Effects of Kneehab 12-week Peri-operative Total Knee Arthroplasty
Effects of Kneehab 12-week Peri-operative Total Knee Arthroplasty
Determine the efficacy of neuromuscular electrical stimulation (NMES, Kneehab) in promoting
 accelerated recovery of quadriceps function in patients recovering from total knee
 arthroplasty (TKA) as measured by increases in isometric strength of the knee extensors and
 scores in the Timed Up and Go (TUG) test.
Knee osteoarthritis is a severe debilitating condition that greatly impacts patient quality
 of life, function, emotional well-being and everyday pain levels. Total knee arthroplasty
 (TKA) is performed as a means of alleviating these symptoms in the long term however short
 term muscle weakness following surgery can elicit its own detrimental effect on performance
 and activities of daily living. This underlines the importance of mitigating strength loss in
 the immediate post-operative period.

 Recent reviews suggest that Neuromuscular Electrical Stimulation (NMES) of the quadriceps
 femoris muscle can be beneficial in the rehabilitation period following knee surgery. It
 appears that early use of NMES can help to recover exercise capacity in the muscle, thus
 allowing the patient to benefit more from volitional exercise therapy later in the
 rehabilitation period1. This in turn can lead to accelerated recovery and improved outcomes.
 A recent and as yet unpublished study of 96 patients following ACL reconstruction has
 demonstrated a clear benefit to the use of Kneehab. The benefit seemed to accrue in the
 six-week post-operative period.

 A recent pilot study by Walls 2 also suggests that NMES applied in the immediate
 pre-operative period before TKA leads to increased muscle strength and improved functional
 abilities. Previously, Mizner (2005) has shown pre operative strength to be a good predictor
 of functional outcome 1 year after surgery3. This proposed study aims to examine whether NMES
 applied in the peri-operative timeframe, 6 weeks before and 6 weeks after, can improve
 outcomes for patients undergoing total knee replacement. The rationale for this approach is
 that NMES can help prepare the quadriceps muscle for the rehabilitation phase by building
 exercise capacity before the operation. The immediate deficit, which normally follows knee
 surgery, would therefore be compensated to some extent and the post-operative NMES treatment
 would be expected to counteract the activation inhibition that is thought to occur in the
 early weeks following surgery. Overall, the patient would be in a better position to benefit
 from conventional rehabilitation exercises aimed at improved co-ordination and functional
 performance.
Inclusion Criteria:

 -  Individuals who are scheduled for elective Total Knee Replacement surgery

 -  Individuals who are at least 18 years of age

 -  Individuals with a body mass index (BMI) <40

 -  Individuals who are walking independently with or without assistive devices

 -  Must be able and willing to complete all study assessments and to be followed for the
 full course of the study.

 -  Must be able to read, write and follow instructions in English.

 -  Must be able and willing to provide informed consent.

 -  Must be willing and able to attend for pre-op assessment

 Exclusion Criteria:

 -  Individuals who have failed the pre-operative assessment

 -  Individuals with a history of foot and/or ankle pathology

 -  Individuals with a history of tibial or femoral fractures

 -  Individuals with a history of underlying neurological conditions

 -  Individuals with physical conditions which would make them unable to perform study
 procedures

 -  Individuals with a total hip replacement

 -  Individuals undergoing revision TKA of the same operated leg

 -  Pregnant women or inadequate precautions to prevent pregnancy

 -  Diagnosis of a medical condition that would contraindicate treatment with the
 product,e.g skin lesions at electrode site.

 -  Individuals with an active implanted medical device (i.e. pacemaker, pump)

 -  Individuals with a history of stroke

 -  Individuals with a history of neurological disorder that affects lower extremity
 function (stroke, peripheral neuropathy, Parkinson's disease, multiple sclerosis,
 etc.)

 -  Individuals with a diagnosis of inflammatory arthritis (including Rheumatoid
 Arthritis, gout or psoriatic arthritis)

 -  Individuals with muscle disease (i.e. muscular dystrophy)

 -  Visible skin injury or disease on their legs

 -  Principal investigator for this study, or member of study staff