Safety and Effects of a Four-Week Preoperative Low-Load Resistance Training With Blood Flow Restriction on Pre- and Postoperative Quadriceps Strength in Patients Undergoing Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial

Yusuke Kubo; Daisuke Fujita; Shuhei Sugiyama; Rie Takachu; Takeshi Sugiura; Masahiro Sawada; Kohtaro Yamashita; Kaori Kobori; Makoto Kobori

doi:10.7759/cureus.64466

Safety and Effects of a Four-Week Preoperative Low-Load Resistance Training With Blood Flow Restriction on Pre- and Postoperative Quadriceps Strength in Patients Undergoing Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial

Cureus. 2024 Jul 13;16(7):e64466. doi: 10.7759/cureus.64466. eCollection 2024 Jul.

Authors

Yusuke Kubo¹, Daisuke Fujita², Shuhei Sugiyama¹, Rie Takachu¹, Takeshi Sugiura¹, Masahiro Sawada¹, Kohtaro Yamashita¹, Kaori Kobori¹, Makoto Kobori¹

Affiliations

¹ Department of Rehabilitation Medicine, Kobori Orthopedic Clinic, Hamamatsu, JPN.
² Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka, JPN.

Abstract

Background/Objectives Enhancing preoperative quadriceps strength and mitigating quadriceps strength loss due to total knee arthroplasty (TKA) is crucial for post-TKA recovery. This study compared the safety and effect of a four-week preoperative regimen of low-load resistance training with blood flow restriction (LLRT-BFR) with those of low-intensity resistance training with slow movement and tonic force generation (LST) on the pre- and postoperative quadriceps strength in patients undergoing TKA. Methods In this randomized controlled trial, 22 patients were assigned to either the LLRT-BFR (n=11) or LST (n=11) group. Primary outcomes included changes in quadriceps strength before and after the intervention and surgery. To assess safety, we monitored D-dimer and high-sensitivity C-reactive protein levels pre- and post-intervention. Statistical analysis involved independent samples t-tests and Mann-Whitney U tests for group comparisons of quadriceps strength changes. Additionally, a two-way repeated-measures analysis of variance was used to assess safety parameters. Results No significant differences were observed between the BFR and LST groups in terms of the rate of increase in quadriceps strength pre- and post-intervention (BFR: median 12.1%, interquartile range -0.8% to 19.5%; LST: median 6.2%, interquartile range 2.7% to 14.7%; p>0.99) or in the rate of reduction in quadriceps strength pre- and post-surgery (BFR: mean -72.4%, standard deviation ±11.2%; LST: mean -75.3%, standard deviation ±12.2%; p=0.57). Safety assessments showed no significant main effects of time, group, or interaction on the safety parameters (all p>0.05). Conclusions LLRT-BFR and LST demonstrated comparable effects on quadriceps strength before and after intervention and surgery in patients undergoing TKA. The lack of significant changes in the safety parameters supports the safety profile of both interventions, indicating their suitability for preoperative conditioning in patients scheduled for TKA.

Keywords: blood flow restriction; low-load resistance training; postoperative recovery; preoperative rehabilitation; quadriceps strength; total knee arthroplasty.

Grants and funding

This research was funded by the JSPS KAKENHI (grant number: JP19K19809). The authors declare no conflict of interest. The funding agency had no role in the design, execution, interpretation, or writing of the study.