Effect of Calcium and Vitamin D Supplementation With and Without Collagen Peptides on Volumetric and Areal Bone Mineral Density, Bone Geometry and Bone Turnover in Postmenopausal Women With Osteopenia.

Collagen peptides (CPs) have been shown to potentially have a role as a treatment option in osteopenia. In the present randomized prospective study, we examined the effect of calcium, vitamin D with and without CPs supplementation on changes in volumetric bone mineral density (vBMD) and bone geometry assessed by peripheral quantitative computed tomography at the tibia, areal bone mineral density (aBMD) assessed by dual-energy X-ray absorptiometry at the lumbar spine and the hip and bone turnover markers over 12-mo. Fifty-one postmenopausal women with osteopenia were allocated to Group A who received orally 5 g CPs, 500 mg calcium and 400 IU vitamin D3 and Group B who received the same dose of calcium and vitamin D3 per day. The primary endpoint was the change of trabecular bone mineral content (BMC) and vBMD after 12-mo supplementation in Groups A and B. At the trabecular site (4% of the tibia length), Group A had a significant increase of total BMC by 1.96 ± 2.41% and cross-sectional area by 2.58 ± 3.91%, trabecular BMC by 5.24 ± 6.48%, cross-sectional area by 2.58 ± 3.91% and vBMD by 2.54 ± 3.43% and a higher % change of these parameters at 12 mo in comparison to Group B (p < 0.01, p = 0.04, p < 0.01, p = 0.04, p = 0.02, respectively). At the cortical site (38% of the tibia length), total and cortical vBMD increased by 1.01 ± 2.57% and 0.67 ± 1.71%. Furthermore, the mean aBMD at the spine was higher (p = 0.01), while bone markers decreased in Group A compared to Group B. The present study shows improvement of trabecular and cortical parameters as assessed by peripheral quantitative computed tomography at the tibia, prevention of aBMD decline and decrease of bone turnover after 12-mo supplementation with calcium, vitamin D with CPs.

Alveolar bone response distal to applied orthodontic forces in ovariectomized rats.

OBJECTIVES: The aim of this study was to investigate the effect of the application of orthodontic tooth forces on the alveolar bone distal to the loaded teeth, in ovariectomized female rats. METHODS: Twenty-four eight-month-old Wistar rats were divided into one group ovariectomized at the age of six months and one control. An orthodontic appliance delivering a mesial traction force of 60 gr* was placed on the right maxillary 1st molar of all animals for 14 days. Histology of the alveolar bone, of the adjacent and distal teeth to the loaded molar and the contralateral side, was performed following euthanasia. RESULTS: In the non-ovariectomized rats, extensive resorption was noticed in the direction of the orthodontic movement in the 2nd and 3rd molar interdental space, whereas the respective contralateral interdental space did not show any remodeling activity. Ovariectomized rats displayed reduced osseous tissue in the interdental space of both sides. The alveolar bone in the interradicular area of the 2nd loaded molar revealed frontal resorption, whereas, the alveolar interradicular bone of the contralateral 2nd molar showed internal resorption. CONCLUSIONS: In conclusion, orthodontic forces applied to the dentoalveolar complex of ovariectomized rats affect bone remodeling, even in areas distal to the site of force application. This finding should be taken into account during orthodontic treatment of women during menopause.

Intrauterine growth restriction affects bone mineral density of the mandible and the condyle in growing rats.

OBJECTIVES: To investigate in growing rats the effect of intrauterine growth restriction (IUGR) on the bone mineral density of the mandible and tibia, as well as the quality of the mandibular and condylar bone. METHODS: Twelve male rats were born IUGR by mothers sustaining 50% food restriction during pregnancy. Twelve control male rats were born by mothers fed ad libitum. Dual-energy X-ray absorptiometry (DEXA) of the tibia, proximal tibial metaphysis and the mandible, biochemical markers, histology and histomorphometrical analysis on the mandibular and subchondral bone of the condyle were performed. RESULTS: IUGR significantly affected bone mineral density (BMD) of both tibial and mandibular bones. IUGR rats had significantly lower osteocalcin values (p=0.021) and phosphorus (p=0.028), but not 25-OH vitamin D (p=0.352). Bone area percentage in the mandible was significantly lower (51.21±5.54) in IUGR compared to controls (66.00±15.49), and for subchondral bone of the condyle for IUGR (47.01±6.82) compared to controls (68.27±13.37). IUGR had a significant reduction in the fibrous layer, but not the proliferating layer, with the hypertrophic layer significantly increased. CONCLUSION: Maternal restricted nutrition during gestation can affect BMD of the mandible and the tibia of the offspring animals.

