Continuous passive motion and its effects on knee flexion after total knee arthroplasty in patients with knee osteoarthritis

Clinical evaluation of usefulness and effectiveness of sitting-type continuous passive motion machines in patients with total knee arthroplasty: a dual-center randomized controlled trial

BACKGROUND

Total knee arthroplasty (TKA) is a treatment option for osteoarthritis of the knee. After undergoing TKA, patients can be treated with continuous passive motion (CPM); however, inconsistent results have been reported on the effectiveness of CPM as part of a rehabilitation strategy. This discrepancy may be due to the difference between the set-arc of CPM and real arcs of knee motion. In this randomized controlled trial, we compared the efficacy of the sitting-type CPM, which can apply a more fitted arc of motion, to that of the conventional CPM.

METHODS

We performed a prospective, multicenter, single-blind, three-arm, randomized controlled trial. Patients who underwent unilateral TKA were recruited and randomly allocated to three groups (151 participants; Group 1, conventional type; Group 2, mixed; and Group 3, sitting type). All participants underwent 10 days of CPM management. Passive and active ranges of motion (ROMs), pain, lower-extremity edema, patient-reported outcomes, and functional assessments were evaluated at four time points.

RESULTS

Passive and active ROMs and pain significantly improved during and after the intervention in all groups; however, no significant differences were noted between the groups. Compared with the conventional type, the sitting-type CPM devices were rated higher in participant's satisfaction questionnaires.

CONCLUSION

The sitting-type CPM had equivalent efficacy to that of the conventional-type CPM but provided higher satisfaction to patients after TKA. Therefore, the sitting-type CPM may be a useful tool in post-TKA rehabilitation.

CLINICAL TRIAL REGISTRATION

This clincial trial was registed with the Clinical Research Information Service of Republic of Korea, KCT0005520, Registered on 21 October 2020, date of first enrollment at 10/11/2020 https://cris.nih.go.kr/cris/search/detailSearch.do/21750 .

Early outcome measurement of the effectiveness of conventional physical therapy versus continuous passive motion in knee function following retrograde femoral nailing-a prospective randomized controlled trial

PURPOSE

This study evaluated the efficacy of continuous passive motion (CPM) versus conventional physical therapy (CPT) in the early postoperative period following retrograde femoral nailing (RFILN). Based on the principles of operation of CPM, we hypothesized that it would improve knee function and decrease pain after open reduction and internal fixation with a retrograde femoral interlocking nail.

PATIENTS AND METHODS

Eighty-eight patients over the age of 18 years who met the inclusion criteria got randomized into one of two groups. The experimental group had CPM, while the control group had CPT. Postoperative knee functions assessed were the degree of knee stiffness, the total arc of motion, and knee pain. Knee stiffness, defined as the range of motion ≤ 90° assessed one week, two weeks, and six weeks postoperatively, while knee pain was measured using the visual analog scale (VAS) on days one, two, three, four, five, six and seven postoperatively.

RESULTS

The CPM group had a significantly lower incidence of knee stiffness at one week, two weeks, and six weeks postoperatively than the CPT group (all p < 0.0001). The VAS scores of the CPM group on days one, two, three, four, five, six and seven were significantly lower than those of the CPT group (p < 0.006 for day one and p < 0.001 for the remaining days). Similarly, the total arc of motion gained postoperatively was significantly greater in the CPM group than in the CPT (all p < 0.001).

CONCLUSION

The continuous passive motion effectively reduced the number of patients with knee stiffness and knee pain. It increased the total arc of motion in the early postoperative period compared to CPT. Therefore, we recommend CPM for patients undergoing retrograde femoral nailing use in the early postoperative period.

Effectiveness of patient education on total knee arthroplasty: A systematic review and meta-analysis

AIMS AND OBJECTIVES

This study was designed to examine the contents and methods of patient educational interventions about total knee arthroplasty (TKA) and their effectiveness in reducing postoperative pain and enhancing range of motion (ROM) in the literature.

BACKGROUND

Patient education has been provided to facilitate recovery after TKA; however, little is known about the contents and methods of the interventions and their effectiveness in reducing postoperative pain and enhancing ROM.

