Comparative Effectiveness of Russian Current and High-voltage Pulsed Galvanic Stimulation on Quadriceps Muscle Atrophy and Functional Recovery Following Total Knee Replacement: A Research Protocol
Published: June 1, 2026 | DOI: https://doi.org/10.7860/JCDR/2026/80409.23481
Nikita Dhanraj Warkad, Soumik Basu
1. Junior Resident, Department of Musculoskeletal, Ravi Nair Physiotherapy College, Wardha, Maharashtra, India.
2. Associate Professor, Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Wardha, Maharashtra, India.
Correspondence
Nikita Dhanraj Warkad,
Junior Resident, Department of Musculoskeletal, Ravi Nair Physiotherapy College, Datta Meghe Higher Education and Research, Sawangi, Wardha, Maharashtra, India.
E-mail: nikitadwarkad@gmail.com
Introduction: Total Knee Replacement (TKR) improves joint function and relieves pain, but postoperative quadriceps atrophy impedes recovery. Neuromuscular Electrical Stimulation (NMES), including Russian Current (RC) and High-Voltage Pulsed Galvanic Stimulation (HVPGS), may counteract atrophy. The present prospective study will compare how well they help quadriceps strength and functional recovery in the early stages of post-TKR rehabilitation.
Need of the study: Quadriceps atrophy following TKR significantly delays functional recovery, limits mobili-ty, and increases fall risk. Conventional rehabilitation is often insufficient in the early postoperative phase due to pain and Arthrogenic Muscle Inhibition (AMI). The NMES, particularly RC and HVPGS, offers potential benefits in enhancing muscle strength and reducing atrophy. However, limited evidence exists comparing their effectiveness. In order to guide clinical rehabilitation strategies and improve early post-TKR outcomes, the present study is nec-essary.
Aim: To compare the efficacy of RC and HVPGS in reducing quadriceps muscle atrophy and enhancing functional outcomes following TKR.
Materials and Methods: The present research protocol is for a prospective, single-blinded, randomised controlled trial that will be conducted from Feb 2025 to Feb 2026 to evaluate and compare the effectiveness of RC and HVPGS in managing quadriceps muscle atrophy and enhancing functional recovery after unilateral TKR. The study will be conducted at Tertiary health care centre i.e., Acharya Vinoba Bhave Rural Hospital (AVBRH) Sawangi, Wardha, Maharashtra, India. The study commenced from Feb 2025 and will be completed in Feb 2026, including recruitment, intervention, and follow-up assessments. A total of 40 participants will be enrolled and randomly allo-cated into two equal groups (n=20 in each group) using a block randomisation method with allocation concealment via the SNOSE (Sequentially Numbered, Opaque, Sealed Envelopes) technique. After screening for eligibility and obtaining consent, participants will be randomised into:
• Group A: Received RC stimulation (2500 Hz, 50 Hz burst frequency)
• Group B: Received HVPGS (100-150 V, 50 Hz)
Both groups will undergo standard physiotherapy (Range of Motion (ROM) exercises, strengthening, gait training) for four weeks, five sessions per week. Each NMES session lasted 20 minutes, supervised by a physiotherapist. Pre and post-intervention assessments will be recorded for each outcome measure. Demographic details such as age, gender, Body Mass Index (BMI), limb dominance, and surgical side will be recorded and analysed to ensure baseline comparability between groups. In Statistical Package for Social Sciences (SPSS), using mean ± Standard Deviation (SD) for baseline descriptive, groups will be compared with independent t-tests or Mann-Whitney U (and paired t-tests or Wilcoxon for pre-post), considering p<0.05 significant, and report the effect sizes via Cohen’s d for parametric tests (0.2=small, 0.5=medium, 0.8=large) or r=Z/vN for non-parametric ones.
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