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. While TKA reliably reduces pain and improves self-reported function, quadriceps strength and functional mobility remain impaired years after surgery. Long-term weakness and deficits in functional mobility likely stem from early post-operative strength loss, especially in the quadriceps muscles. Furthermore, the majority of this early quadriceps weakness occurs because of difficulty activating the muscles early after surgery. Improved rehabilitation strategies are needed to target these early impairments and prevent deficits in functional mobility. While some studies suggest that rehabilitation after TKA has no long-term benefit, emerging investigations suggest that a more aggressive rehabilitation program, using intensive progressive resistance exercise and functional strengthening, may substantially improve patient function without compromising safety. Progressive resistance exercise offers many possible advantages, including the potential to reverse muscle activation deficits, stimulate muscle hypertrophy, and improve functional performance. Early intervention with progressive exercise after TKA offers even greater benefits because preventing the decline of muscle function early after surgery is likely to be more effective than working to reverse losses months after surgery. However, there have been no prospective, randomized clinical trials examining the benefits of a progressive rehabilitation program initiated immediately after TKA. The overall aim of this investigation is to evaluate the effectiveness of a progressive resistance rehabilitation program (PROG) after TKA compared to a traditional rehabilitation program (TRAD) through a prospective, double-blinded, randomized trial. The PROG intervention will involve the early initiation of 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. Functional performance and muscle muscle strength will be measured at six time points (pre-op;1, 2, 3, 6, and 12 months after TKA) (Aims 1&2) with the primary outcome (stair climbing time) measured at 3 months. We will also determine whether PROG enhances improvements in muscle mass and central activation compared to TRAD, and explore the mechanisms by which quadriceps strength improves (Aim 3). We expect PROG will result in substantial improvements in functional mobility and strength and these improvements will specifically relate to better central activation. This study has high potential to shift current clinical practice paradigms with an immediate impact because the PROG program can be easily implemented in most clinical settings. 1

Public Health Relevance

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. Although TKA reduces pain and improves self-reported function, when compared to healthy age-matched adults, patients have 20% slower walking speeds and 50% slower stair climbing speeds years after surgery. The proposed clinical trial is designed to improve functional mobility after TKA through the implementation of a more progressive rehabilitation program.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
3R01HD065900-02S1
Application #
8459719
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Shinowara, Nancy
Project Start
2011-08-15
Project End
2015-05-31
Budget Start
2012-06-01
Budget End
2013-05-31
Support Year
2
Fiscal Year
2012
Total Cost
$48,501
Indirect Cost
$16,801
Name
University of Colorado Denver
Department
Physical Medicine & Rehab
Type
Schools of Medicine
DUNS #
041096314
City
Aurora
State
CO
Country
United States
Zip Code
80045
Bade, Michael; Struessel, Tamara; Paxton, Roger et al. (2018) Performance on a Clinical Quadriceps Activation Battery Is Related to a Laboratory Measure of Activation and Recovery After Total Knee Arthroplasty. Arch Phys Med Rehabil 99:99-106
Loyd, Brian J; Jennings, Jason M; Judd, Dana L et al. (2017) Influence of Hip Abductor Strength on Functional Outcomes Before and After Total Knee Arthroplasty: Post Hoc Analysis of a Randomized Controlled Trial. Phys Ther 97:896-903
Loyd, Brian J; Jennings, Jason M; Falvey, Jason R et al. (2017) Magnitude of Deformity Correction May Influence Recovery of Quadriceps Strength After Total Knee Arthroplasty. J Arthroplasty 32:2730-2737
Bade, Michael J; Struessel, Tamara; Dayton, Michael et al. (2017) Early High-Intensity Versus Low-Intensity Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 69:1360-1368
Gustavson, Allison M; Wolfe, Pamela; Falvey, Jason R et al. (2016) Men and Women Demonstrate Differences in Early Functional Recovery After Total Knee Arthroplasty. Arch Phys Med Rehabil 97:1154-62
Christiansen, Cory L; Bade, Michael J; Davidson, Bradley S et al. (2015) Effects of Weight-Bearing Biofeedback Training on Functional Movement Patterns Following Total Knee Arthroplasty: A Randomized Controlled Trial. J Orthop Sports Phys Ther 45:647-55
Christiansen, Cory L; Bade, Michael J; Paxton, Roger J et al. (2015) Measuring movement symmetry using tibial-mounted accelerometers for people recovering from total knee arthroplasty. Clin Biomech (Bristol, Avon) 30:732-7
Kittelson, Andrew J; Thomas, Abbey C; Kluger, Benzi M et al. (2014) Corticospinal and intracortical excitability of the quadriceps in patients with knee osteoarthritis. Exp Brain Res 232:3991-9
Winters, Joshua D; Christiansen, Cory L; Stevens-Lapsley, Jennifer E (2014) Preliminary investigation of rate of torque development deficits following total knee arthroplasty. Knee 21:382-6
Stevens-Lapsley, Jennifer E; Thomas, Abbey C; Hedgecock, James B et al. (2013) Corticospinal and intracortical excitability of the quadriceps in active older and younger healthy adults. Arch Gerontol Geriatr 56:279-84