Arthroplasty, Gonarthrosis
Conditions
Brief summary
Preoperative rehabilitation before total knee arthroplasty (TKA) has not been proven to be effective. Latest meta-analyzes do not find any improvement of motor performance during gait 6 months after surgery. However, most of the previous studies did not specifically target muscle atrophy to design rehabilitation protocol. Pre-operative muscle atrophy, although not systematic, is often observed. The preoperative muscles volumes of thigh muscles have been poorly identified and never used to adjust the pre operative rehabilitation strategy. As part of the FOLLOWKNEE (RHU) project, which attempts to implement a personalized management of TKA and its follow-up, this study wants to explore the potential effect of adapted treatment to improve muscle force and muscle volume before TKA.
Interventions
OTHERPersonalized rehabilitation program with electrostimulation
Patient with knee arthroplasty indication. After clinical assessment and a MRI measurement of muscle volume, patients start a 2 hours daily rehabilitation including 2 times 20 minutes of electrostimulation of atrophied muscles, 3 days per week during 4 weeks.
OTHERGlobal rehabilitation program
Patient with knee arthroplasty indication. After clinical assessment and a MRI measurement of muscle volume, patient start a 2 hours daily rehabilitation targeting muscles groups with strengthening and stretching exercises, 3 days per week during 4 weeks.
Sponsors
University Hospital, Brest
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Terminal stage gonarthrosis with total knee arthroplasty (TKA) indication * TKA indicated by the surgeon * Body Mass Index \< 35 * Acceptance to realize a preoperative rehabilitation in outpatient setting * Adult between 18 and 80 years old * Patient affiliated to social security * Patient who signed an informed consent
Exclusion criteria
* Functionally uncomfortable osteoarticular illness (disabling pain, functional limitation of joint amplitudes or muscle strength) of controlateral leg. * Unable or refusal to consent * Contraindication to electrostimulation (skin lesion, nearby implanted metallic material, implanted cardiac or neurologic electrostimulator, intolerance to muscle electrical stimulation) * Unstable medical situation preventing the continuous realization of a program of at least 4 weeks
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference of isometric strength D0-W4p | Day 0 to Week 4 postoperative | Isometric strength of quadriceps (QS) and hamstring (HS) will be measured on isokinetic bench and the difference between D0 and W4 will be calculated as follows : (QSW4p-QSD0)+(HSW4p-HSD0). Personalized rehabilitation will first be compared to classic rehabilitation and if positive to global rehabilitation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Difference of isometric strength D0-W12p | Day 0 to Week 12 postoperative | Isometric strength of quadriceps (QS) and hamstring (HS) will be measured on isokinetic bench and the difference between D0 and W12postoperative (W12p) will be calculated. |
| Muscles volumes | Day 0, Week 4, Week 2 postoperative | Quadriceps and hamstring volume as well as all muscles volume of each muscles groups will be evaluated in MRI. |
| Walking speed on 10 meters | Day 0, Week 4, Week 4 postoperative, Week 12 postoperative | The patient will be timed when walking 10meters on a graduated corridor. They will be allowed to stop or use a technical help. |
| Difference of isometric strength D0-W4 | Day 0 to Week 4 | Isometric strength of quadriceps (QS) and hamstring (HS) will be measured on isokinetic bench and the difference between D0 and W4 (W4) will be calculated. |
| Western Ontario McMaster Osteoarthritis Index (WOMAC) | Day 0, Week 4, Week 4 postoperative, Week 12 postoperative | WOMAC is a medical scale for hip and osteoarthritic knee consisting of 24 questions scored between 0 and 4. The questions are about pain, joint stiffness and function. |
| Pain in Analogic Visual Scale (AVS) | Day 0, Week 4, Week 4 postoperative, Week 12 postoperative | The pain during the 5 last days will be evaluated by Analogic Visual Scale. Pain is evaluated on a scale between 0 and 10. 0 is no pain and 10 the worse pain. |
| Time up and go test (TUG) | Day 0, Week 4, Week 4 postoperative, Week 12 postoperative | The patient must get up from the sitting position and walk three meters from the chair and then retrace his steps (turn 180 degrees) and sit down again. The time that the person puts to this activity is timed by the evaluator. |
Countries
France
Outcome results
None listed