Department of Physical and Occupational Therapy, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
Section for Sport Science, Department of Public Health, Aarhus University, Denmark.
PM R. 2018 Jul;10(7):687-692. doi: 10.1016/j.pmrj.2017.11.002. Epub 2017 Nov 9.
Preoperative progressive resistance training (PRT) is controversial in patients scheduled for total knee arthroplasty (TKA), because of the concern that it may exacerbate knee joint pain and effusion.
To examine whether preoperative PRT initiated 5 weeks prior to TKA would exacerbate pain and knee effusion, and would allow a progressively increased training load throughout the training period that would subsequently increase muscle strength.
Secondary analyses from a randomized controlled trial (NCT01647243).
University Hospital and a Regional Hospital.
A total of 30 patients who were scheduled for TKA due to osteoarthritis and assigned as the intervention group.
Patients underwent unilateral PRT (3 sessions per week). Exercise loading was 12 repetitions maximum (RM) with progression toward 8 RM. The training program consisted of 6 exercises performed unilaterally.
Before and after each training session, knee joint pain was rated on an 11-point scale, effusion was assessed by measuring the knee joint circumference, and training load was recorded. The first and last training sessions were initiated by 1 RM testing of unilateral leg press, unilateral knee extension, and unilateral knee flexion.
The median pain change score from before to after each training session was 0 at all training sessions. The average increase in knee joint effusion across the 12 training sessions was a mean 0.16 cm ± 0.23 cm. No consistent increase in knee joint effusion after training sessions during the training period was found (P = .21). Training load generally increased, and maximal muscle strength improved as follows: unilateral leg press: 18% ± 30% (P = .03); unilateral knee extension: 81% ± 156% (P < .001); and unilateral knee flexion: 53% ± 57% (P < .001).
PRT of the affected leg initiated shortly before TKA does not exacerbate knee joint pain and effusion, despite a substantial progression in loading and increased muscle strength. Concerns for side effects such as pain and effusion after PRT seem unfounded.
I.
在接受全膝关节置换术（TKA）的患者中，术前渐进式抗阻训练（PRT）存在争议，因为担心它可能会加重膝关节疼痛和积液。
研究在 TKA 前 5 周开始进行 PRT 是否会加重疼痛和膝关节积液，并允许在整个训练期间逐渐增加训练负荷，从而随后增加肌肉力量。
随机对照试验（NCT01647243）的二次分析。
大学医院和区域医院。
共 30 名因骨关节炎接受 TKA 并被分配为干预组的患者。
患者接受单侧 PRT（每周 3 次）。运动负荷为 12 次最大重复（RM），逐渐增加到 8 RM。该训练计划包括 6 项单侧进行的练习。
每次训练前后，膝关节疼痛均采用 11 分制进行评分，通过测量膝关节周长评估积液，记录训练负荷。第一次和最后一次训练课程通过单侧腿压机、单侧膝关节伸展和单侧膝关节弯曲的 1 RM 测试开始。
每次训练课程前后的疼痛变化中位数评分均为 0。在 12 次训练课程中，膝关节积液的平均增加量为 0.16 cm ± 0.23 cm。在整个训练期间，没有发现训练课后膝关节积液持续增加（P =.21）。训练负荷普遍增加，最大肌肉力量改善如下：单侧腿压机：18% ± 30%（P =.03）；单侧膝关节伸展：81% ± 156%（P <.001）；单侧膝关节弯曲：53% ± 57%（P <.001）。
尽管负荷增加且肌肉力量增强，但在 TKA 前短期内开始对患侧肢体进行 PRT 不会加重膝关节疼痛和积液。对 PRT 后出现副作用（如疼痛和积液）的担忧似乎没有根据。
I 级。
