Early Whole-Body Vibration vs Progressive Resistance Training in Fast-Track Total Knee Arthroplasty: A Randomized Comparative Trial

Abstract

Aim: Whole-body vibration (WBV) and progressive resistance training (PRT) are utilized for rehabilitation in end-stage knee osteoarthritis in total knee arthroplasty (TKA). This randomized study compared the six-week progressive WBV and PRT interventions early after fast-track TKA on primary and secondary outcomes. Material and Method: This randomized comparative trial was conducted between 2021-2022 and consisted of two groups: WBV (n=17) and PRT (n=17). All patients underwent a structured fast-track rehabilitation protocol before and after the surgery. After four weeks post-TKA, the groups initiated two sessions per week of WBV or PRT exercises for six weeks. After each training session, both groups performed neuromuscular balance training. Assessments were conducted at baseline (4th week) and postoperative 10th week. The primary outcomes included neuromuscular balance and quadriceps strength, while secondary outcomes encompassed knee pain and function, physical performance, and quality of life. Results: Two-way mixed-design repeated-measures analysis of variance (ANOVA) test demonstrated similar improvements in primary (F=0.614-2.291, p=0.093-0.439) and secondary outcomes (F=0.009-2.285, p=0.140-0.925) with no significant difference in group×time interaction between groups. When the changes within the groups (time×main effect) were analyzed, significant improvements were found in both groups in primary (F=43.581-89.627, p<0.001) and secondary outcomes (F=36.082-292.834, p<0.001) in both groups. Conclusion: Early six-week progressive WBV or PRT was identically effective in promoting neuromuscular balance, quadriceps strength, knee pain and function, physical performance, and quality of life in fast-track TKA patients. Early postoperative adoption of progressive WBV or PRT interventions is considered feasible for promoting early rehabilitation after fast-track TKA.

Keywords

• knee osteoarthritis
• total knee arthroplasty
• physical therapy
• exercise
• quality of life

References

1. 1. Hsiao YH, Chien SH, Tu HP, Fu JC, Tsai ST, Chen YS, et al. Early post-operative intervention of whole-body vibration in patients after total knee arthroplasty: a pilot study. J Clin Med. 2019;8(11):1902. https://doi.org/10.3390/jcm8111902
2. 2. Bilge A, Ulusoy RG, Üstebay S, Öztürk Ö. Osteoarthritis. Kafkas J Med Sci. 2018;8(1):133–142. https://doi.org/10.5505/kjms.2016.82653
3. 3. Eroğlu PK, Garip Y, Altun ŞC. Preoperative and postoperative factors affecting patient satisfaction after total knee arthroplasty. Kafkas J Med Sci. 2017;7(2):139–143. https://doi.org/10.5505/kjms.2017.68726
4. 4. Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice?. Can Urol Assoc J. 2011;5(5):342–348. https://doi.org/10.5489/cuaj.693
5. 5. Morrell AT, Layon DR, Scott MJ, Kates SL, Golladay GJ, Patel NK. Enhanced recovery after primary total hip and knee arthroplasty: a systematic review. J Bone Joint Surg Am. 2021;103(20):1938–1947. https://doi.org/10.2106/JBJS.20.02169
6. 6. Johnson AW, Myrer JW, Hunter I, Feland JB, Hopkins JT, Draper DO, et al. Whole-body vibration strengthening compared to traditional strengthening during physical therapy in individuals with total knee arthroplasty. Physiother Theory Pract. 2010;26(4):215–225. https://doi.org/10.3109/09593980902967196.
7. 7. Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther. 2010;40(9):559–567. https://doi.org/10.2519/jospt.2010.3317
8. 8. Jakobsen TL, Kehlet H, Husted H, Petersen J, Bandholm T. Early progressive strength training to enhance recovery after fast-track total knee arthroplasty: a randomized controlled trial. Arthritis Care Res (Hoboken). 2014;66(12):1856–1866. https://doi.org/10.1002/acr.22405

