Electrical Stimulation After Total Knee Arthroplasty
| Status: | Recruiting |
|---|---|
| Conditions: | Arthritis, Osteoarthritis (OA), Orthopedic |
| Therapuetic Areas: | Rheumatology, Orthopedics / Podiatry |
| Healthy: | No |
| Age Range: | 45 - 85 |
| Updated: | 4/2/2016 |
| Start Date: | March 2002 |
| Contact: | Lynn Snyder-Mackler, PT, ScD |
| Email: | smack@udel.edu |
| Phone: | 302-831-3613 |
NMES for Older Individuals After Total Knee Arthroplasty
Total knee arthroplasty (TKA) is performed more than 300,000 times a year in the United
States, most often for osteoarthritis (OA). While pain is predictably reduced, function does
not typically ever reach that of age-matched, uninjured subjects. Quadriceps weakness has
been implicated in the development and progression of knee OA and is a significant problem
after TKA. Voluntary exercise has been ineffective at restoring quadriceps strength after
TKA. The aims of this study are: 1) to assess the effectiveness of high-level neuromuscular
electrical stimulation as an adjunct to ongoing intensive, early rehabilitation in restoring
quadriceps strength and improving the functional outcome after primary TKA, and 2) to
identify the physiological and morphological bases for improvements in quadriceps strength
and functional outcome.
States, most often for osteoarthritis (OA). While pain is predictably reduced, function does
not typically ever reach that of age-matched, uninjured subjects. Quadriceps weakness has
been implicated in the development and progression of knee OA and is a significant problem
after TKA. Voluntary exercise has been ineffective at restoring quadriceps strength after
TKA. The aims of this study are: 1) to assess the effectiveness of high-level neuromuscular
electrical stimulation as an adjunct to ongoing intensive, early rehabilitation in restoring
quadriceps strength and improving the functional outcome after primary TKA, and 2) to
identify the physiological and morphological bases for improvements in quadriceps strength
and functional outcome.
Reduced muscle strength from illness or injuries often leads to loss of function and
independence in the elderly. The recovery of muscle strength and function in disabled
elderly individuals is a major challenge in rehabilitation. The etiology of the muscle
weakness with injury or age is not fully elucidated. Training programs designed to maximize
strength gains in young individuals may not be optimal in the elderly because the cause of
the weakness and the morphology of the muscle may be different for young vs. old people. The
overall goal of this work is to determine if physiologically and morphologically based
rehabilitation programs are more effective than traditional rehabilitation to counter
changes in muscle strength and function in older individuals. Neuromuscular electrical
stimulation (NMES) may be used to improve strength and function following injury or surgery.
This study provides motivation for exploring the use of NMES with the elderly. We posit that
using NMES to augment a traditional rehabilitation program for elderly patients with
osteoarthritis following total knee arthroplasties (TKA) will result in greater strength and
functional gains than using only traditional rehabilitation. Elderly patients with
osteoarthritis who undergo TKAs serve as ideal subjects for testing the effectiveness of
rehabilitation programs become those patients almost always exhibit marked quadriceps
weakness that is resistant to traditional physical rehabilitation. More than 300,000 TKAs
are performed each year in the United States to treat osteoarthritis of the knee in older
individuals. So, the successful rehabilitation of elder patients following TKA is an
important and challenging problem. The specific aims of this proposal are: 1) To assess the
effectiveness of high-level neuromuscular electrical stimulation is an adjunct to ongoing
intensive, early rehabilitation in restoring quadriceps strength and improving the
functional outcome after primary TKA, and 2) To identify the physiological and morphological
bases for improvements in quadriceps strength and functional outcome
A total of 200 subjects will participate in this study. Functional and strength testing
provides information for the patients’ clinical treatment and allow us to monitor their
progress. This information will also help in the design of a training program for
individuals following a total knee replacement that optimizes the return to full level of
function after surgery. MRI screening will provide information regarding the size of the
thigh muscle at various periods throughout rehabilitation. It will enable us to assess the
impact of post-operative treatment on increasing the size of the thigh muscle. Patients will
be asked to participate in functional and strength testing sessions, lasting about 1½ hours,
at the following times: 0-2 weeks before surgery, 3-4 weeks, 6-7 weeks, 10-12 weeks, 6
months, 1 year, and 2 years after surgery. MRI testing will last about 30 minutes per
session and will be performed 0-2 weeks before surgery, and 3-4 weeks, 10-12 weeks, and 1
year after surgery.
