Effectiveness Of Muscle Strengthening Interventions In Patient With Grade 4 Osteoarthritis Following Total Knee Replacement Surgery : A Systematic Review And Meta-Analysis
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Published:
Jun 17, 2025
Keywords:
Muscle strengthening, Osteoarthritis, Total Knee Replacement, Post operative, Effectiveness.
Main Article Content
Abstract
ABSTRACT
Background: Osteoarthritis (OA) is the most prevalent kind of arthritis affects joints and one of the main causes of disability. Patients diagnosed with advanced OA in their knees typically undergo total knee arthroplasty (TKA). Strength training is tool for reducing muscle weakness, enhancing ability in functional ambulation after TKA, according to many systematic reviews and meta-analyses.
Objective: The aim is to investigate the importance of muscle-strengthening in individuals who had TKA surgery.
Methods: A systematic literature search of three online databases was performed for randomized controlled trials (RCT) evaluating effects of strength training on functional ambulation by six-minute walk test (6MWT)/ timed-up and go (TUG) test after TKA surgery. Data were pooled by random-effect meta-analyses and presented as standard mean difference (SMD). PRISMA criteria and Cochrane risk-of-bias approach was applied to each research determine the evidence quality.
Results: Eleven RCT were identified. A meta-analysis indicated that post operative 6MWT showed no significant difference between standard therapy and muscle-strengthening, but demonstrated that muscle-strengthening produced better outcomes in TUG test than standard therapy.
Conclusion: Based on existing studies, moderate-certainty evidence suggests that strength training could decrease time to complete TUG after TKA.
Keywords: Muscle strengthening, Osteoarthritis, Total Knee Replacement, Post operative, Effectiveness.
ABSTRAK
Latar Belakang: Osteoartritis (OA) adalah jenis artritis yang paling umum yang memengaruhi sendi dan merupakan salah satu penyebab utama kecacatan. Pasien yang didiagnosis dengan OA lanjut pada lutut mereka menjalani artroplasti total lutut (TKA). Latihan kekuatan merupakan alat untuk mengurangi kelemahan otot, meningkatkan kemampuan atletik dalam ambulasi fungsional setelah TKA, menurut tinjauan sistematis dan meta-analisis.
Tujuan: Tujuan literature ini adalah menyelidiki pentingnya penguatan otot pada individu yang telah menjalani operasi TKA.
Metode: Pencarian literatur sistematis pada tiga database online dilakukan untuk uji coba terkontrol secara acak (RCT) yang mengevaluasi efek latihan kekuatan pada ambulasi fungsional dengan uji jalan enam menit (6MWT)/ uji bangun-dan-jalan (TUG) setelah operasi TKA. Data dikumpulkan dengan meta-analisis efek acak& disajikan sebagai perbedaan rata-rata standar (SMD). Kriteria PRISMA dan pendekatan risiko bias Cochrane diterapkan pada setiap penelitian untuk menentukan kualitas bukti.
Hasil: Sebelas RCT diidentifikasi. Meta-analisis menunjukkan bahwa 6MWT pasca operasi tidak menunjukkan perbedaan signifikan antara terapi standar& penguatan otot, namun menunjukkan bahwa penguatan otot menghasilkan hasil yang lebih baik pada uji TUG dibandingkan terapi standar.
Kesimpulan: Berdasarkan studi, bukti dengan kepastian sedang menunjukkan bahwa latihan kekuatan dapat mengurangi waktu untuk menyelesaikan uji TUG setelah TKA.
Kata Kunci: Penguatan otot, Osteoartritis, Penggantian Lutut Total, Pasca operasi, Efektivitas.
Background: Osteoarthritis (OA) is the most prevalent kind of arthritis affects joints and one of the main causes of disability. Patients diagnosed with advanced OA in their knees typically undergo total knee arthroplasty (TKA). Strength training is tool for reducing muscle weakness, enhancing ability in functional ambulation after TKA, according to many systematic reviews and meta-analyses.
Objective: The aim is to investigate the importance of muscle-strengthening in individuals who had TKA surgery.
Methods: A systematic literature search of three online databases was performed for randomized controlled trials (RCT) evaluating effects of strength training on functional ambulation by six-minute walk test (6MWT)/ timed-up and go (TUG) test after TKA surgery. Data were pooled by random-effect meta-analyses and presented as standard mean difference (SMD). PRISMA criteria and Cochrane risk-of-bias approach was applied to each research determine the evidence quality.
Results: Eleven RCT were identified. A meta-analysis indicated that post operative 6MWT showed no significant difference between standard therapy and muscle-strengthening, but demonstrated that muscle-strengthening produced better outcomes in TUG test than standard therapy.