DESIGN

This is a systematic review and meta-analysis of randomised controlled trials (RCTs).

METHODS

Published studies from June 1998-June 2021 were identified from electronic databases. Two independent investigators assessed the quality of the studies by using the revised Cochrane risk-of-bias tool. Meta-analyses with random-effects models were conducted to assess the effectiveness of the interventions using the Comprehensive Meta-Analysis Software. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

RESULTS

Among 12 articles that met the inclusion criteria, three interventions provided education on pain management and mobility/exercises. The most common educational methods were the combinations of oral explanation, written materials, and audiovisual materials, group discussion, while four studies used information technology (IT) devices. The meta-analysis demonstrated that the educational interventions using IT devices were effective in improving pain and ROM, but not the interventions that did not use IT devices.

CONCLUSION

Structured education for pain management, communication and/or exercise support programs utilising diverse methods have been provided to patients undergoing TKA. Using IT devices could successfully enhance the effectiveness of educational interventions for patients undergoing TKA.

RELEVANCE TO CLINICAL PRACTICE

Integration of postoperative pain management and mobility/exercises with the use of IT devices should be actively considered in providing patient education in clinical nursing practice.

Rehabilitation during early postoperative period following total knee arthroplasty using single-joint hybrid assistive limb as new therapy device: a randomized, controlled clinical pilot study

INTRODUCTION

The first weeks after total knee arthroplasty (TKA) are crucial for the functional outcome. To improve knee mobility, a continuous passive motion (CPM) motor rail is commonly used during in-hospital rehabilitation. The single-joint hybrid assistive limb (HAL-SJ) is a new therapy device. The aim of the study was to improve patients' range of motion (ROM), mobility, and satisfaction using the active-assistive support of the HAL-SJ.

MATERIALS AND METHODS

Between 09/2017 and 10/2020, 34 patients, who underwent TKA and matched the inclusion criteria, were randomized into study (HAL-SJ) and control (CPM) group. Treatment began after drain removal and was carried out until discharge. Primary outcome parameters were raised pre- and postoperatively and included the Oxford knee score (OKS), visual analog scale (VAS), and acquired range of motion. Furthermore complications caused by the device were recorded.

RESULTS

OKS increased in both groups postoperatively, but only significantly in the HAL-SJ group. Postoperative pain improved in both groups without significant differences. Flexion improvement was significant in both groups between days 3/7 and 8 weeks postoperatively. We did not encounter any complications related to HAL-SJ.

CONCLUSIONS

In conclusion, use of the HAL-SJ during rehabilitation in the early postoperative period after TKA was safe without disadvantages compared to the control group and seems to have advantages in terms of daily life impairment.

Spatiotemporal parameters of the operated and non-operated knees before and after unilateral total knee arthroplasty

BACKGROUND

Knee osteoarthritis is a common condition in various orthopedic clinics and hospitals. The aim of this study was to investigate the effects of unilateral total knee arthroplasty (TKA) application on short and long-term spatiotemporal gait parameters, maximum plantar pressure (MPP), and functional status in patients with knee osteoarthritis.

RESEARCH QUESTION

What is the change process in spatiotemporal parameters without any intervention before and after TKA surgery?

METHODS

This study is a prospective and cross-sectional study. Participants were assessed preoperatively at the 1st week (Pre1W), postoperative 1st month (Post1M) and 6th month (Post6M). Spatiotemporal parameters and MMP were assessed using the Win Track platform (Medicapteurs Technology, France) and functional states were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Lequesne Index.

RESULTS

Significant improvements were found in the WOMAC and Lequesne Index values in the Post1M and Post6M periods compared to the preoperative period. However, the improvement in WOMAC and Lequesne Index scores in the Post6M period was significant compared to the scores in the Post1M period (p < 0.01). Spatiotemporal parameters deteriorated in the Post1M period, while improvements were observed in the Post6M period. We observed that patients had worse gait parameters in the near postoperative period than before surgery. It was the period with the greatest improvements in long-term outcomes.

SIGNIFICANCE

In the light of our study results, we think that early gait disturbances in patients who underwent direct TKA may be caused by physiological processes. Therefore, we believe that there is no need for any intervention for gait disorders that occur in the early postoperative period.

