Movement Pattern Biofeedback Training After Total Knee Arthroplasty

Currently in the United States, more than 700,000 total knee arthroplasty (TKA) surgeries are
performed annually, with projections of 3.5 million performed annually by 2030. The
increasing incidence of TKA comes with an immediate need for establishing optimal
rehabilitation guidelines to remediate common post-TKA physical impairments and improve
functional outcomes. Over the past decade, a primary focus of the investigators' TKA
rehabilitation research has been on progressive strengthening, which improves muscle strength
and physical function, and is now the contemporary approach to TKA rehabilitation. However, a
major issue remaining for patients rehabilitating from unilateral TKA is the persistence of
atypical movement patterns. These atypical movement patterns, observed during walking and
other functional tasks, are characterized by disuse of the surgical limb, resulting in
smaller knee extension moments on the surgical limb compared to the non-surgical limb. As a
result, atypical movement patterns following unilateral TKA are associated with persistent
quadriceps weakness and poor physical function.

The investigators will conduct a randomized controlled trial of 150 participants undergoing
unilateral TKA to determine if the addition of a novel movement pattern training program
(MOVE) to contemporary, progressive rehabilitation improves movement pattern quality more
than contemporary progressive rehabilitation alone (CONTROL). The secondary goal is to
determine if movement pattern training improves long-term physical function. Testing will
occur pre-operatively and after TKA at 10 weeks (end of intervention), 6 months (primary
endpoint), and 24 months.

Inclusion Criteria:

1. 50-85 years old

2. primary, unilateral knee arthroplasty for end-stage osteoarthritis

Exclusion Criteria:

1. Moderate to severe contralateral knee OA (<4/10 on verbal pain rating (VPR) or KL
grade >3)

2. Current smoker

3. Drug abuse

4. Comorbid conditions that substantially limit physical function or would interfere with
the participant's ability to successfully complete rehabilitation (e.g. neurologic,
vascular, cardiac problems, or ongoing medical treatments)

5. Discharge to location other than home after surgery

6. Unstable orthopedic conditions that limit function

7. Uncontrolled diabetes (hemoglobin A1c level >8.0)

8. Body mass index >40 kg/m2

9. Surgical complication necessitating an altered course of rehabilitation

10. Previous contralateral TKA

11. Unable to safely walk 30m without an assistive device

Exclusion criteria for MRI

1. Ferromagnetic metal implants or pacemakers

2. Other contraindications to MRI