Perioperative Essential Amino Acid Supplementation Facilitates Quadriceps Muscle Strength and Volume Recovery After TKA

Abstract

Background: Perioperative essential amino acid (EAA) supplementation suppresses lower-limb muscle atrophy and promotes functional improvement in the first 4 weeks after total knee arthroplasty (TKA). However, its effect on the recovery of muscle volume and strength in the intermediate term is unclear. The aim of this study was to evaluate the effect of perioperative EAA supplementation on the recovery of lower-limb muscle volume and strength in the 2 years after TKA.Methods: Sixty patients who underwent unilateral TKA for primary knee osteoarthritis were included in this double-blinded randomized controlled trial. After excluding dropouts, 26 patients assigned to the EAA group (9 g/day) and 26 assigned to the placebo group (powdered lactose, 9 g/day) were available for analysis. Patients received EAA supplementation or a placebo from 1 week prior to surgery to 2 weeks after it. The rectus femoris muscle area was measured using ultrasonography and quadriceps muscle strength was measured isometrically with a handheld dynamometer, preoperatively and periodically up to 2 years postoperatively. Knee pain, knee range of motion, functional mobility, and Knee Society Score 2011 subjective scores were measured at each time point. Perioperative management, except for supplementation, was identical in the 2 groups.Results: Taking the baseline as 100%, the mean values in the EAA and placebo groups were 134% ± 31% and 114% ± 27%, respectively, for the rectus femoris muscle area and 159% ± 54% and 125% ± 40% for the quadriceps muscle strength, respectively, at 2 years after surgery. The differences were significant (p < 0.05). Clinical outcomes were not significantly different between the 2 groups.Conclusions: Perioperative EAA supplementation contributes to the recovery of rectus femoris muscle volume and quadriceps muscle strength in the 2 years after TKA. The EAA supplementation did not impact clinical outcomes.

The Role of Amino Acid Supplementation in Orthopaedic Surgery

“…Studies evaluating EAA supplementation after TKA all demonstrated decreased muscle loss after surgery and improved recovery of functional mobility including rectus femoris muscle volume and quadriceps muscle strength up to 2 years after surgery. 10,15,18 In summary, literature supports the clinical efficacy of EAA supplementation in not just mitigating sarcopenia because of immobility and immobilization but also improved functional recovery postoperatively (Table 1).…”

“…Studies evaluating EAA supplementation after TKA all demonstrated decreased muscle loss after surgery and improved recovery of functional mobility including rectus femoris muscle volume and quadriceps muscle strength up to 2 years after surgery. 10,15,18…”

Joint gap produced by manual stress is dependent on the surgeon’s experience and is smaller in flexion in robotic-assisted total knee arthroplasty

“…Since the accuracy of the bone cut is increasing owing to the development of the navigation and robot systems [15], such inter‐surgeon difference may have significant clinical relevance in robotic‐assisted TKAs. Because the medial flexion gap is a reliable indicator of soft‐tissue balancing and is associated with patient satisfaction and patient‐reported subjective scores after TKA [1, 16, 19], manual stress measurements in navigation and robot systems must be improved [4, 21, 22].…”

“…Accurate soft‐tissue balancing is important in achieving a good clinical outcome, patient satisfaction, and a long‐term implant survival after total knee arthroplasty (TKA) [1, 3, 5, 11, 19]. Joint gap measurement is most commonly performed under static conditions, with the knee extended and performing a 90° flexion using a gap tensioner/spreader [18].…”

What’s New in Adult Reconstructive Knee Surgery

“…Another RCT showed no differences with regard to blood loss, thigh and knee pain, edema, and complications between patients who underwent the procedure without a tourniquet and those patients who had optimized use of it 19 . With regard to quadriceps muscle strength and volume recovery after TKA, a trial comparing perioperative essential amino acid supplementation with placebo showed that the supplementation significantly improved the rectus femoris muscle area and quadriceps muscle strength at 2 years after TKA, although clinical outcomes such as knee pain, 6-meter walk, daily living activities, and range of motion were not significantly different 20 . A separate RCT comparing vitamin D 3 supplementation before TKA with placebo did not demonstrate significant improvements in function, the TUG test, or complications up to 6 weeks after the surgical procedure 21 .…”