A randomized controlled trial assessing the effects of preoperative strengthening plus balance training on balance and functional outcome up to 1 year following total knee replacement

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 29; no. 3; pp. 838 - 848
• Main Authors: Domínguez-Navarro, Fernando, Silvestre-Muñoz, Antonio, Igual-Camacho, Celedonia, Díaz-Díaz, Beatriz, Torrella, Jose Vicente, Rodrigo, Juan, Payá-Rubio, Alfonso, Roig-Casasús, Sergio, Blasco, Jose María
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2021; John Wiley & Sons, Inc
• Subjects: Aged; Arthroplasty, Replacement, Knee - adverse effects; Arthroplasty, Replacement, Knee - rehabilitation; Biomedical materials; Clinical trials; Exercise Therapy - methods; Female; Humans; Intervention; Joint replacement surgery; Knee; Knee Joint - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteoarthritis; Osteoarthritis, Knee - surgery; Patients; Postural Balance; Preoperative Care - methods; Resistance Training; Strengthening; Surgery; Surgical implants; Training; Treatment Outcome; Preoperative period; Total knee arthroplasty; Muscle strength; Knee osteoarthritis; Postural balance; Exercise therapy
• ISSN: 0942-2056; 1433-7347; 1433-7347
• DOI: 10.1007/s00167-020-06029-x

Purpose To investigate the effects of including balance training in a preoperative strengthening intervention on balance and functional outcomes in patients undergoing total knee replacement (TKR) and compare these effects to those induced by preoperative strengthening and no intervention. Methods Eighty-two subjects scheduled for TKR were randomly allocated into the strengthening (ST, n  = 28) group: a preoperative lower limb strengthening intervention; the strengthening + balance (ST + B, n  = 28) group: same intervention augmented with balance training; and the control group ( n  = 26). The Berg Balance Scale (BBS) and the function in daily living subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-ADL) were the primary outcomes. The secondary measures included balance and mobility, self-reported status, and knee function. The outcomes were assessed at baseline, 1 week before surgery, and 2, (primary endpoint), 6 and 52 weeks after surgery. Results Compared with the controls, the participants in the ST and ST + B groups presented significant improvements from baseline to the end of the preoperative intervention in BBS ( p  = 0.005) and KOOS-ADL ( p  < 0.001). At 6 weeks post-surgery, the knee extensor strength values were similar in the two treatment groups and significantly higher than that in the controls. Overall, the participant outcomes in all groups stabilized at 1 year after surgery. Conclusion A preoperative strengthening intervention, regardless of whether it is complemented with balance training, enhances strength but not balance or functional outcomes at 6 weeks after surgery. Patients are expected to present similar performance at 1 year postoperatively, but adequately statistically powered trials are needed to confirm the findings. Level of evidence II. Trial registration NCT02995668.