Pre-TKR isokinetic quadriceps strengthening has a positive effect which may diminish following the intervention despite pain and functional improvements: A case study

Article type: Research Article

Authors: Reynaud, Vivien^{a; d; *} | Dobija, Lech^{a; d} | Fournier, Pierre-Louis^b | Lanhers, Charlotte^c | Coudeyre, Emmanuel^{a; d}

Affiliations: [a] Service de Médecine Physique et de Réadaptation, CHU Clermont-Ferrand, France | [b] Pôle santé république, Clermont-Ferrand, France | [c] Centre de Médecine Physique et de Réadaptation Notre Dame, Chamalières, France | [d] Université Clermont Auvergne, INRA, UNH, Clermont-Ferrand, France

Correspondence: [*] Corresponding author: Vivien Reynaud, Service de Médecine Physique et Réadapatation, CHU Clermont Ferrand, Hôpital Gabriel Montpied, 58 rue Montalembert, 63003 Clermont Ferrand cedex 1, France. Tel.: +33 73 75 41 47; Fax: +33 73 75 09 01; E-mail: [email protected].

Abstract: We report a longitudinal survey of a 53-year-old man suffering from right knee osteoarthritis who has undergone total knee replacement (TKR). We aimed at evaluating the effect of a short preoperative isokinetic strengthening program on the functional status, pain, and quadriceps and hamstrings strength before and after TKR. The patient performed a 4-week (6 sessions) preoperative isokinetic strengthening program of the quadriceps and hamstrings. The findings for the concentric strength at 60∘/s, 6-minute walk test (6MWT), and Knee injury and Osteoarthritis Outcome Score (KOOS) were recorded. At baseline the patient presented with an overall KOOS score of 44%, a 6MWT of 444 m, a 63% and 21% strength deficits of the quadriceps and hamstrings, respectively. Following the strengthening program, the quadriceps strength of the operated limb improved (+121 Nm; +83%), but the function as reflected by the KOOS score remained unchanged. Following the TKR, the concentric isokinetic strength of the quadriceps reappeared altered (63% of deficit) despite pain and functional improvements. This case report underlines the importance of functional evaluation rather than the maximal strength to assess the effectiveness of TKR. However, further studies are necessary to conceptualize the meaning of maximal strength measurement and the impact of associated deficits, if any.

Keywords: Knee osteoarthritis, total knee arthroplasty, muscle strength, rehabilitation

DOI: 10.3233/IES-203122

Journal: Isokinetics and Exercise Science, vol. 28, no. 4, pp. 423-428, 2020