Knee Osteoarthritis Clinical Trial
Official title:
Radiofrequency Facilitates the Prehabilitation Process in Patients Undergoing Total Knee Arthroplasty: Effects on Preoperative and Postoperative Functional Capacity. A Double Blind Randomized Controlled Trial
The purpose of this study is to compare the effects of the radiofrequency applied to the
sensory innervation of the knee, with respect to a control group (standard therapy), in a
prehabilitation program aiming to improve the functional recovery of patients undergoing TKA.
In the present study, the investigators hypothesize that participants treated with
radiofrequency 4-6 weeks before the surgery, should be able to effectively accomplish the
prehabilitation program and, therefore, have a faster recovery of their functional status in
the post operative period , compared with the control group (That use the present state of
the art approach)
Postoperative functional capacity following TKA surgery has been strongly associated with
preoperative functional status. Presence of pain, poor strength and flexibility, and limited
ability to complete physiological tasks have been shown to be consistent predictors of poor
recovery from knee surgery.
The postoperative period is associated with 30-40% decrease in functional capacity, and
efforts have been made to facilitate the recovery by implementing rehabilitative measures
over the period of weeks and months. However, the postoperative period might not be the best
time to engage patients in intensive physiotherapy as they are easily tired and in pain.
Preparing patients for the stress of surgery, called also prehabilitation, is emerging as a
mean to optimize pre-operative status and increase functional reserve thus, increasing
surgical stress tolerance. Observational and randomized controlled studies in patients
scheduled for colorectal, thoracic, and spinal surgeries have suggested that a 4-6 weeks of
moderate preoperative physical activity can lead to significant postoperative improvements in
cardiorespiratory reserve and functional capacity. However, preliminary trials on the effect
of a 6-8 weeks prehabilitation program with structured exercises prior to knee arthroplasty
have reported contrasting results, and one of the reasons might be the high levels of pain
encountered by these patients while exercising, therefore making it difficult to engage them
in achieving effective prehabilitation. It would therefore, make sense if efforts were
directed towards relieving pain thus, facilitating broader fitness enhancement strategies and
improving the surgical experience and the recovery process.
Common pharmacological methods to relieve osteoarthritic pain while waiting for surgery,
include acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDS and Cox-2 inhibitors)
and occasionally opioids. Non-surgical interventions, such as intra-articular injection with
steroids or hyaluronic acids, acupuncture and periosteal stimulation therapy, are often used
as complementary therapies of limited benefit. The use of pulsed and Continuous
radiofrequency (PRF and CRF) to the saphenous nerve and the genicular nerves branches of the
knee, have been shown to decrease significantly pain scores in 44% of patients with chronic
OA of the knee for up to one year after the treatment. Akbasa et al. using the Western
Ontario and McMaster Osteoarthritis Index (WOMAC), reported significant reduction of pain at
rest, movement and flexion of the knee and increase in patient's satisfaction 6 months after
the PRF treatment. Our group has recently demonstrated the benefits of radiofrequency
treatment in patients waiting for total knee replacement TKA 9. More so, the investigators
recent results reported to the American Society of Regional Anesthesia and Pain, showed in a
randomized controlled trial promising results in terms of faster recovery of patients
undergoing TKA, when they received RF instead of the standard postoperative analgesia
technique 10.
The present study is, as mentioned above, related to an already approved and finished study
in this institution: 15-209-MUHC "Functional outcome and postoperative analgesia following
total knee arthroplasty: a prospective, randomized, double blind comparison between
continuous adductor canal block and pulsed radiofrequency of saphenous and genicular nerves
of the knee". In that study, our research group was investigating the effects of the
Radiofrequency treatment preoperatively on the postoperative pain and functional recovery, in
patients who did not participate in a prehabilitation program.
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