The Effect of Continuous Passive Motion in Patients Treated With Total Knee Arthroplasty for Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

The aim of the study was to identify the effectiveness of the continuous passive motion application on clinical outcomes after total knee arthroplasty, based on evidence from recently published high-quality randomized controlled trials.

DESIGN

Two reviewers retrieved platforms of PubMed, Embase, and CENTRAL independently, for identifying eligible randomized controlled trials evaluating the effect of continuous passive motion applied after total knee arthroplasty for knee osteoarthritis. Subgroup meta-analyses were performed for all syntheses based on the follow-up intervals.

RESULTS

A total of 10 randomized controlled trials, involving 841 patients, were finally included. Data were available for 15 different outcomes (including active/passive knee extension/flexion/full range of motion, Western Ontario and McMaster Universities Osteoarthritis Index-pain/physical function/stiffness/total score, visual analogue scale, time up and go, knee girth, Knee Society Scale-function/knee score), at several time points. In general, most of the pools demonstrated similar outcome between continuous passive motion and noncontinuous passive motion groups. Exclusively, the active knee extension at 1 wk (mean difference = 3.00, 95% confidence interval = 0.5-5.5, P = 0.019*), passive knee extension at 1 wk (mean difference = 3.00, 95% confidence interval = 0.28-5.72, P = 0.031*), and 3 mos (mean difference = 3.00, 95% confidence interval = 0.5-5.5, P = 0.019*) were shown to be significantly slightly different between two groups.

CONCLUSIONS

This study demonstrated a limited role of continuous passive motion in patients operated with total knee arthroplasty. Thus, there is at this stage no indication for continuous passive motion procedures in patients operated with total knee arthroplasty as a standard postoperative care.

Effect of continuous passive motion on the early recovery outcomes after total knee arthroplasty

Introduction

Continuous passive motion (CPM) is a frequently used method in the early post-operative rehabilitation of patients after knee surgery. In this study, the effectiveness of the CPM method was evaluated after primary total knee arthroplasty during an early recovery period.

Methods

Eighty patients undergoing total knee arthroplasty were assigned into two groups. The experimental group received CPM and active exercises, while the control group active exercises only. All subjects were evaluated once before the surgery and at a discharge, in terms of mean active range of motion (AROM), mean Knee Society Score (KSS), and Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC).

Results

The mean AROM for the experimental group was 82.3° ± 14.3° and 76.1° ± 22.2° for the control. The mean KSS score was 136.4 ± 19.3 points for the experimental group, and 135.7 ± 15.1 for the control. There were no statistical differences between the two groups. The KSS functional score was 66.4 ± 8.1 points for the experimental group compared to 62.2 ± 7.3 points for the control, but there was a statistically significant difference between the groups at discharge from the hospital (p = 0.009). A subjective estimation of the pain level, joint stiffness and function also showed a statistically significant difference between the two groups (38.6 ± 14.3 points for the CPM group and 21.2 ± 15.7 for the control).

Conclusion

These findings show that there is no significant effect of CPM in terms of improving clinical measurements. However, there was a significant beneficial effect on the subjective assessment of pain level, joint stiffness, and functional ability.

Effect of aqua walking exercise on knee joint angles, muscular strength, and visual analogue scale for patients with limited range of motion of the knee

The purpose of this study is to identify the effects of aqua walking exercise on the joint range of motion (ROM), muscular strength, and pain in patients who have limited knee ROM from surgery or joint fixation. Ten subjects were participated in this study and divided into two groups: continuous passive motion (CPM) therapy+walking exercise on dryland (CWD) and CPM+aqua walking exercise (CAW) groups. The repeated measures analysis of variance was used to verify the difference between the groups and the duration of the program. A paired t-test was used to verify the significance of the observed difference within the groups, and an independent t-test was used to verify the significance of the observed difference between different groups. In this study, ROM in the knee flexion showed interaction effect between the two groups. CAW had a significant increase of knee flexion angle compared to those in CWD. Also, strength on the knee flexors showed interaction effect between the two groups. CAW had a significant increase of knee flexion angle compared to those in CWD, while strength on the knee extensors showed no significant interaction effect between groups. Visual analogue scale (VAS) score showed interaction between the two groups. CAW had a significant increase of the VAS scores compared to those in CWD. Given these findings reported in present study, aqua walking exercise for patients with osteoarthritis is a very safe and effective therapeutic strategies that can move the joint in the optimal ROM.

