https://doi.org/10.4081/ejtm.2021.9932
Blood flow restriction exercise to attenuate postoperative loss of function after total knee replacement: a randomized pilot study
Submitted: 30 June 2021
Accepted: 16 July 2021
Published: 26 August 2021
Accepted: 16 July 2021
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Aging well is directly associated with a healthy lifestyle. The focus of this paper is to relate that attenuation of postoperative loss of muscle function after a total knee arthroplasty (TKA) is an important consideration. Because patients usually do not tolerate standard high-resistance exercise in the preoperative or postoperative period, they often experience a decline in strength and function. Therefore, we tested the feasibility and acceptability of an alternative low-resistance exercise protocol with blood flow restriction (BFR) using a tourniquet in the preoperative period for patients awaiting TKA. We recruited patients undergoing a TKA and randomized six to the BFR exercise for 4 weeks prior to surgery and four to standard of care (no exercise). We measured physical function using the Short Physical Performance Battery (SPPB), the 6-Minute Walk Test (6MWT), leg strength (peak torque), and pain (numerical pain score) 4 to 5 weeks preoperatively and 2 weeks postoperatively. The clinical management, e.g., anesthetic management, did not differ between groups. No complications were observed. Our findings demonstrate the feasibility and acceptability of the BFR intervention. Although preliminary and not powered for comparison, the BFR group demonstrated less decline in SPPB following surgery (−2.2, 95%CI:−4.4,0.1) compared to the no exercise group (−4.8, 95%CI:−7.8,−1.7). No differences were noted for the 6MWT, leg strength, and pain measurements. We conclude that preoperative low-resistance exercise using the BFR is feasible and acceptable, and this test warrants investigation as an intervention to potentially attenuate the postoperative loss of physical function after TKA.
Nelson AE, Allen KD, Golightly YM, Goode AP, Jordan JM. A systematic review of recommendations and guidelines for the management of osteoarthritis: the Chronic Osteoarthritis Management Initiative of the U.S. Bone and Joint Initiative. Semin Arthritis Rheum. 2014;43:701-12.
DOI: https://doi.org/10.1016/j.semarthrit.2013.11.012
Ravi B, Escott B, Shah PS, Jenkinson R, Chahal J, Bogoch E, Kreder H, Hawker G. A systematic review and meta-analysis comparing complications following total joint arthroplasty for rheumatoid arthritis versus for osteoarthritis. Arthritis Rheum. 2012;64:3839-49.
DOI: https://doi.org/10.1002/art.37690
Hofmann S, Seitlinger G, Djahani O, Pietsch M. The painful knee after TKA: a diagnostic algorithm for failure analysis. Knee Surg Sports Traumatol Arthrosc. 2011;19:1442-52.
DOI: https://doi.org/10.1007/s00167-011-1634-6
Schache MB, McClelland JA, Webster KE. Lower limb strength following total knee arthroplasty: a systematic review. Knee. 2014;21:12-20.
DOI: https://doi.org/10.1016/j.knee.2013.08.002
Judd DL, Wolfe P, LeDoux CV, Hogan C, Dayton MR, Stevens-Lapsley JE. Trajectories of functional performance and muscle strength recovery differ after total knee and total hip replacement: a performance-based, longitudinal study. Int J Rehabil Res. 2019;42:211-6.
DOI: https://doi.org/10.1097/MRR.0000000000000344
Rodgers JA, Garvin KL, Walker CW, Morford D, Urban J, Bedard J. Preoperative physical therapy in primary total knee arthroplasty. J Arthroplasty. 1998;13:414-21.
DOI: https://doi.org/10.1016/S0883-5403(98)90007-9
Rooks DS, Huang JIE, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, Alpert S, Iversen MD, Katz JN. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum. 2006;55:700-8.
DOI: https://doi.org/10.1002/art.22223
Yasuda T, Loenneke JP, Ogasawara R, Abe T. Influence of continuous or intermittent blood flow restriction on muscle activation during low-intensity multiple sets of resistance exercise. Acta Physiol Hung. 2013;100:419-26.
DOI: https://doi.org/10.1556/APhysiol.100.2013.4.6
Gundermann DM, Walker DK, Reidy PT, Borack MS, Dickinson JM, Volpi E, Rasmussen BB. Activation of mTORC1 signaling and protein synthesis in human muscle following blood flow restriction exercise is inhibited by rapamycin. Am J Physiol Endocrinol Metab. 2014;306:E1198-204.
Pilot Studies: Common Uses and Misuses. National Center for Complementary and Integrative Health. Accessed August 5, 2021. https://www.nccih.nih.gov/grants/pilot-studies-common-uses-and-misuses
Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45:626-9.
