Abstract
The aim of the study was to evaluate the efficacy of the use of the neuromuscular electrical stimulation after total knee arthroplasty. The study used a systematic review of randomized controlled trials (MEDLINE, PubMed, Cochrane Library, and PEDro) using Patient Population or Problem, Intervention, Comparison, Outcomes, Setting approach to formulate the research question, controlled terms, and Boolean operators. Inclusion and exclusion criteria were defined in advance. "Neuromuscular electrical stimulation" and "total knee arthroplasty" were used as keywords. The overall risk of bias was determined according to the following: random sequence generation, concealment, blinding mass of participants and staff, commissioning blind assessment results, incomplete data, and loans received. Of the 36 identified studies, six were included in the review (496 participants). In these studies, one group of patients followed a rehabilitation protocol (control group) and the other followed a rehabilitation program plus a session of neuromuscular electrical stimulation (neuromuscular electrical stimulation group). Patients of neuromuscular electrical stimulation groups got the best scores (timed up and go test, stair climbing test, and walk test). Neuromuscular electrical stimulation benefits were strong in the first postoperative weeks/months and gradually diminished. Neuromuscular electrical stimulation allows a slightly better functional recovery after total knee arthroplasty, especially in the first period, with more evident benefits in patients with a severe lack of muscular activation. Nevertheless, there is no difference at medium-long term.
Highlights
Total knee arthroplasty (TKA) is effective for relieving pain and improving function in patients with end stage arthritis of the knee [1,2,3,4,5]
The size of the studies included ranged from 30 to 200 participants involving a total of 496 patients
In most of the trials included in the meta-analysis, patient selection was controlled with particular attention to the criteria listed above, including only relatively healthy subjects who had knee replacement surgery for unilateral arthritis of the knee
Summary
Total knee arthroplasty (TKA) is effective for relieving pain and improving function in patients with end stage arthritis of the knee [1,2,3,4,5]. Weakness in particular, which is often already present before surgery, still remains after surgery for long time, differences have been shown between subjects after TKA surgery and healthy adults of the same age [9]. These functional deficits may have major consequences for the patients from a clinical standpoint: reduced walking speed and balance, difficulties with stairs and increased risk of falls [10]. Neuromuscular electrical stimulation (NMES) has been proposed as an adjunct to traditional rehabilitation programs for patients after TKA, especially for those with deficit of the voluntary activation of the muscle and postoperative weakness [11,12]. The inputs generated by NMES may facilitate plastic changes in the networks of the senso-motor neurons at the level of the central nervous system, leading to a strengthening of the signals and pathways dedicated to the muscle control and strength [15, 16]
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