Progressive Rehabilitation Following Total Knee Arthroplasty
Condition: Osteoarthritis
MeSH terms: Osteoarthritis
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the effectiveness of a progressive resistance
      rehabilitation program (PROG) after total knee arthroplasty (TKA) compared to a traditional
      rehabilitation program (TRAD).

      The investigators hypothesized:

        -  PROG will result in greater improvements in functional outcome measures such as: stair
           climbing test (SCT), timed-up-and-go test (TUG), six minute walk test (6MW), the Knee
           Injury and Osteoarthritis Outcome Survey (WOMAC), and knee range of motion (ROM).

        -  PROG will result in greater improvements in quadriceps muscle strength gains after TKA
           compared to TRAD.

        -  PROG will result in greater improvements in muscle mass and central activation compared
           to TRAD.
    

Detailed description: 
      Over 500,000 total knee arthroplasties (TKAs) are performed each year in the United States to
      alleviate pain and disability associated with knee osteoarthritis (OA), and this number is
      expected to grow to 3.48 million per year by the year 2030. TKA reduces pain and improves
      self-reported function compared to pre-operative levels, but post-operative deficits in
      walking speed (20% slower) and stair climbing speed (50% slower) can persist for years. Stair
      climbing performance is the single largest residual deficit after TKA with seventy-five
      percent of TKA patients reporting difficulty negotiating stairs after surgery. Collectively,
      these findings suggest that current rehabilitation does not adequately target the impairments
      that lead to long-term deficits in functional mobility after TKA.

      The aim of the proposed trial is to evaluate the effectiveness of a progressive resistance
      rehabilitation program (PROG) after TKA compared to a traditional rehabilitation program
      (TRAD). The PROG intervention will involve intensive rehabilitation using progressive
      resistance exercise and faster progression to functional strengthening exercises. The TRAD
      intervention represents the synthesis of previously published TKA rehabilitation programs.
      Our preliminary data suggest that the PROG intervention has low risk and results in improved
      functional mobility and muscle strength. The investigators will measure function and strength
      at six time points (pre-op; 1, 2, 3, 6, and 12 months after TKA). The investigators will also
      evaluate the contribution of changes in muscle mass (atrophy/hypertrophy) and central
      activation to changes in muscle strength following PROG and TRAD interventions.
    

Intervention name(s): Total knee replacement rehabilitation
Intervention type(s): Other
Intervention description(s): After total knee arthroplasty, patients will be assigned to an outpatient rehabilitation clinic, based upon geography. Patients will be enrolled randomly into one of two rehabilitation programs (PROG or TRAD). Both rehabilitation programs will take place over 12 weeks. Both groups will receive treatment for range of motion, activities of daily living and gait training, as well as a home exercise program.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Total knee arthroplasty; quadriceps; muscle; arthroplasty; joint diseases; musculoskeletal diseases