Conclusion: Based on existing studies, moderate-certainty evidence suggests that strength training could decrease time to complete TUG after TKA.
Keywords: Muscle strengthening, Osteoarthritis, Total Knee Replacement, Post operative, Effectiveness.
ABSTRAK
Latar Belakang: Osteoartritis (OA) adalah jenis artritis yang paling umum yang memengaruhi sendi dan merupakan salah satu penyebab utama kecacatan. Pasien yang didiagnosis dengan OA lanjut pada lutut mereka menjalani artroplasti total lutut (TKA). Latihan kekuatan merupakan alat untuk mengurangi kelemahan otot, meningkatkan kemampuan atletik dalam ambulasi fungsional setelah TKA, menurut tinjauan sistematis dan meta-analisis.
Tujuan: Tujuan literature ini adalah menyelidiki pentingnya penguatan otot pada individu yang telah menjalani operasi TKA.
Metode: Pencarian literatur sistematis pada tiga database online dilakukan untuk uji coba terkontrol secara acak (RCT) yang mengevaluasi efek latihan kekuatan pada ambulasi fungsional dengan uji jalan enam menit (6MWT)/ uji bangun-dan-jalan (TUG) setelah operasi TKA. Data dikumpulkan dengan meta-analisis efek acak& disajikan sebagai perbedaan rata-rata standar (SMD). Kriteria PRISMA dan pendekatan risiko bias Cochrane diterapkan pada setiap penelitian untuk menentukan kualitas bukti.
Hasil: Sebelas RCT diidentifikasi. Meta-analisis menunjukkan bahwa 6MWT pasca operasi tidak menunjukkan perbedaan signifikan antara terapi standar& penguatan otot, namun menunjukkan bahwa penguatan otot menghasilkan hasil yang lebih baik pada uji TUG dibandingkan terapi standar.
Kesimpulan: Berdasarkan studi, bukti dengan kepastian sedang menunjukkan bahwa latihan kekuatan dapat mengurangi waktu untuk menyelesaikan uji TUG setelah TKA.
Kata Kunci: Penguatan otot, Osteoartritis, Penggantian Lutut Total, Pasca operasi, Efektivitas.
Article Details
How to Cite
Dewi, P. K. M. P., Suariastawa Putra, M., & Dema Prasetya, I. P. (2025). Effectiveness Of Muscle Strengthening Interventions In Patient With Grade 4 Osteoarthritis Following Total Knee Replacement Surgery : A Systematic Review And Meta-Analysis. Indonesian Journal of Physical Medicine and Rehabilitation, 14(1), 116 - 127. https://doi.org/10.36803/indojpmr.v14i1.438
Section
Literature Review
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References
1. Mora J.C., Przkora R., Cruz-Almeida Y. Knee osteoarthritis: Pathophysiology and current treatment modalities. J. Pain Res. 2018;11:2189–2196.
2. Katz J.N., Arant K.R., Loeser R.F. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA. 2020;325:568–578.
3. Pérez-Lozano M.L., Cesaro A., Mazor M., Esteve E., Berteina-Raboin S., Best T.M., Lespessailles E., Toumi H. Emerging Natural-Product-Based Treatments for the Management of Osteoarthritis. Antioxidants. 2021;10:265.
4. Musumeci G., Aiello F.C., Szychlinska M.A., Rosa M.D., Castrogiovanni P., Mobasheri A. Osteoarthritis in the XXIst Century: Risk Factors and Behaviours that Influence Disease Onset and Progression. Int. J. Mol. Sci. 2015;16:6093–6112.
5. Kuyinu E.L., Narayanan G., Nair L.S., Laurencin C.T. Animal models of osteoarthritis: Classification, update, and measurement of outcomes. J. Orthop. Surg. Res. 2016;11:19.
6. Lee YT, Yunus MHM, Ugusman A, Yazid MD. Natural Compounds Affecting Inflammatory Pathways of Osteoarthritis. Antioxidants (Basel). 2022;11(9):1722.
7. Losina E, Walensky RP, Kessler CL, et al. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med. 2009;169(12):1113-1122.
8. Papa EV, Dong X, Hassan M. Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review. Clin Interv Aging. 2017;12:955-961.
9. Chen X, Li X, Zhu Z, Wang H, Yu Z, Bai X. Effects of progressive resistance training for early post-operative fast-track total hip or knee arthroplasty: A systematic review and meta-analysis. Asian J Surg. 2021;44(10):1245-1253.
10. Skoffer B, Dalgas U, Mechlenburg I. Progressive resistance training before and after total hip and knee arthroplasty: a systematic review. Clin Rehabil. 2015;29(1):14-29.
