# Implementation of Neuromuscular Electrical Stimulation after Total Knee Arthroplasty

> **NIH NIH R01** · UNIVERSITY OF COLORADO DENVER · 2024 · $1,023,154

## Abstract

PROJECT SUMMARY / ABSTRACT
 Total Knee Arthroplasty (TKA) reduces pain and disability caused by knee osteoarthritis, but the
surgery results in substantial trauma to the knee. This acute trauma exacerbates underlying weakness—
especially in the quadriceps. Quadriceps strength decreases by 80% just days after surgery and remains
60% impaired 1 month after surgery, which leads to a decrease in patient functional performance of up to
90%. This acute strength leads to muscle atrophy, which likely contributes to the long-term weakness and
disability patients with TKA experience relative to their healthy peers. Therefore, attenuating quadriceps
strength loss should be a primary target for improving rehabilitation outcomes after TKA.
Neuromuscular electrical stimulation (NMES) is recommended in recent TKA clinical practice guidelines to
attenuate quadriceps strength loss. In controlled settings, NMES has established efficacy and attenuates
quadriceps strength loss by 40% in the first month after surgery by overriding muscle activation deficits and
reducing muscle atrophy. However, the effectiveness of NMES after TKA has not been adequately studied in
real-world clinical settings, and our preliminary data suggests that less than 4% of rehabilitation clinicians
are using NMES as recommended by current TKA practice guidelines. Therefore, we propose to conduct
a cluster randomized trial in two healthcare systems (Intermountain Health and UCHealth) and their associated
outpatient physical therapy clinics (n=30) to evaluate the effectiveness and implementation of NMES to
address musculoskeletal deficits after TKA. We will compare outcomes between patients who receive
contemporary rehabilitation supported by a comprehensive NMES implementation strategy (NMES) to patients
who receive contemporary musculoskeletal rehabilitation alone (Usual Care). We will gather information on
NMES implementation to promote its uptake and translation to clinical practice.
 This study will fundamentally change rehabilitation practice to improve function, strength, and
quality of life for millions of Americans who undergo TKA each year. This investigation seeks to provide
large-scale, foundational evidence that NMES is effective and can be systematically implemented into TKA
rehabilitation practice. It will also evaluate and identify effective implementation tools and strategies that
healthcare organizations can readily adopt and deploy to promote widescale NMES usage after TKA.

## Key facts

- **NIH application ID:** 10977557
- **Project number:** 1R01AG084683-01A1
- **Recipient organization:** UNIVERSITY OF COLORADO DENVER
- **Principal Investigator:** Jennifer E. Stevens-Lapsley
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $1,023,154
- **Award type:** 1
- **Project period:** 2024-08-15 → 2029-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10977557

## Citation

> US National Institutes of Health, RePORTER application 10977557, Implementation of Neuromuscular Electrical Stimulation after Total Knee Arthroplasty (1R01AG084683-01A1). Retrieved via AI Analytics 2026-06-12 from https://api.ai-analytics.org/grant/nih/10977557. Licensed CC0.

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