The effects of exercise and active assisted cycle ergometry in post-operative total knee arthroplasty patients - a randomized controlled trial

P Sanzo,K Droll,S Niccoli,D Puskas,S J Lees,C Cullinan

doi:10.1186/s40634-021-00363-w

Abstract

PurposeThe purpose of this study was to examine the effect of the use of an active assisted cycle ergometer as an adjunct to post-operative treatment following total knee arthroplasty.MethodA total of 55 participants aged 50–80 years who had undergone unilateral total knee arthroplasty were randomly assigned to either the control group (standard of care) or the active assisted cycle ergometer (AACE) group. The effect on patient motivation, blood biomarkers, and knee pain, function, range of motion (ROM), strength, and swelling was examined. Qualitative feedback was also obtained post-operatively.ResultsAlthough there was no statistically significant difference in the standard of care compared to the AACE group, there was a trend for a greater reduction in knee pain on the visual analog scale, improved Lower Extremity Functional Scale scores, and knee extension ROM and strength. A greater percentage of the experimental group demonstrated higher motivation. There was no significant difference in swelling or blood biomarker measures. Qualitative feedback from the AACE group post-operatively was also positive.ConclusionsThe use of an AACE protocol as an adjunct to total knee arthroplasty rehabilitation may improve post-operative clinical outcomes. This study has been registered at clinicaltrials.gov (identifier NCT02265523, Oct 16 2014). Level of evidence: Level 1 – randomized controlled trial. Further research with a larger sample size is needed to confirm the benefits of the ergometer use.

Highlights

The combination of an increasing aging population, higher rates of osteoarthritis (OA), and higher rates of obesity have resulted in an increased incidence of total knee arthroplasty (TKA) [1,2,3,4,5,6,7]
Results: there was no statistically significant difference in the standard of care compared to the active assisted cycle ergometer (AACE) group, there was a trend for a greater reduction in knee pain on the visual analog scale, improved Lower Extremity Functional Scale scores, and knee extension range of motion (ROM) and strength
There was no significant difference in follow up times between groups (P = .14; 95% Confidence interval (CI) [− 2.5, 16.9])

Summary

Introduction

The combination of an increasing aging population, higher rates of osteoarthritis (OA), and higher rates of obesity have resulted in an increased incidence of total knee arthroplasty (TKA) [1,2,3,4,5,6,7]. Joint replacement surgery has been reported to be the most effective treatment for severe OA in reducing pain and disability [8, 9]. One must consider the possibility of negative effects and adverse events. Knee flexion contractures have been reported to be a risk factor for the development of a thromboembolic negative event and as a result, improved knee ROM must be maximized to reduce this possible adverse event [10]. Surgery is often combined with post-operative rehabilitation and treatment often includes education, active and passive exercises, and therapeutic modalities to maximize recovery and reduce post-operative complications [10, 11]. It is proposed that exercise reduces pain and improves function. The optimal exercise program has not been determined, it continues to be an

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