title: Effects of supplementation with a combination of β-hydroxy-β-methyl butyrate, L-arginine, and L-glutamine on postoperative recovery of quadriceps muscle strength after total knee arthroplasty.
abstract: OBJECTIVE
  Total knee arthroplasty (TKA) performed in knee osteoarthritis patients is reported to be immediately followed by a decrease in quadriceps muscle strength. We investigated the effects of supplementation with a combination β-hydroxy-β-methyl butyrate, L-arginine, and L-glutamine (HMB/Arg/Gln) on the postoperative recovery of quadriceps muscle strength in patients after TKA.
  
  
  METHODS
  Study subjects were 23 patients (12 women; mean age: 70.5) who underwent TKA. The patients were randomly allocated into the control group or the group that consumed HMB/Arg/Gln supplementation (HMB/Arg/Gln group). HMB/Arg/Gln supplementation or control food were consumed for 5 days before the surgery and for 28 days after the surgery, and maximal quadriceps strength was measured at 7 days before the surgery, and at 14, 28 and 42 days after the surgery. During the study, total energy expenditure was measured using a lifestyle recording device. The two groups followed the rehabilitation in the same way.
  
  
  RESULTS
  The maximal quadriceps strength was 1.1±0.62 Nm/Kg before surgery and 0.7±0.9 Nm/Kg after surgery 14 days in the control group (p=0.02), and 1.1±0.3 Nm/Kg before surgery and 0.9±0.4 Nm/Kg after surgery 14 days in the HMB/Arg/Gln group. Although the control group experienced a significant loss of muscle strength after the surgery, the HMB/Arg/Gln group did not. There was no significant difference in total energy expenditure between the two groups.
  
  
  CONCLUSIONS
  Consuming HMB/Arg/Gln supplementation may suppress the loss of muscle strength after TKA. Intervention with exercise and nutrition appears to enable patients to maintain their quadriceps strength.
authors.affiliation: Department of Rehabilitation, Kugawa Hospital for Orthopaedic Surgery, Yamanashi, Japan.
authors.forename: Kanae
authors.initials: K
authors.lastname: Nishizaki
authors.affiliation: Department of Orthopaedic Surgery, Kugawa Hospital for Orthopaedic Surgery, Yamanashi, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ikegami
authors.affiliation: Department of Anesthesiology, Kugawa Hospital for Orthopaedic Surgery, Yamanashi, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Imai
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan. Email: hmatsu-tki@umin.ac.jp.
authors.forename: Hajime
authors.initials: H
authors.lastname: Matsumura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000494:pharmacology*; D019645:Arthroplasty, Replacement, Knee; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D005260:Female; D005973:Glutamine / Q000494:pharmacology*; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000187:drug effects*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods; D052097:Quadriceps Muscle / Q000187:drug effects*; D016896:Treatment Outcome; D014631:Valerates / Q000494:pharmacology*
chemical_list: D014631:Valerates; D005973:Glutamine; C004961:beta-hydroxyisovaleric acid; D001120:Arginine