X10, In-Home Prehabilitation Increases Post-Surgical Range of Motion, Quadriceps and Calf Strength

The efficacy of prehabilitation, for knee surgery, is controversial. Meta analyses show that range of motion is improved, but not quadriceps or hamstring strength. Here, we evaluate prehabilitation using the newly patented, computerized, in-home, X10 knee recovery system for both prehabilitation and rehabilitation. We retrospectively examined 201 patients at multiple time points for range of motion (extension, flexion), quadriceps, hamstring, and calf strength between the intervention group (n=125) which used the X10 for both prehabilitation (2-3 weeks) and rehabilitation (3-4 weeks)and the control group (n=76) which used the X10 for only rehabilitation (3-4 weeks). Range of motion was measured by the X10 machine using an ultrasensitive inclinometer and strength was measured as pressure applied to a load cell. We also compared X10 prehabilitation and rehabilitation to standard physical therapy using a literature study (Calatayud et al. 2017).

Prior to surgery, prehabilitation significantly improved extension, 8.0°(5.8°) mean (standard deviation), flexion 12.1°(12.3°), range of motion 16.0° (16.7°); quadriceps strength 5.8 (5.4) kg, hamstring strength 2.5 (2.3) kg, and calf strength 11.2 (9.3) kg. Post-surgically, X10 prehabilitation increased flexion 120.7° (10.7°) vs 113.8° (13.0°), range of motion, 120.4°(11.6°) vs 112.9° (11.7°). X10 prehabilitation improved quadriceps strength 5.5%, while the non-prehabilitation group lost 17.1%. Calf strength improved in the prehabilitation group by 30.5%, but only 0.2% in the control group. Hamstring strength was unchanged. Compared to standard physical therapy, X10 prehabilitation and rehabilitation were superior.

Keywords: Knee, Prehabilitation, X10, Total knee arthroplasty

Abbreviations: RoM: Range of motion; NIMS: Neuromuscular stimulations, KG: kilogram, ANOVA: Analysis of Variance; TUG: Timed up and go test; NS: Not Significant