The effect of table olive wastewater extract administration on the adult ovariectomised rat model of osteoporosis.

Recent efforts for alternative non-pharmaceutical treatments for postmenopausal osteoporosis are focused on nutritional measures. The aim of this study was to investigate the effect of table olive wastewater extract (OE) administration on bone mineral density (BMD) and biomechanical strength in ovariectomised rats. Thirty mature 9-month-old female Wistar rats were separated into three groups of ten: Control, Ovariectomised (OVX) and OVX + OE. BMD was measured before ovariectomy, 3 and 6 months afterwards. At the end of the study, blood, both femurs and tibias, internal organs and abdominal fat were collected. After 3 months, the percentage changes from baseline of the total and proximal tibial BMD of the OVX + OE group were both higher compared with the OVX group (P < 0·005). Similar results were found after 6 months, when the percentage changes from baseline of the total and proximal tibial BMD of the OVX + OE group were both higher compared with the OVX group (P < 0·005). Biomechanical testing of the femurs did not reveal any statistically significant difference between the groups. Body weights throughout the study, organs' and abdominal fat ratios to final body weight and blood results (alanine aminotransferase (ALT), gamma-glutamyltransferase (γ-GT), total cholesterol, HDL-cholesterol, LDL-cholesterol, Ca and P) were within normal limits and did not show any significant difference between the treated and untreated groups. As a conclusion, the administration of OE for 6 months protected tibial BMD loss in comparison with the untreated OVX group without causing adverse effects.

The effect of osteopenia on tooth movement in ovariectomized rats. An experimental study.

OBJECTIVE: The purpose of this experimental study was to investigate in depth the effects of osteopenia related to the rate, as well as to the quality of orthodontic tooth movement, by combining experimental ovariectomy and molar movement in rats. METHODS: Twenty-four six-month-old female Wistar rats were used in this study. The animals were divided into two groups consisting of twelve animals each: Group A (control group) was subjected to orthodontic movement of the upper right first molars. Group B was subjected to orthodontic movement of the upper right first molar following bilateral ovariectomy. Ovariectomy was performed on the first experimental day and the upper right first molars were subjected to orthodontic forces 60 days post-ovariectomy, lasting for 14 days. RESULTS AND CONCLUSION: Direct inspections of the upper jaws, measurements of orthodontic movement of the upper right first molars of Group A and B, as well as histologic examinations of the alveolar bone in the upper right and left first molar regions, showed that osteopenia affects the rate of orthodontic tooth movement, as well as the quality of alveolar bone remodeling, in ovariectomized rats. Specifically, in the ovariectomized animals the alveolar bone of the non-loaded side showed extensive internal resorption, with large marrow cavities, whereas the alveolar bone of the loaded side was dense with almost no marrow cavity and frontal resorption on the surface. It appears that alveolar remodeling after the exertion of orthodontic forces follows the general paradigm of osteoporotic bone remodeling after loading.

Per os colchicine administration in cholesterol fed rabbits: Triglycerides lowering effects without affecting atherosclerosis progress.

