Home-Based Exercise With Blood Flow Restriction to Improve Quadriceps Muscle and Physical Function After Total Knee Arthroplasty: A Case Report.

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Department of Kinesiology and Integrative Physiology


BACKGROUND AND PURPOSE: After total knee arthroplasty (TKA), persistent quadriceps muscle atrophy and weakness impairs physical function. Blood flow restriction (BFR) exercise is emerging as a potential method to improve muscle size and strength in clinical populations with orthopedic limitations. There are no randomized controlled studies documenting BFR exercise after TKA. This case report describes the use of home-based BFR exercise to increase quadriceps size, strength, and physical function after TKA.

CASE DESCRIPTION: A 59-year-old man (6 months post-TKA) performed body weight and walking exercises with BFR 5x/wk for 8 weeks. Blood flow in the TKA leg was restricted using a thigh cuff inflated to 50% of limb occlusion pressure. Lean leg mass, vastus lateralis thickness, knee extensor strength, and physical function were measured at baseline (6 months post-TKA), post-training (8 months post-TKA), and long-term follow-up (14 months post-TKA).

OUTCOMES: After training, lean leg mass, vastus lateralis thickness, and knee extensor strength in the TKA leg increased by 4%, 14%, and 55%, respectively. Compared to baseline, post-training knee extensor strength symmetry (TKA/uninvolved leg) increased from 64% to 98%. The patient's performance improved for the 30s chair stand, 40m fast walk, and 6min walk tests. Increased quadriceps and physical function were maintained at the long-term follow-up.

DISCUSSION: With enhanced quadriceps and physical function, the patient resumed independent physical activity. Muscle and strength gains surpassed those typically reported after TKA. Outcomes suggest that home-based BFR exercise was feasible, safe, and effective. BFR exercise after TKA is promising and warrants further research.

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© American Physical Therapy Association 2019. Publisher's version of record: https://doi.org/10.1093/ptj/pzz110

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Physical therapy