Knee Pre-hab Enhances Outcomes
by Dr. Carl Freeman
Using pre-habilitation as a strategy to reduce both short and long-term strength deficits following knee surgery has recently begun to receive the serious attention it deserves. We now know definitively that knee pre-hab enhances outcomes.
Below we compare a recent X0 study, on pre-habilitation, with the results of a recent 2016 published study which we will refer to going forward as CALATAYUD ET AL.:
Calatayud, J. · Casaña, UJ. 1,2 · Ezzatvar, Y., Jakobsen, M. D., Sundstrup, E. and L. L. Andersen. 2016. High‑intensity preoperative training improves physical and functional recovery in the early post‑operative periods after total knee arthroplasty: a randomized controlled trial. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA). Published online: 14 January 2016.
CALATAYUD ET AL. STUDY
The CALATAYUD ET AL. patients engaged in intensive pre-hab for 8 weeks and normal physical therapy for three months.
- Calatayud et al. screened 186 patients.
- However, only 34% of the qualified patients actually participated (22 participated in each of their 2 groups). The main reasons given were travel and the time commitment.
X10 PATIENT STUDY
The X10 PATIENTS engaged in pre-hab for 3 weeks and used the X10 only for 4 weeks post surgery.
- For the X10 study, all 19 of the invited patients participated. We believe the major reasons for this high participation are:
1) Having the machine in their home;
2) Having a personal telemedicine coach, and
3) The digital feedback provided instantly on the computer display.
Important Conclusions from the Comparison
The major conclusions from this comparison are that:
1) Knee pre-hab definitely enhances strength before and after surgery
2) The results of the X10 one month post surgically are vastly superior, in term of patient strength (X10 patients one month were 4.3 x stronger than normal patients in the above study), and
3) X10 compliance was almost three times higher that of the above study.
Below we compare two measures of strength: the Timed Up and Go test (TUG) and Quadriceps Strength.
Looking at the control group (normal patients), they were six percent slower before surgery than they were eight weeks early when the baseline number was obtained. At one month after surgery the control group were still 11% slower than their baseline. In contrast, both the groups that exercised their legs were faster completing the task in less time, and importantly the reduced time was still evident one month later. So, we can categorically state that the pre-hab patients were significantly more functional. This is true both right before surgery and, one month after surgery. Of course, we are pleased to note that at one month the X10 performed the best.
The major muscles of concern in knee replacement surgery are the quadriceps muscles that extends your leg. Our three groups have major differences in the performance of these muscles. The normal no-pre-hab, 3 month standard PT patients are 67% weaker at one month than when the baseline measurement was taken eight weeks before surgery. Surprisingly, the high intensive leg exercise group was 57% weaker than their baseline, despite being the strongest group right before surgery.
The X10 group is the best group. At one month following surgery they were 41% stronger than their baseline. Normally, there is a quadriceps strength deficit of 50-60% at one month (as the Catalayud et al. groups demonstrate) and a 30% strength quadriceps strength deficit for one to 13 years. Despite, what normally happens, the X10 patients, at one month have stronger quadriceps muscle strength than at their baseline.
“Effectiveness of Knee Pre-hab
The benefits of pre-hab are many and include: Going into surgery with stronger more stable legs, greater flexibility and range of motion, and less pain. Importantly, the reduction in pain and the additional strength and range of motion carry over after surgery. Pre-hab patients have superior post-surgical outcomes compared to control patients. The benefits of knee pre-hab have been followed for up to three months following surgery and are still statistically significant even at that later date.
Working your legs is the best and most important thing you can do.
Many patients feel that the more care they receive the better they will be (i.e., nursing homes will speed their recovery). This argument is appealing but wrong. Many nursing homes are risk-adverse and so patients are constantly moved from place to place in wheel chairs. This is the exact opposite of what is good for them and what happened in the hospital. Standard hospital practice is that patients are forced to walk the day of surgery and each day they stayed in the hospital.
You are less likely to catch a “hospital infection” at home than in a nursing center. Skilled nursing centers typically do not have an X10 or exercise equipment found at outpatient clinics. Patient outcomes suffer in nursing homes.
A study by researchers at New England Baptist Hospital, Beth Israel Deaconess Medical Center and Harvard Medical School, all based in Boston, found that knee and hip replacement surgery patients who had participated in water- and land-based strength training, and aerobic and flexibility exercises for six weeks prior to their surgeries reduced their odds of needing inpatient rehabilitation by 73 percent.
“Even in a fairly brief time period, the exercise paid off for the participants,” says lead study author Daniel Rooks, PHD, former clinical research investigator and professor of medicine at Harvard Medical School. “Their level of function and pain stabilized prior to surgery, whereas those who did not exercise got worse. The benefits of exercise before surgery are very clear.”
The Choice is Yours
At this point you can stick with conventional practices. If you do, history shows us you will, on average, show a 50% quadriceps strength deficit at one month and a 30% quadriceps deficit for one to 13 years after surgery.
Or, you can promise yourself that you are going to do intensive therapy at a local physical therapy clinic. In this case, based on the results of patients who have tried this same plan you stand less than a 50% chance of completing the program. You have a high probability of pain while you’re in the program.
Or, you can have the outcome that patients experience with using the X10. X10 knee pre-hab takes three weeks, and lets you work on your schedule in the convenience of your own home. You will have over a 90% chance of completing the program and doing it all without additional pain.
The X10 Meta-Blog
We call it a “Meta-Blog” because we step back and give you a broad perspective on all aspects of knee health, surgery and recovery.
In this one-of-a-kind blog we gather together great thinkers, doers, writers related to Knee Surgery, Recovery, Preparation, Care, Success and Failure. Meet physical therapists, coaches, surgeons, patients, and as many smart people as we can gather to create useful articles for you. Whether you have a surgery upcoming, in the rear-view mirror, or just want to take care of your knees to avoid surgery, you should find some value here.