Early High-Intensity Versus Low-Intensity Rehabilitation After Total Knee Arthroplasty: A Randomized Controlled Trial.
To examine the safety and efficacy of a high-intensity (HI) progressive rehabilitation protocol beginning 4 days after total knee arthroplasty (TKA) compared to a low-intensity (LI) rehabilitation protocol.



A total of 162 participants (mean ± SD ages 63 ± 7 years; 89 women) were randomized to either the HI group or LI group after TKA. Key components of the HI intervention were the use of progressive resistance exercises and a rapid progression to weight-bearing exercises and activities. Both groups were treated in an outpatient setting 2 to 3 times per week for 11 weeks (26 total sessions). Outcomes included the stair climbing test (SCT; primary outcome), timed-up-and-go (TUG) test, 6-minute walk (6MW) test, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 12-item Short Form health survey (SF-12), knee range of motion (ROM), quadriceps and hamstring strength, and quadriceps activation. Outcomes were assessed preoperatively and at 1, 2, 3 (primary end point), 6, and 12 months postoperatively.



There were no significant differences between groups at 3 or 12 months in SCT, TUG, 6MW, WOMAC scores, knee ROM, quadriceps and hamstrings strength, quadriceps activation, or adverse event rates. By 12 months, outcomes on the 6MW, TUG, WOMAC, SF-12, quadriceps and hamstring strength, and quadriceps activation had improved beyond baseline performance in both groups.



Both the HI and LI interventions were effective in improving strength and function after TKA. HI progressive rehabilitation is safe for individuals after TKA. However, its effectiveness may be limited by arthrogenic muscular inhibition in the early postoperative period.
University of Colorado Anschutz Medical Campus, Aurora.
Michael J
MJ
Bade
University of Colorado Anschutz Medical Campus, Aurora.
Tamara
T
Struessel
University of Colorado Anschutz Medical Campus, Aurora.
Michael
M
Dayton
The Steadman Clinic and The Steadman Philippon Research Institute, Vail, Colorado.
Jared
J
Foran
The Steadman Clinic and The Steadman Philippon Research Institute, Vail, Colorado.
Raymond H
RH
Kim
Colorado Joint Replacement, Denver, Colorado.
Todd
T
Miner
University of Colorado Anschutz Medical Campus, Aurora.
Pamela
P
Wolfe
University of Colorado Anschutz Medical Campus, Aurora, and Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado.
Wendy M
WM
Kohrt
Colorado Joint Replacement, Denver, Colorado.
Douglas
D
Dennis
University of Colorado Anschutz Medical Campus, Aurora, and Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado.
Jennifer E
JE
Stevens-Lapsley
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005080:Exercise Test / Q000379:methods; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D000070633:Hamstring Muscles / Q000503:physiopathology; D000072696:High-Intensity Interval Training / Q000379:methods*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000601:surgery*; D052097:Quadriceps Muscle / Q000503:physiopathology; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D016474:Weight-Bearing