11. Jette DU, Hunter SJ, Burkett L, et al. Physical Therapist Management of Total Knee Arthroplasty. Phys Ther. 2020;100(9):1603-1631
12. Millar SC, Bennett K, Rickman M, Thewlis D. Retention of kinematic patterns during a 6-minute walk test in people with knee osteoarthritis. Gait Posture. 2023;101:106-113.
13. Kear BM, Guck TP, McGaha AL. Timed Up and Go (TUG) Test: Normative Reference Values for Ages 20 to 59 Years and Relationships With Physical and Mental Health Risk Factors. J Prim Care Community Health. 2017;8(1):9-13.
14. Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?. Disabil Rehabil. 2012;34(12):1034-1040.
15. Vuorenmaa M, Ylinen J, Piitulainen K, et al. Efficacy of a 12-month, monitored home exercise programme compared with normal care commencing 2 months after total knee arthroplasty: a randomized controlled trial. J Rehabil Med. 2014;46(2):166-172.
16. Bily W, Franz C, Trimmel L, et al. Effects of Leg-Press Training With Moderate Vibration on Muscle Strength, Pain, and Function After Total Knee Arthroplasty: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2016;97(6):857-865.
17. Harikesavan K, Chakravarty RD, Maiya AG, Hegde SP, Y Shivanna S. Hip Abductor Strengthening Improves Physical Function Following Total Knee Replacement: One-Year Follow-Up of a Randomized Pilot Study. Open Rheumatol J. 2017;11:30-42.
18. Jørgensen PB, Bogh SB, Kierkegaard S, et al. The efficacy of early initiated, supervised, progressive resistance training compared to unsupervised, home-based exercise after unicompartmental knee arthroplasty: a single-blinded randomized controlled trial. Clin Rehabil. 2017;31(1):61-70.
19. Calatayud J, Casaña J, Ezzatvar Y, Jakobsen MD, Sundstrup E, Andersen LL. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2864-2872.
20. Husby VS, Foss OA, Husby OS, Winther SB. Randomized controlled trial of maximal strength training vs. standard rehabilitation following total knee arthroplasty. Eur J Phys Rehabil Med. 2018;54(3):371-379.
21. Schache MB, McClelland JA, Webster KE. Incorporating hip abductor strengthening exercises into a rehabilitation program did not improve outcomes in people following total knee arthroplasty: a randomised trial. J Physiother. 2019;65(3):136-143.
22. Do K, Yim J. Effects of Muscle Strengthening around the Hip on Pain, Physical Function, and Gait in Elderly Patients with Total Knee Arthroplasty: A Randomized Controlled Trial. Healthcare (Basel). 2020;8(4):489.
23. Liao CD, Tsauo JY, Chiu YS, Ku JW, Huang SW, Liou TH. Effects of Elastic Resistance Exercise After Total Knee Replacement on Muscle Mass and Physical Function in Elderly Women With Osteoarthritis: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2020;99(5):381-389.
24. Lee HG, An J, Lee BH. The Effect of Progressive Dynamic Balance Training on Physical Function, The Ability to Balance and Quality of Life Among Elderly Women Who Underwent a Total Knee Arthroplasty: A Double-Blind Randomized Control Trial. Int J Environ Res Public Health. 2021;18(5):2513.
25. Price AJ, Alvand A, Troelsen A, et al. Knee replacement. Lancet. 2018;392(10158):1672-1682.
26. Pozzi F, Snyder-Mackler L, Zeni J. Physical exercise after knee arthroplasty: a systematic review of controlled trials. Eur J Phys Rehabil Med. 2013;49(6):877-892.
27. Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?. Disabil Rehabil. 2012;34(12):1034-1040.
28. Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee 2007; 335(7624):812.
29. Petterson SC, Mizner RL, Stevens JE, et al. Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum. 2009;61(2):174–83
2. Katz J.N., Arant K.R., Loeser R.F. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA. 2020;325:568–578.
3. Pérez-Lozano M.L., Cesaro A., Mazor M., Esteve E., Berteina-Raboin S., Best T.M., Lespessailles E., Toumi H. Emerging Natural-Product-Based Treatments for the Management of Osteoarthritis. Antioxidants. 2021;10:265.
4. Musumeci G., Aiello F.C., Szychlinska M.A., Rosa M.D., Castrogiovanni P., Mobasheri A. Osteoarthritis in the XXIst Century: Risk Factors and Behaviours that Influence Disease Onset and Progression. Int. J. Mol. Sci. 2015;16:6093–6112.
5. Kuyinu E.L., Narayanan G., Nair L.S., Laurencin C.T. Animal models of osteoarthritis: Classification, update, and measurement of outcomes. J. Orthop. Surg. Res. 2016;11:19.