9. 9. Liu H, Cong H, Chen L, Wu H, Yang X, Cao Y. Efficacy and safety of lower limb progressive resistance exercise for patients with total knee arthroplasty: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2021;102(3):488–501. https://doi.org/10.1016/j.apmr.2020.05.021
10. 10. Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?. Disabil Rehabil. 2012;34(12):1034–1040. https://doi.org/10.3109/09638288.2011.629019
11. 11. Husby VS, Foss OA, Husby OS, Winther SB. Randomized controlled trial of maximal strength training vs. standard rehabilitation following total knee arthroplasty. Eur J Phys Rehabil Med. 2018;54(3):371–379. https://doi.org/10.23736/S1973-9087.17.04712-8
12. 12. Wang P, Yang L, Liu C, Wei X, Yang X, Zhou Y, et al. Effects of whole body vibration exercise associated with quadriceps resistance exercise on functioning and quality of life in patients with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2016;30(11):1074–1087. https://doi.org/10.1177/0269215515607970
13. 13. Liao CD, Lin LF, Huang YC, Huang SW, Chou LC, Liou TH. Functional outcomes of outpatient balance training following total knee replacement in patients with knee osteoarthritis: a randomized controlled trial. Clin Rehabil. 2015;29(9):855–867. https://doi.org/10.1177/0269215514564086
14. 14. Chen X, Li X, Zhu Z, Wang H, Yu Z, Bai X. Effects of progressive resistance training for early postoperative fast-track total hip or knee arthroplasty: a systematic review and meta-analysis. Asian J Surg. 2021;44(10):1245–1253. https://doi.org/10.1016/j.asjsur.2021.02.007
15. 15. Karatekin BD, Yasin S, Yumusakhuylu Y, Bayram F, Icagasioglu A. Validity of the Korebalance® balance system in patients with postmenopausal osteoporosis. Medeniyet Med J. 2020;35(2):79–84.
16. 16. Kittelson AJ, Christensen JC, Loyd BJ, Burrows KL, Iannitto J, Stevens-Lapsley JE. Reliability, responsiveness, and validity of handheld dynamometry for assessing quadriceps strength in total knee arthroplasty. Disabil Rehabil. 2021;43(21):3070–3077. https://doi.org/10.1080/09638288.2020.1730454
17. 17. Tolk JJ, Janssen RPA, Prinsen CAC, Latijnhouwers DAJM, van der Steen MC, Bierma-Zeinstra SMA, et al. The OARSI core set of performance-based measures for knee osteoarthritis is reliable but not valid and responsive. Knee Surg Sports Traumatol Arthrosc. 2019;127(9):2898–2909. https://doi.org/10.1007/s00167-017-4789-y
18. 18. Clement ND, Weir D, Deehan D. Meaningful values in the short form health survey-36 after total knee arthroplasty -an alternative to the EuroQol five-dimension index as a measure for health-related quality of life: minimal clinically important difference, minimal important change, patient-acceptable symptom state thresholds, and responsiveness. Bone Joint Res. 2022;11(7):477–483. https://doi.org/10.1302/2046-3758.117.BJR-2021-0493.R1
19. 19. Zech A, Hendrich S, Pfeifer K. Association between exercise therapy dose and functional improvements in the early postoperative phase after hip and knee arthroplasty: an observational study. PMR. 2015;7(10):1064–1072. https://doi.org/10.1016/j.pmrj.2015.04.008
20. 20. Simão AP, Avelar NC, Tossige-Gomes R, Neves CD, Mendonça VA, Miranda AS, et al. Functional performance and inflammatory cytokines after squat exercises and whole-body vibration in elderly individuals with knee osteoarthritis. Arch Phys Med Rehabil. 2012;93(10):1692–1700. https://doi.org/10.1016/j.apmr.2012.04.017
21. 21. Castorina S, Guglielmino C, Castrogiovanni P, Szychlinska MA, Ioppolo F, Massimino P, et al. Clinical evidence of traditional vs fast track recovery methodologies after total arthroplasty for osteoarthritic knee treatment. A retrospective observational study. Muscles Ligaments Tendons J. 2018;7(3):504–513. https://doi.org/10.32098/mltj.03.2017.14
22. 22. Bily W, Franz C, Trimmel L, Loefler S, Cvecka J, Zampieri S, et al. Effects of leg-press training with moderate vibration on muscle strength, pain, and function after total knee arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil. 2016;97(6):857–865. https://doi.org/10.1016/j.apmr.2015.12.015
23. 23. Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005;87(5):1047–1053. https://doi.org/10.2106/00004623-200505000-00016
24. 24. Ko MC, Wu LS, Lee S, Wang CC, Lee PF, Tseng CY, et al. Whole-body vibration training improves balance control and sit-to-stand performance among middle-aged and older adults: a pilot randomized controlled trial. Eur Rev Aging Phys Act. 2017;14(1):11. https://doi.org/10.1186/s11556-017-0180-8
25. 25. Liao CD, Tsauo JY, Chiu YS, Ku JW, Huang SW, Liou TH. Effects of elastic resistance exercise after total knee replacement on muscle mass and physical function in elderly women with osteoarthritis: a randomized controlled trial. Am J Phys Med Rehabil. 2020;99(5):381–389. https://doi.org/10.1097/PHM.0000000000001344
26. 26. Molla RY, Sadeghi H, Kahlaee AH. The effect of early progressive resistive exercise therapy on balance control of patients with total knee arthroplasty: a randomized controlled trial. Top Geriatr Rehabil. 2017;33(4):286–294. https://doi.org/10.1097/TGR.0000000000000165
27. 27. Larsen K, Hansen TB, Søballe K, Kehlet H. Patient-reported outcome after fast-track knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2012;20(6):1128–1135. https://doi.org/10.1007/s00167-012-1919-4
28. 28. Winther SB, Foss OA, Wik TS, Davis SP, Engdal M, Jessen V, et al. 1-year follow-up of 920 hip and knee arthroplasty patients after implementing fast-track. Acta Orthop. 2015;86(1):78–85. https://doi.org/10.3109/17453674.2014.957089