JMIR Publications

ABSTRACT

Background:

Total joint arthroplasty (TJA) is among the most common elective surgeries performed in the US, and recent advances in perioperative care have shortened hospital stays and streamlined recovery. Yet even brief periods of mechanical ventilation and anesthesia measurably weaken respiratory muscle function in the early postoperative period. Preoperative inspiratory strength training (IST) has been shown to reduce postoperative pulmonary complications in patients undergoing major cardiothoracic surgery, but whether these benefits extend to shorter procedures like TJA, where hospital stays are already brief, remains unknown.

Objective:

This study aims to address this gap by investigating whether preoperative IST prior to TJA surgery alters respiratory strength, lung function, and functional mobility. We hypothesize that preoperative IST is feasible and effective to increase inspiratory strength and promote the return of early post-operative respiratory function and functional mobility in advance of hospital discharge.

Methods:

The study hypothesis will be tested with a randomized, prospective design at a single urban academic health system. Adults scheduled for TJA surgery will be randomized to either undergo daily preoperative IST (dIST), complete an acute IST session in the preoperative area (aIST), or receive clinical standard of care (SOC). Inspiratory muscle strength and pulmonary function will be evaluated upon enrollment at a baseline assessment approximately 4 weeks in advance of surgery and repeated on the day of surgery. Post-operative changes will be evaluated through the first 24 hours across three aims: feasibility and effectiveness of dIST to increase preoperative respiratory strength (Aim 1), comparative effects of dIST versus aIST on post-operative respiratory strength measures and lung function (Aim 2), and 24-hour functional outcomes (Aim 3).

Results:

The study was funded in September 2023 and received IRB and Safety Officer approval in December 2023. Enrollment began in March 2024, and by May 2026, 31 participants had been enrolled. Data analysis and publication of primary results are expected in 2027.

Conclusions:

This trial will be the first controlled investigation of preoperative inspiratory strength training in TJA, offering early evidence on whether a low-cost, nonpharmacological intervention can preserve respiratory strength and speed functional recovery in this high-volume surgical population. Clinical Trial: ClinicalTrials.gov NCT5381818