Danielle D.P. Berghmans1; 4; Antoine F. Lenssen1; 4; Pieter J. Emans2; Rob A. de Bie3; 4

A Progressive Strength Training Program Starting 3 Months Post Total Knee Arthroplasty Surgery Improves Strength but Not Functional Outcome

**Danielle D.P. Berghmans^1,4, Antoine F. Lenssen^1,4*, Pieter J. Emans², Rob A. de Bie^3,4**¹Department of Physical Therapy, Maastricht University Medical Center, Maastricht, The Netherlands
²Department of Orthopedics, Maastricht University Medical Center, Maastricht, The Netherlands
³Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
⁴Maastricht University, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
^*Corresponding author: Antoine F. Lenssen, Maastricht University Medical Center, PO Box 5800
6202, AZ Maastricht, The Netherlands. Tel: +31433877146; Email:
6202, AZ Maastricht, The Netherlands. Tel: +31433877146; Email: af.lenssen@mumc.nl
Received Date: 25 September, 2018; Accepted Date: 28 September, 2018; Published Date: 04 October, 2018

Citation: Berghmans DDP, Lenssen AF, Emans PJ, de Bie RA (2018) A Progressive Strength Training Program Starting 3 Months Post Total Knee Arthroplasty Surgery Improves Strength but Not Functional Outcome. J Orthop Res Ther 2018: 1118. DOI: 10.29011/2575-8241.001118

1.       Abstract
1.1.  Background: Decreased quadriceps and hamstring strength is common even one year after a total knee arthroplasty. Hence, patients with persistent functional complaints treated at the Maastricht University Medical Centre (MUMC+) received a progressive strength training program.
1.2.  Objectives: The aim of this study was to investigate the impact of the progressive strength training program on quadriceps and hamstring strength.
1.3.  Methods: Patients were referred to the outpatient physical therapy department of MUMC+ and received a 6-week progressive strength training program. Their isokinetic quadriceps and hamstring strength and functional ability were assessed before and after the program.
1.4.  Results: Men significantly improved in terms of all strength parameters assessed at an angular velocity of 60°/sec and 180°/sec. Women only improved their quadriceps strength at 180°/sec. No significant improvement at functional level was seen.
1.5.  Conclusion: A 6-week progressive strength training program has a positive impact on the isokinetic quadriceps and hamstring strength in both men and women, but not on functional ability.
1.6.  Level of Evidence:  Level 3.
2.       Keywords: Arthroplasty; Knee; Physical Therapy; Rehabilitation; Total

Figure 1: Shows the change in quadriceps strength of all individual patients before and after training, in Nm. Each line represents an individual patient. Their sex is given to the right of the diagram (F[Female] and M[male]).

Figure 2: Shows the mean quadriceps and hamstrings strengths in men, at baseline and after the training program, in Nm with standard deviations Q60: isokinetic quadriceps strength 60^°/sec. Q180: isokinetic quadriceps strength 180^°/sec. H60: isokinetic hamstring strength 60^°/sec. H180: isokinetic hamstring strength 180^°/sec. Normative values are the means of the individual normative values based on sex and age. * Significant improvement between baseline and post-training assessments (p < 0.05)

Figure 3: Shows the mean quadriceps and hamstrings strengths in women, at baseline and after the training program, in Nm with standard deviations Q60: isokinetic quadriceps strength 60^°/sec. Q180: isokinetic quadriceps strength 180^°/sec. H60: isokinetic hamstring strength 60^°/sec. H180: isokinetic hamstring strength 180^°/sec. Normative values are the means of the individual norm values based on sex and age. * Significant improvement between baseline and post-training assessments (p < 0.05).

Figure 4: Shows the change in WOMAC Function score of each individual patient before and after training. Each line represents an individual patient. The sex is given to the right of the diagram (F[Female] and M[male]).

TABLE 1 Normative values
	Men (n=129)		Women (n=166)
	mean	SD	mean	SD
Q60	129	17	79	9
H60	78	12	49	6
Q180	84	10	46	6
H180	59	9	35	5

Table 1: Shows the normative values calculated using equations including age and sex [4]. Nm: Newton meter. SD: standard deviation. Q60: isokinetic quadriceps strength 60^°/sec. Q180: isokinetic quadriceps strength 180^°/sec. H60: isokinetic hamstring strength 60^°/sec. H180: isokinetic hamstring strength 180^°/sec.

TABLE 2 Patient Characteristics
	Men (n=7)		Women (n=5)
	Mean	SD	Mean	SD
Age (years)	66.0	6.3	67.4	7.3
Height (m)	1.75	0.07	1.59	0.04
Weight (kg)	88.2	13.2	81.9	22.4
BMI (kg/m²)	28.9	4.9	32.5	9.4

Table 2: Shows the patients characteristics. BMI: Body Mass Index, SD: Standard Deviation.

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A Progressive Strength Training Program Starting 3 Months Post Total Knee Arthroplasty Surgery Improves Strength but Not Functional Outcome

Citation: Berghmans DDP, Lenssen AF, Emans PJ, de Bie RA (2018) A Progressive Strength Training Program Starting 3 Months Post Total Knee Arthroplasty Surgery Improves Strength but Not Functional Outcome. J Orthop Res Ther 2018: 1118. DOI: 10.29011/2575-8241.001118

Journal of Orthopedic Research and Therapy