Abstract
BackgroundPatients with knee osteoarthritis (OA) report knee pain, limitation in physical activities and low quality of life. The two primary treatments for knee OA are non-surgical treatment (e.g., exercise) and surgery (total knee arthroplasty (TKA)); however, national guidelines recommend non-surgical treatment to be tried prior to surgical procedures. Patients with knee OA are characterized by decreased muscle strength, particularly in the knee-extensor muscles. Correspondingly, decreased knee-extensor strength is found to be associated with an increased risk of development, progression and severity of knee OA symptoms. Recent trials suggest a positive effect of pre-operative exercise on pre- and post-operative outcome; however, the most effective pre-operative knee-extensor strength exercise dosage is not known. The purpose of the present trial is to investigate the efficacy of three different exercise dosages of pre-operative, home-based, knee-extensor strength exercise on knee-extensor strength before and shortly after surgery in patients eligible for TKA due to end-stage knee OA.MethodsIn this randomized dose-response trial with a three-arm parallel design, 140 patients with end-stage knee OA (candidates for TKA) are randomized to one of three exercise dosages (two, four or six session/week) of knee-extensor strength exercise (three sets, 12 repetitions at 12 RM, per exercise session) for 12 weeks. The knee-extensor strength exercise is home-based (unsupervised) and performed with an elastic exercise band following an initial exercise instruction. Adherence is objectively quantified using a sensor attached to the exercise band. The primary outcome will be the change in knee-extensor strength. Following the 12-week exercise period, the need for TKA surgery is re-assessed by an orthopedic surgeon.DiscussionDecreased knee-extensor strength is a major challenge in patients with knee OA. Exercise programs focusing on knee-extensor strength are found to be more effective in relieving knee OA pain and symptoms compared to more general exercise programs. However, the optimal exercise dosage for knee-extensor strength deficits in patients with knee OA is inconclusive. Knowledge on the dose-response relationship for knee-extensor strength exercise in patients with knee OA will help guide future non-surgical treatment in this patient population.Trial registrationClinicalTrials.gov, ID: NCT02931058. Pre-registered on 10 October 2016.
Highlights
Patients with knee osteoarthritis (OA) report knee pain, limitation in physical activities and low quality of life
Patients diagnosed with knee osteoarthritis (OA) report pain, low quality of life and limitation in physical activities [1]
It showed an added effect of 30% by total knee arthroplasty (TKA) and nonsurgical treatment to that achieved by non-surgical treatment alone (30%). This highlights the importance of coordinating non-surgical and surgical care to select the right candidates for surgery, especially as patients undergoing TKA seem to experience more serious adverse events compared to non-surgical treatment [6]. These results suggest that non-surgical treatment should at least be tried out and considered before commencing surgical procedures
Summary
Literature search and search matrix Before commencing the planning of this trial, a systematic literature search was conducted to locate trials investigating the same research question or planning to do so (protocols). At the orthopedic outpatient clinic, possible patients for TKA surgery due to end-stage knee OA are introduced to the trial and offered to participate by the orthopedic surgeon if they fit the initial eligibility criteria (please see below). Eligible patients are informed that participation in the project includes 12 weeks of home-based, kneeextensor strength exercise with the purpose of improving knee-extensor strength, relieving knee pain and improving functional performance. They are informed that after the exercise period, they will be re-assessed at the orthopedic outpatient clinic with regards to undergo surgery or not. Society of Anesthesiologists’ physical status classification score (ASA) ≥ 4) Patient with terminal illness Patient has severe bone deformity demanding use of non-standard implants Weekly alcohol consumption above national recommendations (>7 units for women, > 14 units for men)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
