Vasileiadis Dimitrios, Drosos Georgios, Charitoudis Georgios, Dontas Ismene A, Vlamis John
Laboratory for Research of the Musculoskeletal System, KAT General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, GRC.
Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, GRC.
Cureus. 2022 Mar 15;14(3):e23191. doi: 10.7759/cureus.23191. eCollection 2022 Mar.
Several studies have shown that patients with severe osteoarthritis (OA) of the knee can reduce their knee pain, improve their quadriceps strength, and improve their functional ability through regular exercise training. The purpose of this study was to investigate the efficacy of a six-week supervised high-intensity preoperative training program on muscle strength, functional performance, and patient-reported outcomes in patients undergoing total knee arthroplasty (TKA).
Ninety-eight patients scheduled for unilateral TKA for severe OA were allocated to an intervention group (N = 49) who completed a six-week preoperative training program, five days per week prior to surgery, and a control group (N=49) who did not follow any preoperative training program. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), Knee Injury and Osteoarthritis Outcome Score (KOOS), quadriceps strength, 20-meter walk test, and 30-second chair stand test were assessed at six weeks before surgery (T0), just before surgery (T1), four weeks (T2) and finally 12 weeks (T3) after TKA.
Of 98 patients included in our study, 10 individuals withdrew from the study at different stages. Finally, 44 patients were allocated to the intervention group and 44 patients to the control group. When comparing the changes from baseline to the primary test points at T1, T2, and T3, we found a significant group difference in favor of the intervention group for quadriceps strength (<0.001, 0.001, 0.009), 20-meter walk test (<0.001, 0.023, 0.032), 30-second chair stand test (0.001, <0.001, <0.001) and all patient-reported outcomes WOMAC (<0.001, 0.001, 0.007) except from KOOS that showed significant difference only at T1 (<0.001) at T2 (0.048) but not at T3 (0.087).
Our study demonstrated that a six-week preoperative physiotherapy training program supervised by a physiotherapist before TKA is efficacious for decreasing knee pain, improving knee function, and enhancing daily living activities.
多项研究表明，重度膝关节骨关节炎（OA）患者可通过定期运动训练减轻膝关节疼痛、增强股四头肌力量并提高功能能力。本研究的目的是调查为期六周的术前高强度监督训练计划对接受全膝关节置换术（TKA）患者的肌肉力量、功能表现和患者报告结局的疗效。
98例计划接受单侧TKA治疗重度OA的患者被分为干预组（N = 49），在手术前每周五天完成为期六周的术前训练计划，以及对照组（N = 49），不遵循任何术前训练计划。在手术前六周（T0）、手术前即刻（T1）、TKA术后四周（T2）以及最终12周（T3）时，评估西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、简短健康调查问卷36项身体功能量表（SF-36）、膝关节损伤和骨关节炎结局评分（KOOS）、股四头肌力量、20米步行测试和30秒坐立试验。
在纳入本研究的98例患者中，有10例在不同阶段退出研究。最终，44例患者被分配至干预组，44例患者被分配至对照组。比较从基线到T1、T2和T3主要测试点的变化时，我们发现干预组在股四头肌力量（<0.001、0.001、0.009）、20米步行测试（<0.001、0.023、0.032）、30秒坐立试验（0.001、<0.001、<0.001）以及所有患者报告结局WOMAC（<0.001、0.001、0.007）方面存在显著组间差异，但KOOS仅在T1（<0.001）和T2（0.048）时显示出显著差异，在T3（0.087）时无显著差异。
我们的研究表明，TKA术前由物理治疗师监督的为期六周的物理治疗训练计划对于减轻膝关节疼痛、改善膝关节功能和增强日常生活活动有效。
