Journal of Orthopedic Research and Therapy (ISSN: 2575-8241)

Article / Research Article

"A Progressive Strength Training Program Starting 3 Months Post Total Knee Arthroplasty Surgery Improves Strength but Not Functional Outcome"

Danielle D.P. Berghmans1,4, Antoine F. Lenssen1,4*, Pieter J. Emans2, Rob A. de Bie3,4
1Department of Physical Therapy, Maastricht University Medical Center, Maastricht, The Netherlands
2Department of Orthopedics, Maastricht University Medical Center, Maastricht, The Netherlands
3Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
4Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
*Corresponding author: Antoine F. Lenssen, Maastricht University Medical Center, PO Box 5800
6202, AZ Maastricht, The Netherlands. Tel: +31433877146; Email:
6202, AZ Maastricht, The Netherlands. Tel: +31433877146; Email: af.lenssen@mumc.nl
Received Date: 25 September, 2018; Accepted Date: 28 September, 2018; Published Date: 04 October, 2018

1.       Abstract 
1.1.  Background: Decreased quadriceps and hamstring strength is common even one year after a total knee arthroplasty. Hence, patients with persistent functional complaints treated at the Maastricht University Medical Centre (MUMC+) received a progressive strength training program. 
1.2.  Objectives: The aim of this study was to investigate the impact of the progressive strength training program on quadriceps and hamstring strength. 
1.3.  Methods: Patients were referred to the outpatient physical therapy department of MUMC+ and received a 6-week progressive strength training program. Their isokinetic quadriceps and hamstring strength and functional ability were assessed before and after the program. 
1.4.  Results: Men significantly improved in terms of all strength parameters assessed at an angular velocity of 60°/sec and 180°/sec. Women only improved their quadriceps strength at 180°/sec. No significant improvement at functional level was seen. 
1.5.  Conclusion: A 6-week progressive strength training program has a positive impact on the isokinetic quadriceps and hamstring strength in both men and women, but not on functional ability. 
1.6.  Level of Evidence:  Level 3. 
2.       Keywords: Arthroplasty; Knee; Physical Therapy; Rehabilitation; Total 

    

Figure 1: Shows the change in quadriceps strength of all individual patients before and after training, in Nm. Each line represents an individual patient. Their sex is given to the right of the diagram (F[Female] and M[male]).


Figure 2: Shows the mean quadriceps and hamstrings strengths in men, at baseline and after the training program, in Nm with standard deviations Q60: isokinetic quadriceps strength 60°/sec. Q180: isokinetic quadriceps strength 180°/sec. H60: isokinetic hamstring strength 60°/sec. H180: isokinetic hamstring strength 180°/sec. Normative values are the means of the individual normative values based on sex and age. * Significant improvement between baseline and post-training assessments (p < 0.05)


Figure 3: Shows the mean quadriceps and hamstrings strengths in women, at baseline and after the training program, in Nm with standard deviations Q60: isokinetic quadriceps strength 60°/sec. Q180: isokinetic quadriceps strength 180°/sec. H60: isokinetic hamstring strength 60°/sec. H180: isokinetic hamstring strength 180°/sec. Normative values are the means of the individual norm values based on sex and age. * Significant improvement between baseline and post-training assessments (p < 0.05).


Figure 4: Shows the change in WOMAC Function score of each individual patient before and after training. Each line represents an individual patient. The sex is given to the right of the diagram (F[Female] and M[male]).

TABLE 1 Normative values

 

Men (n=129)

Women (n=166)

 

mean

SD

mean

SD

Q60

129

17

79

9

H60

78

12

49

6

Q180

84

10

46

6

H180

59

9

35

5

Table 1: Shows the normative values calculated using equations including age and sex [4]. Nm: Newton meter. SD: standard deviation. Q60: isokinetic quadriceps strength 60°/sec. Q180: isokinetic quadriceps strength 180°/sec. H60: isokinetic hamstring strength 60°/sec. H180: isokinetic hamstring strength 180°/sec.

TABLE 2 Patient Characteristics

 

Men (n=7)

Women (n=5)

 

Mean

SD

Mean

SD

Age (years)

66.0

6.3

67.4

7.3

Height (m)

1.75

0.07

1.59

0.04

Weight (kg)

88.2

13.2

81.9

22.4

BMI (kg/m2)

28.9

4.9

32.5

9.4

Table 2: Shows the patients characteristics. BMI: Body Mass Index, SD: Standard Deviation.

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Citation: Berghmans DDP, Lenssen AF, Emans PJ, de Bie RA (2018) A Progressive Strength Training Program Starting 3 Months Post Total Knee Arthroplasty Surgery Improves Strength but Not Functional OutcomeJ Orthop Res Ther 2018: 1118. DOI: 10.29011/2575-8241.001118