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Does Pre-Surgery Exercise result in better outcomes for Total Knee Replacement?


Clinical trial finds that pre-surgery exercise means better outcomes for total knee replacement surgery

A clinical trial has explored pre-surgery exercise conditioning as a novel approach to improving outcomes following total knee replacement.

Total knee arthroplasty (TKA) or total knee replacement (TKR) is a common orthopedic surgery that involves replacing the articular surfaces of the knee joint with smooth metal and highly cross-linked polyethylene plastic. The main aim of this surgery is to improve the quality of life of patients with severe osteoarthritis by reducing pain and increasing functional mobility.

Traditional strategies for prehabilitation and rehabilitation associated with total knee replacement surgery have focused on improving joint range of motion and function with less emphasis on neuromuscular performance. Furthermore, the standard pre-surgery exercise plans are too long and generic in effect to be considered suitable for routine clinical practice.

Recently, a new prehabilitative protocol, known as acute prehabilitative neuromuscular exercise-conditioning (APNEC), has been introduced for TKA patients. 

Clinical Trial

The clinical trial investigated the effects of APNEC on physical function and muscle strength in patients undergoing TKA. The trial involved 29 patients who were randomly assigned to either a prehabilitation group or a control group. The prehabilitation group participated in a 1-week neuromuscular exercise program prior to their TKA surgery, while the control group did not receive any prehabilitation.

The APNEC group received nine stressful exercise-conditioning sessions for the knee extensors of the surgery leg, done over one week. Prescribed exercise stress ranged between 60%—100% of the participant’s daily voluntary strength capacity. The primary outcomes were muscle activation capacity and muscle strength.

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The results of the clinical trial showed that the prehabilitation group had significant improvements in knee muscle strength compared to the control group. In addition, the prehabilitation group also had better physical function outcomes and muscle activation capacity.

These findings suggest that prehabilitative neuromuscular exercise conditioning may be a promising approach for improving outcomes following TKA. By improving muscle strength and muscle activation before surgery, patients may experience better outcomes and faster recovery following their procedure.


Overall, the clinical trial provides exploratory insights into a novel approach for improving outcomes following TKA. Prehabilitative neuromuscular exercise conditioning has the potential to improve muscle strength and physical function prior to surgery, leading to better outcomes and a faster recovery. The results demonstrate that APNEC is a safe and effective option for improving functional outcomes after TKA. Patients undergoing total knee replacement may want to discuss this approach with their healthcare provider to determine if it is a viable option for them.
BMC Musculoskeletal Disorders, Jun-07-22
ClinicalTrials.gov: NCT03113032

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This content is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions. CenTrial Data Ltd. does not take responsibility for possible health consequences of any person or persons reading or following the information in this educational content. Treatments and clinical trials mentioned may not be appropriate or available for all trial participants. Outcomes from treatments and clinical trials may vary from person to person. Consult with your doctor as to whether a clinical trial is a suitable option for your condition. Assistance from generative AI tools may have been used in writing this article.