Functional testing will include 5 parts: a timed walking test, a timed stair climbing test,
a timed balance test, a timed step test, and a six-minute walk test. A strength test will be
used to assess the strength of the thigh muscles.
The second part of this study involves treatment. Patients participate in 6 weeks of
physical therapy, 3 times per week. They are randomly assigned to one of 2 groups. One group
will participate in a traditional rehabilitation program. The other group will receive
electrical stimulation for strengthening of the thigh muscle in addition to the traditional
rehabilitation program.
independence in the elderly. The recovery of muscle strength and function in disabled
elderly individuals is a major challenge in rehabilitation. The etiology of the muscle
weakness with injury or age is not fully elucidated. Training programs designed to maximize
strength gains in young individuals may not be optimal in the elderly because the cause of
the weakness and the morphology of the muscle may be different for young vs. old people. The
overall goal of this work is to determine if physiologically and morphologically based
rehabilitation programs are more effective than traditional rehabilitation to counter
changes in muscle strength and function in older individuals. Neuromuscular electrical
stimulation (NMES) may be used to improve strength and function following injury or surgery.
This study provides motivation for exploring the use of NMES with the elderly. We posit that
using NMES to augment a traditional rehabilitation program for elderly patients with
osteoarthritis following total knee arthroplasties (TKA) will result in greater strength and
functional gains than using only traditional rehabilitation. Elderly patients with
osteoarthritis who undergo TKAs serve as ideal subjects for testing the effectiveness of
rehabilitation programs become those patients almost always exhibit marked quadriceps
weakness that is resistant to traditional physical rehabilitation. More than 300,000 TKAs
are performed each year in the United States to treat osteoarthritis of the knee in older
individuals. So, the successful rehabilitation of elder patients following TKA is an
important and challenging problem. The specific aims of this proposal are: 1) To assess the
effectiveness of high-level neuromuscular electrical stimulation is an adjunct to ongoing
intensive, early rehabilitation in restoring quadriceps strength and improving the
functional outcome after primary TKA, and 2) To identify the physiological and morphological
bases for improvements in quadriceps strength and functional outcome
A total of 200 subjects will participate in this study. Functional and strength testing
provides information for the patients’ clinical treatment and allow us to monitor their
progress. This information will also help in the design of a training program for
individuals following a total knee replacement that optimizes the return to full level of
function after surgery. MRI screening will provide information regarding the size of the
thigh muscle at various periods throughout rehabilitation. It will enable us to assess the
impact of post-operative treatment on increasing the size of the thigh muscle. Patients will
be asked to participate in functional and strength testing sessions, lasting about 1½ hours,
at the following times: 0-2 weeks before surgery, 3-4 weeks, 6-7 weeks, 10-12 weeks, 6
months, 1 year, and 2 years after surgery. MRI testing will last about 30 minutes per
session and will be performed 0-2 weeks before surgery, and 3-4 weeks, 10-12 weeks, and 1
year after surgery.
Functional testing will include 5 parts: a timed walking test, a timed stair climbing test,
a timed balance test, a timed step test, and a six-minute walk test. A strength test will be
used to assess the strength of the thigh muscles.
The second part of this study involves treatment. Patients participate in 6 weeks of
physical therapy, 3 times per week. They are randomly assigned to one of 2 groups. One group
will participate in a traditional rehabilitation program. The other group will receive
electrical stimulation for strengthening of the thigh muscle in addition to the traditional
rehabilitation program.
Inclusion Criteria:
- TKA for unilateral tricompartmental knee OA
Exclusion Criteria:
- Insulin dependent diabetes
- neurological conditions
- other lower extremity orthopedic problems that affect function
- BMI>40
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