JMIR Publications

ABSTRACT

Total joint arthroplasty (TJA) surgeries are common elective surgeries in the US, and recent care optimization practices have enhanced preoperative readiness. Despite improvements in the efficiency of pre- and post-operative TJA care, even short periods of mechanical ventilation and anesthesia reduce early postoperative lung and respiratory muscle function. In patients undergoing other major surgeries, preoperative inspiratory strength training (IST) reduces the occurrence of post-operative pulmonary complications (PPC’s), but the potential benefits of preoperative IST have not been systematically investigated in shorter surgeries such as TJA with expected brief hospital length of stay. We intend to address this gap in understanding by investigating whether preoperative IST prior to TJA surgery alters respiratory strength, lung function, and functional mobility. The primary study hypothesis is 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. The study hypothesis will be tested with a randomized, prospective study 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 ~4 weeks in advance of surgery and repeated on the day of surgery. Post-operative changes will be evaluated through the first 24 hours. The study design will establish feasibility and effectiveness of dIST to increase preoperative respiratory strength (Aim 1). We will also compare effects of dIST versus aIST on important post-operative respiratory strength measures and lung function (Aim 2) and 24-hour functional outcomes (Aim 3). This investigation will provide the first controlled study of preoperative IST to optimize respiratory recovery following TJA.