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Journal of Chinese Integrative Medicine ›› 2012, Vol. 10 ›› Issue (11): 1247-1253.doi: 10.3736/jcim20121108

Special Issue: Massages

• Original Clinical Research • Previous Articles     Next Articles

Effects of early application of Tuina treatment on quadriceps surface myoelectricity in patients after total knee arthroplasty: a randomized controlled trial

Nian-hong Wang1, Jun-tao Yan2(), Wu-quan Sun2, Yong-shan Hu1, Jun Xia3, Li-cheng Wei3, Jie Jia1, Gui-lin Ouyang4, Yong He4, Yan-ming Guo5, Jie Xu5   

  1. 1. Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
    2. Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
    3. Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai 200040, China
    4. Department of Orthopedics, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 200052, China
    5. Department of Rehabilitation Medicine, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 200052, China
  • Received:2012-04-10 Accepted:2012-05-25 Online:2012-11-20 Published:2018-11-15

Background: Total knee replacement surgery is commonly used in end-stage diseases of the knee. It is important for improving surgical efficacy and patient satisfaction by promoting early rehabilitation of patients and improving knee function.

Objective: To observe the effects of early application of Tuina treatment on quadriceps surface electromyography (EMG) in patients with rheumatoid arthritis having undergone total knee arthroplasty.

Design, setting, participants and intervention: The study was performed at the Orthopedic Department of Huashan Hospital, Fudan University, and the Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine from June 2010 to September 2011. A total of 66 patients with rheumatoid arthritis who had undergone total knee replacement surgery were randomly divided into control group and observation group, 33 cases in each. The patients in the control group were administered with continuous passive training (CPM), and the patients in the observation group were treated with CPM combined with Tuina, from prior surgery to four weeks post-surgery.


Main outcome measures: The knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire at baseline and 4 weeks after the surgery. Quadriceps surface EMG was also detected at the same time points.

Results: After 4 weeks of Tuina and comprehensive rehabilitation intervention, the WOMAC questionnaire score of the observation group was decreased compared with the control group (P<0.01); median frequency and integrated electromyography of the rectus femoris and vastus medialis muscles, which were recorded by EMG, in the observation group were higher than those in the control group (P<0.01).

Conclusion: Tuina can improve the recovery of patients who have undergone total knee replacement by increasing quadriceps EMG.

Key words: arthritis,rheumatoid, total knee replacement, Tuina, electromyography, randomized controlled trial

Table 1

General condition of patients with rheumatoid arthritis in two groups before surgery"

Item Control group (n=28) Observation group (n=30) P value
Gender (male/female) 5/23 5/25 0.905
Age (Mean±SD, years) 62.6±10.3 58.3±12.3 0.184
Height (Mean±SD, cm) 159.16±6.07 160.21±6.72 0.569
Body weight (Mean±SD, kg) 58.82±10.24 62.54±12.55 0.26
Body mass index (Mean±SD, kg/m2) 23.23±4.06 24.33±4.15 0.357
RA disease duration (Mean±SD, years) 15.36±9.24 14.83±8.67 0.841
Exacerbations time (Mean±SD, years) 1.68±2.15 1.88±3.13 0.806
Knee deformity degree (Mean±SD, °) 12.95±10.31 13.70±12.08 0.826
Varus/valgus deformity (Mean±SD, °) 5.14±6.21 4.57±6.01 0.755

Figure 1

Flow diagram of this trial"

Table 2

WOMAC score before and four weeks after surgery in two groups (Mean±standard deviation)"

Group n Score of pain Score of stiffness Score of function Total score
Before After 4 weeks Before After 4 weeks Before After 4 weeks Before After 4 weeks
Control 28 10.73±4.61 4.79±2.57 2.24±2.21 3.09±2.22 24.09±14.68 25.24±10.30 37.06±17.07 33.12±11.07
Observation 30 10.06±3.90 6.65±3.54 1.97±1.64 2.45±2.01 20.03±14.64 12.68±5.47 31.68±17.74 21.77±9.19
P value 0.538 0.352 0.576 0.595 0.273 0.000 0.221 0.000

Table 3

Median frequency under 60°/s angular velocity isokinetic exercise of different muscles before and four weeks after surgery in two groups (Mean±standard deviation, Hz)"

Group n Rectus femoris Vastus medialis Vastus lateralis Semitendinosus
Before After 4 weeks Before After 4 weeks Before After 4 weeks Before After 4 weeks
Control 15 50.05±10.98 39.45±7.20 39.25±3.88 34.42±4.55 47.02±15.14 43.21±4.83 54.00±23.41 26.94±14.32
Observation 15 51.69±9.26 52.90±4.92 43.02±6.46 45.30±4.11 54.29±4.18 47.65±12.15 36.78±8.01 34.00±18.25
P value 0.827 0.000 0.356 0.000 0.414 0.318 0.214 0.377

Table 4

Muscle integrated myoelectricity under 60°/s angular velocity isokinetic exercise of different muscles before and four weeks after surgery in two groups (Mean±standard deviation, μV*s)"

Group n Rectus femoris Vastus medialis Vastus lateralis Semitendinosus
Before After 4 weeks Before After 4 weeks Before After 4 weeks Before After 4 weeks
Control 15 134.92±29.70 74.10±29.16 60.52±8.94 51.03±21.51 97.50±33.57 77.17±19.96 45.58±43.35 55.32±29.46
Observation 15 100.28±53.87 125.07±75.83 45.77±21.87 73.83±25.86 72.51±44.45 72.81±43.30 41.75±42.19 60.62±37.85
P value 0.133 0.038 0.108 0.022 0.192 0.746 0.865 0.731
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