Feasibility and efficacy of knee extension training using a single-joint hybrid assistive limb, versus conventional rehabilitation during the early postoperative period after total knee arthroplasty

Objectives: To evaluate the feasibility and efficacy of treatment for the recovery of knee joint function after total knee arthroplasty (TKA) using a robotic suit.

Patients and Methods: Knee joint extension exercise sessions were started with a robotic suit (single-joint hybrid assistive limb [HAL-SJ, Cyberdyne, Inc., Tsukuba, Japan]) in one group of patients after TKA. Patients who underwent standard rehabilitation were enrolled in the control group. To evaluate feasibility and safety, we assessed the adverse events, the number of training sessions, and training time. We compared the changes in knee joint pain and extension lag (°) between the groups.

Results: The average age was 71.3 ± 6.2 years in the HAL-SJ group and 74.9 ± 8.7 years in the control group. There were no severe adverse events. In the HAL-SJ group, training was performed 2.9 times, on average, and lasted 18.8 min. In the HAL-SJ group, there was a reduction in the visual analog scale (VAS) for pain after training, which was not significant. In the control group, the VAS score worsened after the sessions. The extension lag significantly improved in the HAL-SJ group after the 2nd and 3rd sessions, and this was more due to improvements in their active extension range of motion than their passive extension range of motion.

Conclusions: HAL-SJ-based training is safe and effective, and leads to instantaneous improvement of extension lag, without worsening knee joint pain. HAL-SJ-based knee extension training could represent a viable novel post-TKA rehabilitation modality.

Impact of continuous passive motion on rehabilitation following total knee arthroplasty

BACKGROUND AND PURPOSE

There is an ongoing controversy in respect of the usage of continuous passive motion (CPM) following total knee arthroplasty (TKA). We analysed the impact of CPM on the early rehabilitation after TKA and the clinical outcome over the time.

METHODS

Forty patients were prospectively randomized to postoperative protocols following TKA. Half of them (n = 20) received the standard manual therapy alone and the others (n = 20) were treated additionally with CPM. Identical implants were used in all patients. Passive range of movement (PROM) was noted. Patient satisfaction and knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as well as the Knee Society Score (KSS) at time of discharge and 2 years postoperatively.

RESULTS

The patients in the solitary manual therapy group (MT) showed preoperatively a 7.2° greater PROM (p = .03) with 5.4° higher flexion (p = .05). Analogously, the KSS presented with 42.7 points a higher score result compared to the CPM group with 35.9 points (p = .03). Although the preoperative ability with 105.2° for flexion and 97.2° for the PROM were in favour of the group without CPM (99.8° resp. 90.0°), at time of discharge the patients with CPM reached with 111.0° a significant higher flexion and with 109.0° a higher PROM (MT group: 107.0° resp. 103.5°) (p = .04/.02). At 2 years follow-up both scores (WOMAC/KSS) and function (extension, flexion and PROM) were balanced (p > .05). Patella resurfacing showed no impact on the clinical results at discharge or at time of last follow-up (p > .05).

DISCUSSION

Although the addition of CPM did significantly improve knee flexion in the early postoperative stage, the difference might not represent a clinical relevance. Further, there were no notable effects on long-term clinical and functional results following TKA, so the routine application of CPM in the above stated setting might be ceased.

The effects of immediate programmed cryotherapy and continuous passive motion in patients after computer-assisted total knee arthroplasty: a prospective, randomized controlled trial

Background

The postoperative nursing intervention with immediate cryotherapy and continuous passive motion (CPM) remains elusive regarding the postoperative pain and range of motion (ROM) for patients undergoing computer-assisted total knee arthroplasty (CAS-TKA).

