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CompletedNCT01713140Updated Jun 25, 2013

Experimental Study of Strength Training to Activate the Quadriceps Muscle After Total Knee Arthroplasty

An interventional study of 1 strength training set performed until contraction failure in Osteoarthritis, Knee, sponsored by Copenhagen University Hospital, Hvidovre. Completed at 1 site in Denmark. Open to participants aged 18 Years to 80 Years. Per ClinicalTrials.gov, last updated 2013-06-25.

Sponsored by Copenhagen University Hospital, Hvidovre · Not applicable, Interventional, and Basic science

Phase
Not applicable
Study type
Interventional
Enrollment
20
Allocation
Not applicable
Ages
18 Years to 80 Years
Sex
All
01

Study summary

Background:

Progressive strength training is a training modality used in rehabilitation after total knee arthroplasty (TKA). Strength deficits up to 80% in the quadriceps muscle is shown to be present in the operated leg after TKA, which relates to reduced central nervous system (CNS) activation of the muscle. As increased CNS activation occurs during strength training when muscular fatigue is approaching in healthy subjects, it is relevant to investigate if this also is the case after TKA. The clinical implication is that repetitions performed to contraction failure during strength training, may help reduce CNS activation deficits of the quadriceps muscle after TKA.

Purpose:

The aim of this study is to investigate CNS activation of the quadriceps muscle during strength training performed with repetitions to contraction failure after TKA.

Method:

Electromyographic (EMG) activity of the vastus medialis (VM), vastus lateralis (VL), semitendinosus (ST) and biceps femoris (BF) muscles will be recorded during knee extensions performed in a knee extension machine until contraction failure. The relative loading will be 10 repetition maximum (RM). The absolute load (kilograms) corresponding to 10 RM is defined a minimum of 3 days before the day where the EMG-data are recorded. The primary outcomes will be normalized EMG amplitude and median power frequency for each 10th (10%, 20%, 30% failure, etc.) of the set to failure.

Hypothesis:

Based on previous findings in healthy subjects, we hypothesize that in patients with a TKA, the EMG amplitude will increase while the median power frequency will decrease during a strength training set performed to contraction failure after TKA.

02

Conditions studied

  • Osteoarthritis, Knee

Keywords

  • strength training
  • resistance training
  • fatigue
  • knee extension
  • total knee arthroplasty
  • total knee replacement
  • electromyography
  • physical therapy modalities
03

In context

Osteoarthritis, Knee

3,302 studies on the registry are indexed under Osteoarthritis, Knee; 608 are open to participants now.

This study's enrollment of 20 is below the median of 70 across 2,731 interventional studies indexed under Osteoarthritis, Knee.

Browse Osteoarthritis, Knee studies →

Lead sponsor

Copenhagen University Hospital, Hvidovre is the lead sponsor of 76 studies on the registry; 17 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 80 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Unilateral primary TKA
  • Between the age of 18 to 80 years
  • Understand and speak Danish
  • Informed consent
  • 4 to 8 weeks after TKA

Exclusion criteria

Exclusion Criteria:

  • Disease/Musculoskeletal disorder, which requires special rehabilitation modality
  • Alcohol and drug abuse
  • Lack of wish to participate or unwillingness to sign an informed consent
05

Study design

Phase
Not applicable
Primary purpose
Basic science
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
20 participants (actual)

Study arms

  • Experimental
    1 strength training set performed until contraction failure

    Knee extensions until contraction failure will be performed, using a relative loading of 10 repetition maximum (RM).

    Other: 1 strength training set performed until contraction failure

Interventions

  • Other1 strength training set performed until contraction failure

    Electromyographic (EMG) activity of the vastus medialis (VM), vastus lateralis (VL), semitendinosus (ST) and biceps femoris (BF) muscles will be recorded during knee extensions performed in a knee extension machine in a single set performed until contraction failure. The relative loading will be 10 repetition maximum (RM). The absolute load (kilograms) corresponding to 10 RM is defined a minimum of 3 days before the day where the EMG-data are recorded. Range of motion and time under tension for each repetition will be controlled for.

