Article

The recovery of quadriceps muscle force and function after total knee
arthroplasty (TKA) is suboptimal, which predisposes patients to disability with
increasing age. The purpose of this investigation was to evaluate the
efficacy of quadriceps muscle neuromuscular electrical stimulation (NMES),
initiated 48 hours after TKA,
as an adjunct to standard rehabilitation. DESIGN:
This was a prospective, longitudinal randomized controlled trial. METHODS:
Sixty-six patients, aged 50 to 85 years and planning a primary unilateral TKA,
were randomly assigned to receive either standard rehabilitation (control) or
standard rehabilitation plus NMES applied to the quadriceps muscle (initiated 48
hours after surgery). The NMES was applied twice per day at the maximum tolerable
intensity for 15 contractions. Data for muscle strength, functional performance,
and self-report measures were obtained before surgery and 3.5, 6.5, 13, 26, and
52 weeks after TKA. RESULTS: At 3.5 weeks after TKA, significant improvements
with NMES were found for quadriceps and hamstring muscle strength, functional
performance, and knee extension active range of motion. At 52 weeks, the
differences between groups were attenuated, but improvements with NMES were still
significant for quadriceps and hamstring muscle strength, functional performance,
and some self-report measures. LIMITATIONS: Treatment volume was not matched for
both study arms; NMES was added to the standard of care treatment. Furthermore,
testers were not blinded during testing, but used standardized scripts to avoid
bias. Finally, some patients reached the maximum stimulator output during at
least one treatment session and may have tolerated more stimulation. CONCLUSIONS:
The early addition of NMES effectively attenuated loss of quadriceps muscle
strength and improved functional performance following TKA.
The effects were most
pronounced and clinically meaningful within the first month after surgery, but
persisted through 1 year after surgery.

Langue : ANGLAIS