Bade Michael J, Christiansen Cory L, Zeni Joseph A, Dayton Michael R, Forster Jeri E, Cheuy Victor A, Christensen Jesse C, Hogan Craig, Koonce Ryan, Dennis Doug, Peters Amy, Stevens-Lapsley Jennifer E
University of Colorado Anschutz Medical Campus and Eastern Colorado VA Health Care System, Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado.
Rutgers University, Newark, New Jersey.
Arthritis Care Res (Hoboken). 2025 Jun;77(6):732-743. doi: 10.1002/acr.25489. Epub 2025 Jan 25.
Habitual movement compensations, such as decreased surgical peak knee extension moments (pKEM), persist years after total knee arthroplasty (TKA), are linked to poorer recovery, and may influence contralateral osteoarthritis progression. The purpose of this randomized clinical trial was to determine if a movement training program (MOVE) improves movement quality and recovery after TKA compared to a standardized rehabilitation program without movement training (CONTROL).
One hundred thirty-eight individuals were randomized to either MOVE or CONTROL groups after TKA. Participants were assessed preoperatively, 10 weeks after (end of intervention), and six months after (primary endpoint) TKA. Outcomes assessed were pKEM during walking, six-minute walk test, stair climb test, 30-second sit to stand test (30STS), timed up and go test (TUG), physical activity level, strength, range of motion, and self-reported outcomes.
At six months, there were no between-group differences in surgical pKEM during walking (primary outcome). The MOVE group exhibited less contralateral pKEM compared to CONTROL during self-selected gait speed (d = 0.44, P = 0.01). CONTROL performed better on TUG and 30STS at 10 weeks (P < 0.05), but differences attenuated at six months.
The MOVE intervention did not lead to improved surgical pKEM during walking after TKA compared to CONTROL. However, the MOVE group did demonstrate less contralateral pKEM during walking. The CONTROL group demonstrated faster recovery on the TUG and 30STS, but it is unknown if this is due to improved recovery in the surgical knee or increased movement compensation relying on contralateral knee function.
习惯性运动代偿，如手术中膝关节伸展峰值力矩（pKEM）降低，在全膝关节置换术（TKA）后数年仍持续存在，与较差的恢复情况相关，并可能影响对侧骨关节炎的进展。这项随机临床试验的目的是确定与无运动训练的标准化康复计划（对照组）相比，运动训练计划（MOVE）是否能改善TKA后的运动质量和恢复情况。
138名个体在TKA后被随机分为MOVE组或对照组。在术前、术后10周（干预结束时）和术后6个月（主要终点）对参与者进行评估。评估的结果包括步行时的pKEM、6分钟步行试验、爬楼梯试验、30秒坐立试验（30STS）、计时起立行走试验（TUG）、身体活动水平、力量、活动范围和自我报告的结果。
在6个月时，步行时手术pKEM的组间差异无统计学意义（主要结果）。在自我选择的步态速度下，与对照组相比，MOVE组对侧pKEM较低（d = 0.44，P = 0.01）。对照组在10周时的TUG和30STS表现更好（P < 0.05），但在6个月时差异减弱。
与对照组相比，MOVE干预并未导致TKA后步行时手术pKEM的改善。然而，MOVE组在步行时对侧pKEM确实较低。对照组在TUG和30STS上恢复得更快，但尚不清楚这是由于手术膝关节恢复改善还是依赖对侧膝关节功能的运动代偿增加所致。