BACKGROUND: Atherosclerosis is a chronic inflammatory disease that is promoted, among others, by pro-inflammatory cytokines such as IL-1ß and IL-18 produced by NLRP 3 inflammasome. Development of atherosclerotic lesions is also affected by leptin. Furthermore, inflammasome's action is interfered with other inflammatory diseases, like diabetes. On the other hand, colchicine is reported to act as anti-inflammatory agent inhibiting inflammasome's action and stabilizing atherosclerotic lesions. The purpose of this study is to investigate the effect of per os colchicine on the de novo formation of atherosclerotic lesions and on the levels of IL-18, leptin and insulin in cholesterol-fed rabbits. METHODS: Twenty-three male, 2 months old New Zealand White rabbits, were seperated in 3 groups and were fed with different types of diet for 7 weeks: standard, cholesterol 1% w/w and cholesterol 1% w/w plus colchicine 2 mg/kg body weight. Blood was collected for biochemical measurements and conduction of ELISA for leptin, IL-18 and insulin. Histologic examination of stained with eosin and hematoxylin aorta specimens was performed. Aortic intimal thickness was evaluated using image analysis. The statistical analysis included non-parametric tests: a) paired-sample Wilcoxon test, b) Spearman correlation coefficient and c) Kruscal-Wallis test. RESULTS: Triglerycide levels were decreased in cholesterol plus colchicine group in the end of the experiment (p < 0.05), whereas the cholesterol group had increased levels. No statistical differences were observed in the levels of IL-18, leptin and insulin between groups. Likewise, there was neither any correlation between IL-18, leptin and intima thickness nor between IL-18 and glucose and between leptin and weight. In cholesterol and colchicine group there was a strong positive correlation between IL-18 and insulin levels in the 4th week (r s = .66, n = 10, p < 0.05), whereas in the 7th week this correlation became strong negative (r s = -.86, n = 10, p < 0.05). Finally, intima thickness in the ascending and thoracic aorta of the cholesterol and colchicine group was significantly greater than that of the other groups (p < 0.05). CONCLUSIONS: Per os administration of colchicine did not influence atherosclerosis progression in cholesterol-fed rabbits, levels of IL-18, insulin and leptin. We encountered the attenuating role of colchicine on TG levels.

Effects of mechanical loading on the expression of pleiotrophin and its receptor protein tyrosine phosphatase beta/zeta in a rat spinal deformity model.

Mechanical loading of the spine is a major causative factor of degenerative changes and causes molecular and structural changes in the intervertebral disc (IVD) and the vertebrae end plate (EP). Pleiotrophin (PTN) is a growth factor with a putative role in bone remodeling through its receptor protein tyrosine phosphatase beta/zeta (RPTPß/ζ). The present study investigates the effects of strain on PTN and RPTPß/ζ protein expression in vivo. Tails of eight weeks old Sprague-Dawley rats were subjected to mechanical loading using a mini Ilizarov external apparatus. Rat tails untreated (control) or after 0 degrees of compression and 10°, 30° and 50° of angulation (groups 0, I, II and III respectively) were studied. PTN and RPTPß/ζ expression were evaluated using immunohistochemistry and Western blot analysis. In the control group, PTN was mostly expressed by the EP hypertrophic chondrocytes. In groups 0 to II, PTN expression was increased in the chondrocytes of hypertrophic and proliferating zones, as well as in osteocytes and osteoblast-like cells of the ossification zone. In group III, only limited PTN expression was observed in osteocytes. RPTPß/ζ expression was increased mainly in group 0, but also in group I, in all types of cells. Low intensity RPTPß/ζ immunostaining was observed in groups II and III. Collectively, PTN and RPTPß/ζ are expressed in spinal deformities caused by mechanical loading, and their expression depends on the type and severity of the applied strain.

Rodent models of hepatic ischemia-reperfusion injury: time and percentage-related pathophysiological mechanisms.

Ischemia and reperfusion (IR) injury remains one of the major problems in liver surgery and transplantation, which determines the viability of the hepatic tissue after resection and of the grafted organ. This review aims to elucidate the mechanisms involved in IR injury of the liver in rodent experimental studies and the preventative methods and pharmacologic agents that have been applied. Many time- and percentage-related liver IR injury rodent models have been used to examine the pathophysiological mechanisms and the parameters implicated with different morbidity, mortality, and pathology findings. The most preferred experimental rodent model of liver IR is the induction of 70% IR for 45 min, which is associated with almost 100% survival. In this model, plasma levels of several parameters such as alanine transaminase, aspartate aminotransferase, gamma-glutamyltransferase, endothelin-1, malonodialdehyde, tumor necrosis factor α, interleukin 1b, inducible nitric oxide synthase, and caspases are increased. The increase of caspases is associated with the initiation of hepatic cellular apoptosis. The main injuries observed 24 h after reperfusion are nuclear pyknosis, cytoplasmic hypereosinophilia, severe necrosis, and loss of intercellular borders. Both ischemic pre- and post-conditioning preventative methods and pharmacologic agents are successfully applied to alleviate the IR injuries. The selection of the time- and percentage-related liver IR injury rodent model and the potential preventative method should be related to the clinical question being answered.