Methods

A prospective, randomized controlled trial with a purposive sampling method was utilized. Sixty patients scheduled for a unilateral CAS-TKA at a medical center were randomly assigned to the intervention group (n = 30) and control group (n = 30). The intervention group applied programed cryotherapy and CPM within 1 h while returning to the ward on the day of surgery, while the control group did not. Data were analyzed using mixed models to compare the numeric rating scale (NRS) for pain, ROM, and swelling at postoperative day (POD) 4.

Results

There was no significant difference in the NRS score between the groups (p = 0.168). The intervention group had significantly higher ROM than the control group (98° vs. 91°, p = 0.004) at POD 4. Although no significant difference in joint swelling was found between groups (p = 0.157), the intervention group had lower mean joint swelling (32.2 cm) than the control group (33.9 cm).

Conclusions

Immediate programmed cryotherapy and continuous passive motion could help to improve ROM quickly after CAS-TKA. It should be incorporated into the daily nursing plan for patients undergoing CAS-TKA.

Trial registration

ClinicalTrials.gov, NCT04136431. Registered 23 October 2019—retrospectively registered

Physical Therapist Management of Total Knee Arthroplasty

A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.

Novel Design and Adaptive Fuzzy Control of a Lower-Limb Elderly Rehabilitation

Design and control of a lower-limb exoskeleton rehabilitation of the elderly are the main challenge for health care in the past decades. In order to satisfy the requirements of the elderly or disabled users, this paper presents a novel design and adaptive fuzzy control of lower-limb empowered rehabilitation, namely MOVING UP. Different from other rehabilitation devices, this article considers active rehabilitation training devices. Firstly, a novel product design method based on user experience is proposed for the lower-limb elderly exoskeleton rehabilitation. At the same time, in order to achieve a stable operation control for the assistant rehabilitation system, an adaptive fuzzy control scheme is discussed. Finally, the feasibility of the design and control method is validated with a detailed simulation study and the human-interaction test. With the booming demand in the global market for the assistive lower-limb exoskeleton, the methodology developed in this paper will bring more research and manufacturing interests.

Preoperative range of motion and applications of continuous passive motion predict outcomes after knee arthroplasty in patients with arthritis

PURPOSE

This study evaluated the clinical efficacy of continuous passive motion (CPM) following knee arthroplasty and determined the predictors of effect sizes of range of motion (ROM) and functional outcomes in patients with knee arthritis.

METHODS

A comprehensive electronic database search was performed for randomized controlled trials (RCTs), without publication year or language restrictions. The included RCTs were analyzed through meta-analysis and risk of bias assessment. Study methodological quality (MQ) was assessed using the Physiotherapy Evidence Database (PEDro) scale. Inverse-variance weighted univariate and multivariate metaregression analyses were performed to determine the predictors of treatment outcomes.

RESULTS

A total of 77 RCTs with PEDro scores ranging from 6/10 to 8/10 were included. Meta-analyses revealed an overall significant favorable effect of CPM on treatment success rates [odds ratio: 3.64, 95% confidence interval (CI) 2.21-6.00]. Significant immediate [postoperative day 14; standard mean difference (SMD): 1.06; 95% CI 0.61-1.51] and short-term (3-month follow-up; SMD: 0.80; 95% CI 0.45-1.15) effects on knee ROM and a long-term effect on function (12-month follow-up; SMD: 1.08; 95% CI 0.28-1.89) were observed. The preoperative ROM, postoperative day of CPM initiation, daily ROM increment, and total application days were significant independent predictors of CPM efficacy.

CONCLUSION

Early CPM initiation with rapid progress over a long duration of CPM application predicts higher treatment effect on knee ROM and function. The results were based on a moderate level of evidence, with good MQ and potential blinding biases in the included RCTs. An aggressive protocol of CPM has clinically relevant beneficial short-term and long-term effects on postoperative outcomes.

LEVEL OF EVIDENCE

II.

Continuous Passive Motion After Total Knee Arthroplasty: A Systematic Review and Meta-analysis of Associated Effects on Clinical Outcomes

OBJECTIVE

To evaluate the efficacy of continuous passive motion (CPM) after total knee arthroplasty (TKA) and whether the use of CPM is related to improved clinical and functional outcomes.

DATA SOURCES

A systematic MEDLINE search via Web of Science, Cochrane Library, and PubMed databases was conducted.