    Also known as: Resistance training.

06

What researchers measure

Primary outcomes

  1. Change from 10% contraction failure in normalized EMG amplitude (%EMGmax).

    EMG amplitude-data from the set performed until contraction failure will be reduced to time points corresponding to 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100% contraction failure.

    Time frame: 10% to 100% contraction failure in a single set performed until contraction failure. The set is performed at a single day, 4 to 8 weeks after surgery.

  2. Change from 10% contraction failure in median power frequency (Hz)

    Median power frequency-data from the set performed until contraction failure will be reduced to time points corresponding to 10, 20, 30, 40, 50, 60, 70, 80, 90, and 100% contraction failure.

    Time frame: 10% to 100% contraction failure in a single set performed until contraction failure. The set is performed at a single day, 4 to 8 weeks after surgery.

Secondary outcomes

  1. Change from baseline (pre strength training) in Nm/kg body mass

    Maximal isometric knee-extension force will be measured, using a fixated hand-held dynamometer, and expressed as the maximal voluntary torque per kilo body mass, using the external lever arm and body weight of each subject.

    Time frame: From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery.

  2. Change from baseline (pre strength training) in knee pain (VAS-mm)

    Knee pain is scored by each subject at rest and during strength training, using a standard VAS-ruler with endpoints of "no pain" (0 mm) and "worst pain imaginable" (100 mm).

    Time frame: From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery.

Other outcomes

  1. Change from baseline (pre strength training) in perceived exertion (Borg CR 10 scale points)

    The rate of perceived exertion scale (Borg CR 10) is used to monitor the subjects self-reported experience of exertion.

    Time frame: From baseline (pre strength training) to after the set. The set is performed at a single day, 4 to 8 weeks after surgery.

07

Study locations

1 site
  • Clinical Reaserch Center, Copenhagen University Hospital, Hvidovre
    Copenhagen, Hvidovre 2650, Denmark
08

References and documents

Publications

  • Thomas AC, Stevens-Lapsley JE. Importance of attenuating quadriceps activation deficits after total knee arthroplasty. Exerc Sport Sci Rev. 2012 Apr;40(2):95-101. doi: 10.1097/JES.0b013e31824a732b. PubMed 22249398 ↗
  • Jakobsen TL, Husted H, Kehlet H, Bandholm T. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible? Disabil Rehabil. 2012;34(12):1034-40. doi: 10.3109/09638288.2011.629019. Epub 2011 Nov 15. PubMed 22084974 ↗
  • Sundstrup E, Jakobsen MD, Andersen CH, Zebis MK, Mortensen OS, Andersen LL. Muscle activation strategies during strength training with heavy loading vs. repetitions to failure. J Strength Cond Res. 2012 Jul;26(7):1897-903. doi: 10.1519/JSC.0b013e318239c38e. PubMed 21986694 ↗
  • Mikkelsen EK, Jakobsen TL, Holsgaard-Larsen A, Andersen LL, Bandholm T. Strength Training to Contraction Failure Increases Voluntary Activation of the Quadriceps Muscle Shortly After Total Knee Arthroplasty: A Cross-sectional Study. Am J Phys Med Rehabil. 2016 Mar;95(3):194-203. doi: 10.1097/PHM.0000000000000361. PubMed 26339729 ↗
09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Jun 25, 2013, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT01713140
Lead sponsor
Copenhagen University Hospital, Hvidovre
Collaborators
University of Southern Denmark
Responsible party
Elin Andersson (Physiotherapist, Copenhagen University Hospital, Hvidovre) — Principal investigator
First posted
Oct 24, 2012
Start date
Oct 2012
Primary completion
Mar 2013
Completion
Mar 2013
Last update
Jun 25, 2013

Study contacts

Thomas Bandholm, PhD
study director · Clinical Research Center, Copenhagen University Hospital, Hvidovre, Denmark

Oversight

Data monitoring committee
Yes
View the source record on ClinicalTrials.gov ↗

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