Celebrating Women in Science: Pioneering Contributions to Animal Behaviour and Welfare.

In the scientific domain, women have historically demonstrated their dedication, intellect, and innovative input in relation to animal behaviour and welfare [...].

Reliability and validity of the Greek adaptation of the Modified Barthel Index in neurorehabilitation patients.

BACKGROUND: The Modified Barthel Index (MBI) (Shah version) is a widely used functional assessment measure with greater sensitivity and improved reliability compared to the original Barthel Index. AIM: The aim of this study was to adapt the MBI for use in Greece and measure its reliability and validity on a Greek neuro-rehabilitation population. DESIGN: Observational study. SETTING: KAT Hospital Rehabilitation Clinic and National Rehabilitation Centre in Athens, Greece. POPULATION: A total of 100 rehabilitation inpatients and outpatients consisting of 50 stroke and 50 spinal cord injury (SCI) patients were evaluated. METHODS: The MBI underwent the proper translation and cultural adaptation procedure as required by the World Health Organization and was administered to 100 rehabilitation patients. For criterion validity evaluation all patients were also assessed with the Katz Index of Independence in Activities of Daily Living (Katz Index) and the 36-Item Short Form Survey (SF-36) physical functioning subscale, both questionnaires having been validated for use in Greece. RESULTS: The unidimensionality solution was rejected and a two- factor solution was adopted based on exploratory and confirmatory factor analysis (Factor 1 - Transfers and Activities of Daily Living, Factor 2 - Mobility). Very high correlation was presented between the Katz Index score and the Greek MBI Factor 1 (r=0.888, P<0.001) and total score (r=0.873 P<0.001) respectively and high with MBI Factor 2 (r=0.561, P<0.001). High correlation was observed between the SF-36 physical functioning subscale score with MBI Factor 1 (r=0.522, P<0.001), MBI Factor 2 (r=0.590, P<0.001) and MBI Total score (r=0.580, P<0.001). The internal consistency of the MBI Factor 1, Factor 2 and Total score was 0.920, 0.860 and 0.923 respectively. Test-retest reliability was remarkably consistent (total score 0.994, P<0.001). CONCLUSIONS: The Greek version of the Modified Barthel Index has been found to exhibit satisfactory levels of reliability and validity. CLINICAL REHABILITATION IMPACT: The Greek MBI adaptation is an adequate and useful instrument for use on Greek neuro-rehabilitation patients.

European Union Legislation for the Welfare of Animals Used for Scientific Purposes: Areas Identified for Further Discussion.

The Directive 2010/63/EU of the European Parliament and of the Council has been in force for more than a decade and has brought about significant improvements and novel requirements for the welfare of animals used for scientific purposes, while safeguarding research integrity. The Directive sets clear provisions for its scope, the authorization procedures, animal welfare bodies, national committees, cost/benefit analysis, severity classification, retrospective assessment, and statistical reporting, among many others. From this perspective, indicative areas in the existing legislative texts and guidance documents, which may influence animal welfare and scientific integrity, have been identified by the authors after years of working in this field. Suggested solutions to address these areas by potential future revisions in the legislation or other actions to benefit animal welfare are discussed, with the aim to clarify and simplify them for all stakeholders involved.

Tuberculosis of the Spine in a Patient With Kidney Cancer.

Tuberculosis is a widespread, airborne infectious disease caused by Mycobacterium tuberculosis bacteria. This infection is often misdiagnosed, particularly in the case of spinal tuberculosis which can present atypically. Although rare, tuberculosis can mimic bone tumors or metastatic lesions in the spine. In patients with immunosuppression who have cancer and show signs of lymph node involvement and bone lesions, it is important to explore other potential causes as part of the diagnosis process. Here, we present a case of renal cell carcinoma in which a lytic lesion in the spinal cord was initially misdiagnosed as a metastatic lesion due to the presence of cancer. Skeletal tuberculosis is a rare condition, and it is crucial to maintain a high level of suspicion for a proper diagnosis.

Rehabilitation Prognostic Factors following Hip Fractures Associated with Patient's Pre-Fracture Mobility and Functional Ability: A Prospective Observation Study.

