Preoperative Strength Training in Patients With Total Knee Arthroplasty

Study Overview
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Brief Summary
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The purpose of this study is to investigate if preoperative strength training will result in faster recovery and higher level of function six weeks after total knee arthroplasty (TKA).

Detailed Description
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Reduced strength of the quadriceps muscle is a common clinical finding in patients with Knee Osteoarthritis and this seems to play a central role in the development of the disease. The strength of the quadriceps muscle have been shown to be reduced by 20-40% as compared to age-matched healthy controls and this decrease in muscle strength have been closely associated with a reduced level of function and increase of pain. Furthermore, it has been demonstrated that the preoperative strength of the quadriceps muscle in patients undergoing TKA, is associated with the level of function one year after surgery. Compared to the level before the operation, an additional operation-induced reduction of the strength of the quadriceps muscle up to 60% as has been demonstrated. Presumably, an optimizing of the strength of the quadriceps muscle could counteract the impact of the expected postoperative loss of muscle strength to such an extent that the loss will be of less clinical significance. It is hypothesized that an optimizing of the strength of the quadriceps muscle may have a favorable effect on the postoperative rehabilitation program and shorten the period of convalescence.

Official Title
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Effect of Preoperative Strength Training on Postoperative Quadriceps Strength and Ability of Function in Patients With Total Knee Arthroplasty in Fast Track Regi

Conditions
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Osteoarthritis, Knee

Intervention / Treatment
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* Other: Preoperative strength training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Planned TKA at the Aarhus University Hospital or Region Hospital Silkeborg, Living in Aarhus Municipality, Primary knee osteoarthritis or secondary osteoarthritis after meniscectomy or ligament injury Exclusion Criteria: Unstable blood pressure, Neuromuscular or neurodegenerative disease, Comprehension or dementia problems

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Preoperative strength training<br>Progressive strength training on group basis four weeks before the operation and progressive strength training on group basis four weeks after the operation | Other: Preoperative strength training<br>* Progressive strength training on group basis (not more than 3 subjects) 3 sessions weekly starting 4 weeks before the operation, in total 12 sessions Strength training 3 sessions weekly 4 weeks postsurgery<br>* Other names: Preoperative training;|
| No Intervention: Living as usual<br>The patients are living as usual the last 4 weeks before operation | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary outcome: Sit-to-stand test | Ability of function test | Change from Baseline 6 weeks preoperative in Sit-to-Stand at 6 weeks postoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Isokinetic: Quadriceps 60 gr./sek | Muscle strength test in dynamometer | 6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| Isokinetic: Hamstrings 60 gr./sek | Muscle strength test in dynamometer | 6 weeks and 1 week before the operation, 1 week, 6 weeks 12 weeks and 1 year after the operation | 
| Isometric: Quadriceps (70 gr. flexion) | Muscle strength test in dynamometer | 6 weeks and 1 week before the operation and 11 week, 6 weeks, 12 weeks and 1 year after the operation | 
| Isometric: Hamstrings (20 gr. flexion) | Muscle strength test in dynamometer | 6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| Rate of force development (flexion and extension) | Muscle test in dynamometer | 6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| Timed Up and Go | Ability of function test | 6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| 10 meter walk test | Ability of function test | 6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| 6 minute walk test | Ability of function test | 6 weeks and 1 week before operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| Knee injury and Osteoarthritis Outcome Score (KOOS) | Disease-specific questionnaire | 6 weeks and 1 week before operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| Oxford Knee Score (OKS) | Disease-specific questionnaire | 6 weeks before the operation and 6 weeks after | 
| EuroQol-5 dimensions (EQ-5D) | Generic questionnaire for self-rated health | 6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| Short-Form Health Survey (SF 12) | Generic questionnaire for self-rated health | 6 weeks before the operation and 1 year after | 
| Background data questionnaire | Questionnaire about pain, medicine use, alcohol intake, smoking, education, job | 6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| Range of motion of the knee | Extension of the knee Flexion of the knee | 6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 
| Body mass index | Weight/height2 | 6 weeks and 1 week before the operation, 1 week, 6 weeks, 12 weeks and 1 year after the operation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Knee osteoarthritis, Total knee arthroplasty, Preoperative training, Strength training