6. Lee YT, Yunus MHM, Ugusman A, Yazid MD. Natural Compounds Affecting Inflammatory Pathways of Osteoarthritis. Antioxidants (Basel). 2022;11(9):1722.
7. Losina E, Walensky RP, Kessler CL, et al. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med. 2009;169(12):1113-1122.
8. Papa EV, Dong X, Hassan M. Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review. Clin Interv Aging. 2017;12:955-961.
9. Chen X, Li X, Zhu Z, Wang H, Yu Z, Bai X. Effects of progressive resistance training for early post-operative fast-track total hip or knee arthroplasty: A systematic review and meta-analysis. Asian J Surg. 2021;44(10):1245-1253.
10. Skoffer B, Dalgas U, Mechlenburg I. Progressive resistance training before and after total hip and knee arthroplasty: a systematic review. Clin Rehabil. 2015;29(1):14-29.
11. Jette DU, Hunter SJ, Burkett L, et al. Physical Therapist Management of Total Knee Arthroplasty. Phys Ther. 2020;100(9):1603-1631
12. Millar SC, Bennett K, Rickman M, Thewlis D. Retention of kinematic patterns during a 6-minute walk test in people with knee osteoarthritis. Gait Posture. 2023;101:106-113.
13. Kear BM, Guck TP, McGaha AL. Timed Up and Go (TUG) Test: Normative Reference Values for Ages 20 to 59 Years and Relationships With Physical and Mental Health Risk Factors. J Prim Care Community Health. 2017;8(1):9-13.
14. Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?. Disabil Rehabil. 2012;34(12):1034-1040.
15. Vuorenmaa M, Ylinen J, Piitulainen K, et al. Efficacy of a 12-month, monitored home exercise programme compared with normal care commencing 2 months after total knee arthroplasty: a randomized controlled trial. J Rehabil Med. 2014;46(2):166-172.
16. Bily W, Franz C, Trimmel L, et al. Effects of Leg-Press Training With Moderate Vibration on Muscle Strength, Pain, and Function After Total Knee Arthroplasty: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2016;97(6):857-865.
17. Harikesavan K, Chakravarty RD, Maiya AG, Hegde SP, Y Shivanna S. Hip Abductor Strengthening Improves Physical Function Following Total Knee Replacement: One-Year Follow-Up of a Randomized Pilot Study. Open Rheumatol J. 2017;11:30-42.
18. Jørgensen PB, Bogh SB, Kierkegaard S, et al. The efficacy of early initiated, supervised, progressive resistance training compared to unsupervised, home-based exercise after unicompartmental knee arthroplasty: a single-blinded randomized controlled trial. Clin Rehabil. 2017;31(1):61-70.
19. Calatayud J, Casaña J, Ezzatvar Y, Jakobsen MD, Sundstrup E, Andersen LL. High-intensity preoperative training improves physical and functional recovery in the early post-operative periods after total knee arthroplasty: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2864-2872.
20. Husby VS, Foss OA, Husby OS, Winther SB. Randomized controlled trial of maximal strength training vs. standard rehabilitation following total knee arthroplasty. Eur J Phys Rehabil Med. 2018;54(3):371-379.
21. Schache MB, McClelland JA, Webster KE. Incorporating hip abductor strengthening exercises into a rehabilitation program did not improve outcomes in people following total knee arthroplasty: a randomised trial. J Physiother. 2019;65(3):136-143.
22. Do K, Yim J. Effects of Muscle Strengthening around the Hip on Pain, Physical Function, and Gait in Elderly Patients with Total Knee Arthroplasty: A Randomized Controlled Trial. Healthcare (Basel). 2020;8(4):489.
23. Liao CD, Tsauo JY, Chiu YS, Ku JW, Huang SW, Liou TH. Effects of Elastic Resistance Exercise After Total Knee Replacement on Muscle Mass and Physical Function in Elderly Women With Osteoarthritis: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2020;99(5):381-389.
24. Lee HG, An J, Lee BH. The Effect of Progressive Dynamic Balance Training on Physical Function, The Ability to Balance and Quality of Life Among Elderly Women Who Underwent a Total Knee Arthroplasty: A Double-Blind Randomized Control Trial. Int J Environ Res Public Health. 2021;18(5):2513.
25. Price AJ, Alvand A, Troelsen A, et al. Knee replacement. Lancet. 2018;392(10158):1672-1682.
26. Pozzi F, Snyder-Mackler L, Zeni J. Physical exercise after knee arthroplasty: a systematic review of controlled trials. Eur J Phys Rehabil Med. 2013;49(6):877-892.
27. Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?. Disabil Rehabil. 2012;34(12):1034-1040.
28. Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee 2007; 335(7624):812.
29. Petterson SC, Mizner RL, Stevens JE, et al. Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum. 2009;61(2):174–83