STUDY SELECTION

English-language articles published between January 2000 and May 2018 reporting the related clinical outcomes of CPM after TKA were included. A total of 3334 titles and abstracts were preliminarily reviewed, of which 16 studies were included according to the eligibility criteria.

DATA EXTRACTION

Two different reviewers were selected to perform the study extraction, independent of each other. If there were any disagreements regarding the final list of studies, the third reviewer reviewed the list as an arbitrator for completeness.

DATA SYNTHESIS

A total of 16 trials with 1224 patients were included. The pooled results revealed that use of CPM did not show a statistically significant improvement of postoperative knee range of motion (ROM) except for middle-term passive knee extension and long-term active knee flexion ROM. Also, CPM therapy did not show a significant positive effect on the functional outcomes. No significant reduction in length of stay (LOS) and incidence of adverse events (AEs) was identified.

CONCLUSION

Among patients undergoing TKA, neither the ROM nor the functional outcomes could be improved by CPM therapy. Moreover, the risk of AEs and LOS could not be reduced by application of CPM. The current available evidence suggested that this intervention was insufficient to be used routinely in clinical practice.

Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors

BACKGROUND

Total knee arthroplasty is regarded as the most effective treatment for severe knee osteoarthritis. The influential factors of blood loss in total knee arthroplasty remain controversial. The study aims to explore the influential factors of blood loss in total knee arthroplasty comprehensively.

MATERIAL AND METHODS

Three hundred and four osteoarthritis patients undergoing unilateral primary total knee arthroplasty were enrolled. Demographic characteristics, laboratory results, surgical protocol, and hemostatic and anticoagulation drugs were collected. Estimation of blood loss was calculated using the Gross equation. Multivariable stepwise linear regression analysis was performed to find out the influential factors.

RESULTS

Total blood loss reached the biggest volume (1346 ± 671 mL) in the post-operative third day. Hidden blood loss reached 465 ± 358 mL. Gender, tranexamic acid, prosthesis type, and drainage were proven to be positively correlated with the total blood loss (all P < 0.05). Male appeared to suffer more surgical blood loss than female. Posterior cruciate stabilizing prosthesis might lead to more surgical blood loss than posterior cruciate retaining prosthesis. Tranexamic acid could effectively reduce total blood loss while drainage might increase bleeding. Gender and anticoagulation drugs were correlated with hidden blood loss (both P < 0.05). Low molecular weight heparin resulted in less hidden blood loss than rivaroxaban.

CONCLUSIONS

Posterior cruciate retaining prosthesis and topical use of tranexamic acid were preferred to reduce total blood loss. Drainage was not recommended due to the risk of increasing bleeding. Low molecular weight heparin was recommended to prevent venous thrombosis.

Systematic Review of Three Electrical Stimulation Techniques for Rehabilitation After Total Knee Arthroplasty

BACKGROUND

The comparative effectiveness of neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and electroacupuncture (EA) for improving patient rehabilitation following total knee arthroplasty (TKA) is controversial. Therefore we conducted this systematic review to assess the available evidence.

METHODS

The PubMed, OVID, and ScienceDirect databases were comprehensively searched and studies were selected and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Data were extracted and qualitatively synthesized for several outcomes.

RESULTS

Data were analyzed from 17 randomized controlled trials involving 1285 procedures: 8 NMES studies (608 procedures), 7 TENS studies (560 procedures), and 2 EA studies (117 procedures). Qualitative analysis suggested that NMES was associated with higher quadriceps strength and functional recovery after TKA. Recovery benefits were maximal when the stimulation was performed once or twice a day for 4-6 weeks at an intensity of 100-120 mA and frequency of 30-100 Hz. The electrode should be sufficiently large (100-200 cm²) to reduce discomfort. TENS at an intensity of 15-40 mA and frequency of 70-150 Hz provided effective analgesia after TKA. EA at an intensity of 2 mA and frequency of 2 Hz may also provide postoperative analgesia of TKA.

CONCLUSION

As adjunct modalities, NMES and TENS can effectively improve rehabilitation after TKA without triggering significant intolerance, and maximal benefits depend on optimized parameters and intervention protocols. EA may be an effective adjunct modality for analgesia after TKA.