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The Use of Electrical Stimulation to Increase Quadriceps Femoris Muscle Force in an Elderly Patient Following a Total Knee Arthroplasty

Mr Lewek, PT, MPT, is a doctoral student, Department of Biomechanics and Movement Science, University of Delaware. He was a graduate student in the Department of Physical Therapy, University of Delaware, on affiliation at the University of Delaware Physical Therapy Clinic at the time the patient was managed for this case report.
J Stevens, PT, MPT, is a doctoral student, Department of Biomechanics and Movement Science, University of Delaware. She was Clinical Instructor, University of Delaware Physical Therapy Clinic, at the time the patient was managed
L Snyder-Mackler, PT, ScD, SCS, ATC, is Associate Professor, Department of Physical Therapy, and Academic Director, Physical Therapy Clinic, University of Delaware

Address all correspondence to Mr Lewek at Department of Physical Therapy, University of Delaware, 303 McKinly Lab, Newark, DE 19711 (USA) (mlewek{at}udel.edu)

Background and Purpose. Persistent residual quadriceps femoris muscle force deficits after total knee arthroplasty (TKA) are commonly reported and can prevent patients from returning quickly and fully to functional activities. Neuromuscular electrical stimulation offers a potentially more effective means of increasing muscle force than current rehabilitation protocols. Case Description. The patient was a 66-year-old man. Neuromuscular electrical stimulation for increasing quadriceps femoris muscle force was initiated 3 weeks after TKA for 11 sessions to supplement stretching exercises and a high-intensity volitional strengthening program. Outcome. The patient's isometric quadriceps femoris muscle force increased from 50% (involved/uninvolved) at 3 weeks after surgery to 86% at 8 weeks after surgery. A concurrent increase in his uninvolved quadriceps femoris muscle force concealed the patient's true increase in his involved quadriceps femoris muscle force in a side-to-side comparison. The patient's final involved quadriceps femoris muscle force (10 weeks after surgery) was 93% of the initial uninvolved quadriceps femoris muscle force. Discussion. Our patient was able to return to independent activities of daily living and recreational activities, with force gains that surpassed those reported in the literature.

Key Words: Geriatrics • Neuromuscular electrical stimulation • Quadriceps femoris muscle • Strength training • Total knee arthroplasty

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