Stevens-Lapsley JE, Balter JE, Wolfe P, Eckhoff DG, Kohrt WM. Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial. Phys Ther. 2012 Feb;92(2):210-26. doi: 10.2522/ptj.20110124. Epub 2011 Nov 17. PubMed PMID: 22095207; PubMed Central PMCID: PMC3269772.
• Level of evidence of the article ([ Ссылка ]): 2, a randomized controlled trial
• Target population: 66 patients with unilateral TKA
• Type of electrotherapy used in article: NMES
• Specific electrotherapy parameters used in the article:
o Self-adherent, flexible rectangular electrode (7.6x12.7cm)
Placement was on the medial and proximal lateral thigh and marked for consistent placement following d/c from hospital
o Used a bi-phasic current
o Symmetrical waveform at 50 pps for 15 seconds (including a 3-second ramp-up)
o 45 second off time
o Pulse duration = 250microsecond
o Intensity to patient tolerance
• Protocol used in the article:
o Used an Empi 300PV stimulator
o Intervention began 48 hours s/p TKA
o Pts received NMES 2x/day 6 weeks post discharge from hospital
During treatment pt is seated in a stable chair to allow for ~85 degrees of hip flexion and 60 degrees of knee flexion, with a Velcro strap placed in front of the surgical knee, preventing the knee from extending
o Control group and treatment group both received PT 3 days/6 sessions for inpatient, 2 weeks/6 sessions home PT and 6 weeks/10-12 outpatient PT sessions
• Outcome found with the protocol:
o Patient’s that received NMES attenuated quadriceps muscle loss, 6 minute walk test distance loss, improved functional performance
I would suggest the use of NMES s/p acute TKA surgical procedures to help attenuate the loss of muscle mass. Attenuating the loss of the quadriceps muscle is key in positive outcomes following TKA. The timing to begin the treatment needs to be researched more, possibly using more sessions with NMES s/p TKA and possibly pairing that with a pre-habilitation program. Also having access to NMES is another key aspect to being able to use this treatment.