DOI: https://doi.org/10.1016/j.jpsychires.2010.10.008
Treacy D, Hassett L. The Short Physical Performance Battery. J Physiother. 2018;64:61.
DOI: https://doi.org/10.1016/j.jphys.2017.04.002
American Thoracic Society ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111-7.
DOI: https://doi.org/10.1164/ajrccm.166.1.at1102
Borges O. Isometric and isokinetic knee extension and flexion torque in men and women aged 20-70. Scand J Rehabil Med. 1989;21:45-53.
Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332:556-61.
DOI: https://doi.org/10.1056/NEJM199503023320902
Vechin FC, Libardi CA, Conceição MS, Damas FR, Lixandrão ME, Berton RPB, Tricoli VAA, Roschel HA, Cavaglieri CR, Chacon-Mikahil MPT, Ugrinowitsch C. Comparisons between low-intensity resistance training with blood flow restriction and high-intensity resistance training on quadriceps muscle mass and strength in elderly. J Strength Cond Res. 2015;29:1071-6.
DOI: https://doi.org/10.1519/JSC.0000000000000703
Segal N, Davis MD, Mikesky AE. Efficacy of blood flow-restricted low-load resistance training for quadriceps strengthening in men at risk of symptomatic knee osteoarthritis. Geriatr Orthop Surg Rehabil. 2015;6:160-7.
DOI: https://doi.org/10.1177/2151458515583088
Segal NA, Williams GN, Davis M, Wallace RB, Mikesky A. Efficacy of blood flow-restricted, low-load resistance training in women with risk factors for symptomatic knee osteoarthritis. PM R 2015;7:376-84.
DOI: https://doi.org/10.1016/j.pmrj.2014.09.014
Ashikaga K, Saji M, Takanashi S, Nagayama M, Akashi YJ, Isobe M. Physical performance as a predictor of midterm outcome after mitral valve surgery. Heart Vessels. 2019;34:1665-73.
DOI: https://doi.org/10.1007/s00380-019-01397-y
Hanada M, Yamauchi K, Miyazaki S, Oyama Y, Yanagita Y, Sato S, Miyazaki T, Nagayasu T, Kozu R. Short-Physical Performance Battery (SPPB) score is associated with postoperative pulmonary complications in elderly patients undergoing lung resection surgery: a prospective multicenter cohort study. Chron Respir Dis. 2020;17:1479973120961846.
DOI: https://doi.org/10.1177/1479973120961846
Przkora R, Kinsky MP, Fisher SR, Babl C, Heyde CE, Vasilopoulos T, Kaye AD, Volpi E. Functional improvements utilizing the Short Physical Performance Battery (SPPB) in the elderly after epidural steroid injections. Curr Pain Headache Rep. 2019;23:14.
DOI: https://doi.org/10.1007/s11916-019-0748-2
Fry CS, Glynn EL, Drummond MJ, Timmerman KL, Fujita S, Abe T, Dhanani S, Volpi E, Rasmussen BB. Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men. J Appl Physiol. 2010;108:1199-209.
DOI: https://doi.org/10.1152/japplphysiol.01266.2009
Gundermann DM, Walker DK, Reidy PT, Borack MS, Dickinson JM, Volpi E, Rasmussen BB. Activation of mTORC1 signaling and protein synthesis in human muscle following blood flow restriction exercise is inhibited by rapamycin. Am J Physiol Endocrinol Metab. 2014;306:E1198-204.
DOI: https://doi.org/10.1152/ajpendo.00600.2013
Manini TM, Vincent KR, Leeuwenburgh CL, Lees HA, Kavazis AN, Borst SE, Clark BC. Myogenic and proteolytic mRNA expression following blood flow restricted exercise. Acta Physiol (Oxf). 2011;201:255-63.
DOI: https://doi.org/10.1111/j.1748-1716.2010.02172.x
Larkin KA, Macneil RG, Dirain M, Sandesara B, Manini TM, Buford TW. Blood flow restriction enhances post-resistance exercise angiogenic gene expression. Med Sci Sports Exerc. 2012;44:2077-83.
DOI: https://doi.org/10.1249/MSS.0b013e3182625928
How to Cite
Przkora, R., Sibille, K., Victor, S., Meroney, M., Leeuwenburgh, C., Gardner, A., Vasilopoulos, T., & Parvataneni, H. K. (2021). Blood flow restriction exercise to attenuate postoperative loss of function after total knee replacement: a randomized pilot study. European Journal of Translational Myology, 31(3). https://doi.org/10.4081/ejtm.2021.9932
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