Low physical function is associated with poor outcomes in the elderly population suffering from hip fractures. The present study aims to evaluate the prognostic tools for predicting patient recovery after hip fractures and investigate the correlation between the pre-fracture motor and functional statuses. A prospective study was performed, including 80 patients suffering from hip fractures. Patient history, previous falls, the type of fracture and overall survival were evaluated. Patient-reported outcome measures (SF-36, EQ-5D/VAS, Charlson Comorbidity Index (CCI), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and Harris Hip Score (HHS)) were monitored before hospital discharge at 6 weeks, and 3, 6 and 12 months postoperatively. Overall, 55% of patients experienced at least one fall, and 46% of them used crutches before the fracture. The average CCI score was 6.9. The SPPB score improved from 1.4 ± 1.3 (1 week) to 4.4 ± 2.1 (48 weeks). A one-year age increase, female sex, and prior history of falls lead to 0.1-, 0.92-, 0.56-fold lower SPPB scores, respectively, at 12 months. The HHS recorded the greatest improvement between 6 and 12 weeks (52.1 ± 14.6), whereas the TUG score continued to improve significantly from 139.1 ± 52.6 s (6 weeks) to 66.4 ± 54 s (48 weeks). The SPPB and performance test can be routinely used as a prognostic tool.

The Effect of Postoperative Physical Therapy Following Hip Fracture: A Literature Review.

Hip fractures in the elderly have become a major public health concern as the population ages. Post-operative rehabilitation is associated with improved outcomes and a greater likelihood of returning to pre-operative functional capacity. Several studies have been conducted to investigate various post-operative recovery pathways. However, little is known about which post-operative rehabilitation pathways for hip fractures are most effective in improving patient outcomes. No clear evidence-based guidelines for a standard mobilization protocol for patients are currently available. This review aims to investigate post-operative recovery pathways to help patients suffering from hip fracture return to pre-fracture condition and to quantify pre-operative and post-operative scores for objective rehabilitation evaluation. Measuring pre-operative activity and comparing it to post-operative follow-up values can help predict post-operative rehabilitation functional outcomes.

Fall risk question-based tools for fall screening in community-dwelling older adults: a systematic review of the literature.

Fall screening tools aim to accurately identify the high fall risk individuals. To increase ease of administration and cost-effectiveness many studies focus on question-based tools. The purpose of this systematic review was to identify question-based tools for fall risk assessment in community-dwelling older adults over the age of 60 and the risk factors that are covered by these tools. The PRISMA guidelines were followed. A literature search was conducted in PubMed/MEDLINE, Web of Science and Google Scholar. Data quality assessment was performed with the Ottawa-Newcastle scale. The results identified 20 studies that used 22 question-based tools to assess fall risk. The number of questions per tool varied from 1 to 41 questions. Data quality varied greatly, with values 3-9 for cohort and 2-7 for cross-sectional studies. The most commonly reported fall risk factors were fall history, feeling of unsteadiness, fear of falling, muscle strength, gait limitation and incontinence. Healthcare providers should use the above tools with caution regarding the limitations of each tool. Further studies should be designed to address individuals with high fall risk, such as individuals with cognitive impairment, as they are under-represented or excluded from most of the existing studies.

The Effect of Ceratonia siliqua Supplement on Bone Mineral Density in Ovariectomy-induced Osteoporosis in Rats.

AIM: This study aimed to investigate the effect of Ceratonia siliqua on bone mineral density (BMD) as a non-pharmaceutical alternative treatment for postmenopausal osteoporosis. MATERIALS AND METHODS: Thirty mature female Wistar rats were randomly separated into three groups of 10: Control, ovariectomized (OVX), and ovariectomized-plus-C. siliqua (OVX+CS). Total and proximal BMD were measured by dual-energy X-ray absorptiometry (DEXA) in all groups before ovariectomy, and at 3 and 6 months postoperatively. At the end of the study, the femurs were subjected to a three-point bending test. RESULTS: DEXA revealed no statistically significant difference in absolute values or percentage changes for total tibial BMD between OVX+CS and OVX groups throughout the study. In the proximal tibia, both absolute values and BMD percentage changes from baseline were higher in the OVX+CS group compared to the OVX group after 3 and 6 months of C. siliqua administration. Three-point bending test revealed a significantly higher thickness index in the OVX+CS group compared to the OVX group and a higher cross-sectional area index compared to the control group. CONCLUSION: Long-term administration of C. siliqua may be considered a non-pharmaceutical alternative treatment for postmenopausal osteoporosis. Further research is required to properly investigate the effects, and suitable treatment dose and schedule.

