Early progressive strength training to enhance recovery after fast-track total knee arthroplasty. A randomized controlled trial

Objective. To compare 7 weeks of supervised physical rehabilitation with or without progressive strength training (PST) commenced early after fast-track total knee arthroplasty (TKA) on functional performance. Methods. Eighty-two patients with a unilateral primary TKA were randomized to 2 different interventions: 7 weeks of supervised physical rehabilitation with (PST-group) and without (CON-group) PST commenced early after fast-track TKA. The primary outcome was the maximal distance walked in 6 minutes (6-minute walk test). Secondary outcomes were lower limb strength and power, knee joint effusion and range of motion, knee pain and self-reported disability and quality of life. All outcome measures were assessed before (baseline) and 4, 8 and 26 weeks after TKA. Results. There was no statistically significant difference between the PST- and CON-group in the change score from baseline to the 8-week postoperative assessment (primary endpoint) for the 6-minute walk test with unadjusted baseline scores (mean difference between groups: -11.3 meters, 95% confidence interval -45.4 to 22.7 meters; analysis of variance (ANOVA), p=0.51). There were no statistically significant or clinically meaningful differences between groups in change scores from baseline to any other time point for all secondary outcomes. The secondary outcome, knee-extension strength did not reach the level recorded before surgery in both groups. Conclusions. Seven weeks of supervised physical rehabilitation with PST was not superior to 7 weeks of supervised physical rehabilitation without PST in improving functional performance, measured as the maximal walking distance in 6 minutes, at the primary endpoint 8 weeks after fast-track TKA. © 2014 American College of Rheumatology.