Abstract
Despite technological advances in total knee arthroplasty (TKA), management of postoperative
muscle weakness and pain continue to pose challenges for both patients and health
care providers. Nonpharmacologic therapies, such as neuromodulation in the form of
neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation
(TENS), and other modalities, such as cryotherapy and prehabilitation, have been highlighted
as possible adjuncts to standard-of-care pharmacologic management to treat postoperative
pain and muscle weakness. The aim of this review was to discuss existing evidence
for neuromodulation in the treatment of pain and muscular weakness following TKA,
and to shed light on other noninvasive and potential future modalities. Our review
of the literature demonstrated that NMES, prehabilitation, and some specialized exercises
are beneficial for postoperative muscle weakness, and TENS, cooling therapies, and
compression may help to alleviate post-TKA pain. However, there are no clear guidelines
for the use of these modalities. Further studies should be aimed at developing guidelines
or delineating indications for neuromodulation and other nonpharmacologic therapies
in the management of post-TKA pain and muscle weakness.
Keywords
pain management - total knee arthroplasty - strengthening - nonpharmacologic
