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Ergometer Cycling After Hip or Knee Replacement SurgeryA Randomized Controlled Trial
Thoralf R. Liebs, MD1; Wolfgang Herzberg, MD2; Wolfgang Rüther, MD, PhD3; Jörg Haasters, MD, PhD4; Martin Russlies, MD, PhD5; Joachim Hassenpflug, MD, PhD1
1 Department of Orthopaedic Surgery, University of Schleswig-Holstein Medical Center, Campus Kiel, Michaelisstrasse 1, 24105 Kiel, Germany. E-mail address for T.R. Liebs: liebs@liebs.eu
2 Department of Orthopaedic Surgery, Asklepios Westklinikum Hamburg, Suurheid 20, 22559 Hamburg, Germany
3 Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
4 Department I of Orthopaedic Surgery, Ostseeklinik Damp, Seute-Deern-Ring 20, 24351 Damp, Germany
5 Department of Orthopaedic Surgery, University of Schleswig-Holstein Medical Center, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Society for Support of Research in and Fighting of Rheumatic Diseases, Bad Bramstedt; Society for Support of Rehabilitation Research, Schleswig-Holstein; State Insurance Agency of the Free and Hanseatic City of Hamburg; and German Arthrosis Society. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedic Surgery, University of Schleswig-Holstein Medical Center, Kiel and Lübeck; Department of Surgery, Wedel Hospital, Wedel; Department I of Orthopaedic Surgery, Ostseeklinik Damp, Damp; Department of Orthopaedic Surgery, Klinikum Bad Bramstedt, Bad Bramstedt; and University Medical Center Hamburg-Eppendorf, Hamburg, Germany

on behalf of the Multicenter Arthroplasty Aftercare Project (MAAP)

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Apr 01;92(4):814-822. doi: 10.2106/JBJS.H.01359
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Abstract

Background: 

The optimal treatment strategy following primary total hip or knee replacement remains unknown. The purpose of this study was to evaluate the effect of ergometer cycling after hip or knee replacement surgery on health-related quality of life and patient satisfaction.

Methods: 

Three hundred and sixty-two patients were randomly assigned to either perform or not perform ergometer cycling beginning two weeks after total hip or knee replacement. The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at three, six, twelve, and twenty-four months postoperatively. Results were compared with published thresholds for minimal clinically important improvements.

Results: 

The baseline characteristics of the two groups were similar. After the hip arthroplasties, all of the outcome parameters were superior in the ergometer cycling group at all follow-up intervals, and the primary outcome, physical function as measured with the WOMAC, was significantly better at three months (21.6 compared with 16.4 points, effect size = 0.33, p = 0.046) and twenty-four months (14.7 compared with 9.0 points, effect size = 0.37, p = 0.019). After the hip arthroplasties, a higher percentage of the ergometer cycling group was "very satisfied" at all follow-up intervals (for example, 92% compared with 80% at three months; p = 0.027). The significant differences in the primary outcome exceeded the absolute minimal clinically important improvement threshold by a factor of 2.0. No significant differences between the study groups were seen after the knee arthroplasties.

Conclusions: 

Ergometer cycling after total hip arthroplasty is an effective means of achieving significant and clinically important improvement in patients’ early and late health-related quality of life and satisfaction. However, this study does not support the use of ergometer cycling after knee arthroplasty.

Level of Evidence: 

Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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