stand, timed-up-and-go, 6-minute walk, and single-limb stance tests), and selfreported function (Hip Disability and Osteoarthritis Score, SF-36, and UCLA activity score) were compared. Results One month after THA, patients had 15% less hip flexor and extensor torque, 26% less abductor torque, 14% less knee extensor and flexor torque, and worse performance on the stair climbing, timed-up-and-go, single-limb stance, and 6-minute walk. Compared with healthy adults, patients 12 months after THA had 17% less knee extensor and 23% less knee flexor torque; however, the functional testing (including stair climbing, five times sit-to-stand, and the 6-minute walk) showed no significant differences with the patient numbers available between individuals undergoing THA and healthy control subjects. SF-36 Physical Component Scores, although significantly improved from preoperative levels, were significantly worse than healthy adults 1 year after THA (p \ 0.01).

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“…Se emplea con la idea de ejercitar la contracción muscular y mejorar su resistencia. Algunos autores recomiendan su uso en el músculo cuádriceps, después de la ATR, a pesar de su limitada evidencia (108). Una revisión Cochrane del año 2010 no recomienda su utilización debido al bajo grado de evidencia disponible (109).…”

Section: Movilización Precoz Rehabilitación Postquirúrgicaunclassified

Abordaje del dolor agudo en traumatología

Álvaro¹

2017

Rev. Soc. Esp. Dolor.

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Instrucciones de citación para el artículo / Citation instructions for the article:Oteo Álvaro Ángel. Abordaje del dolor agudo en traumatología / Acute pain management in orthopedics. Rev. Soc. Esp. Dolor. 2017. doi: 10.20986/resed.2017.3639/2017 Este es un archivo PDF de un manuscrito inédito que ha sido aceptado para su publicación en la Revista de la Sociedad Española del Dolor. Como un servicio a nuestros clientes estamos proporcionando esta primera versión del manuscrito en estado de prepublicación. El manuscrito será sometido a la corrección de estilo final, composición y revisión de la prueba resultante antes de que se publique en su forma final. Tenga en cuenta que durante el proceso de producción se pueden dar errores lo que podría afectar el contenido final. El copyright y todos los derechos legales que se aplican al artículo pertenecen a la Revista de la Sociedad Española de Dolor.

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Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength After Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract: The early addition of NMES effectively attenuated loss of quadriceps muscle strength and improved functional performance following TKA. The effects were most pronounced and clinically meaningful within the first month after surgery, but persisted through 1 year after surgery.

Cited by 218 publications

References 64 publications

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Muscle Strength and Functional Recovery During the First Year After THA

Abordaje del dolor agudo en traumatología

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