Key result
Preoperative blood flow restriction exercise was feasible and resulted in less decline in physical function following total knee arthroplasty compared to standard care (SPPB change -2.2 vs -4.8).
Why the study?
Patients awaiting TKA often experience strength and functional decline because standard high-resistance exercise is poorly tolerated preoperatively or postoperatively.
Does preoperative blood flow restriction exercise attenuate postoperative loss of physical function in patients undergoing total knee arthroplasty?
RCT (n=10)
Open-label
Randomized
No
Does preoperative blood flow restriction exercise attenuate postoperative loss of physical function in patients undergoing total knee arthroplasty?
Preoperative low-resistance exercise using blood flow restriction is feasible and may attenuate postoperative loss of physical function after total knee arthroplasty.
This is the authors' abstract. We don't add key points for this paper.
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.
Answers are grounded in this paper and cite their sources.
Supports preoperative blood flow restriction exercise to lessen functional decline after knee arthroplasty; extends evidence to surgical populations.
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Przkora et al. (2021) conducted an RCT in Osteoarthritis requiring total knee arthroplasty (n=10). Blood flow restriction (BFR) exercise vs. Standard of care (no exercise) was evaluated on Change in Short Physical Performance Battery (SPPB) score at 2 weeks postoperatively. Preoperative blood flow restriction exercise was feasible and resulted in less decline in physical function following total knee arthroplasty compared to standard care (SPPB change -2.2 vs -4.8).
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