Delivery of Porphyrins Through Self-Assembling Peptide Hydrogels for Accelerated Healing of Experimental Skin Defects In Vivo.

INTRODUCTION: The care and healing of skin defects resulting from different causes has been the object of research to achieve rapid and complete skin regeneration. Hydrogels have been used for their ability to maintain hydration during wound healing, absorb wound exudate, and cover the underlying tissue without adherence while being transparent. In this study, we evaluated the efficacy of a hydrogel (H) with encapsulated porphyrin (H+P) on a rat model of surgically-induced skin defects. METHODS: Four round 6 mm diameter skin defects were performed under general anesthesia on the dorsal area of 24 three-month-old "Young" and 24 twelve-month-old "Mature" male rats. Each age group was separated into the Control, H, and H+P groups, n=8 each, where no therapy, H, or H+P was respectively applied daily for 20 days. Digital photographs and skin biopsies were taken on the third, seventh, 10th, and 20th postoperative days and evaluated by planimetry, histology, and immunohistochemistry. RESULTS: Planimetry results demonstrated significantly decreased perimeter, diameter, and area measurements (p<0.005) of group H+P compared to Control and H groups on days 10 and 20 in the young rats, while in the mature rats, the significant differences were evident earlier (perimeter third day p<0.05; diameter and area seventh day p<0.05 and p<0.005, respectively vs. H). Granulation and scar tissue formation were also reduced in the H+P groups although they were not statistically significant. CONCLUSIONS: The application of H+P on the skin defects benefited the healing process in both young and mature animal groups, as evidenced by the statistically significant findings of planimetry. The beneficial healing process was more pronounced in the mature animals, both in the level of statistical significance as well as regarding time (evident already on the third day of healing), probably due to porphyrin assisting the reduced healing rate, which is observed in organisms of advanced age.

Bone and Joint Tuberculosis in Greece: A Retrospective Study From 2011 to 2019.

PURPOSE: Bone and joint tuberculosis (BJTB) represents approximately 2-5% of all tuberculosis (TB) cases and its characteristics are infrequently discussed. The aim of this study was to examine the epidemiology, characteristics, and management of BJTB in Greece. METHODS: We conducted retrospective analyses of demographic clinical and treatment data accessed from medical records of patients with BJTB and with pulmonary involvement between 2011 and 2019 from the national TB reference hospital in Greece. Factors associated with treatment outcomes among patients were evaluated. RESULTS:  Out of the total 3064 confirmed TB cases during the study period, 54 patients had either BJTB or skeletal TB with pulmonary involvement. The majority of patients were males (81.5%) and the mean age of the patients was 37.81±18.92 years. Out of the total patients, 11 were Greek and 43 were immigrants. Women had a higher probability of experiencing a stable or negative treatment outcome. Also, the patients that received therapy for less than nine months had 16.3 times higher probability of experiencing a stable or negative treatment outcome, compared to those that received therapy for more than 12 months. CONCLUSIONS: The study indicated that the sex and the duration of treatment correlated with the treatment outcomes. It is essential to monitor and accurately report treatment outcomes so as to achieve disease control.

The Efficacy of High-Intensity Preoperative Physiotherapy Training on Postoperative Outcomes in Greek Patients Undergoing Total Knee Arthroplasty: A Quasi-Experimental Study.

PURPOSE: Several studies have shown that patients with severe osteoarthritis (OA) of the knee can reduce their knee pain, improve their quadriceps strength, and improve their functional ability through regular exercise training. The purpose of this study was to investigate the efficacy of a six-week supervised high-intensity preoperative training program on muscle strength, functional performance, and patient-reported outcomes in patients undergoing total knee arthroplasty (TKA). METHODS: Ninety-eight patients scheduled for unilateral TKA for severe OA were allocated to an intervention group (N = 49) who completed a six-week preoperative training program, five days per week prior to surgery, and a control group (N=49) who did not follow any preoperative training program. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Physical Functioning Scale of the Short Form-36 questionnaire (SF-36), Knee Injury and Osteoarthritis Outcome Score (KOOS), quadriceps strength, 20-meter walk test, and 30-second chair stand test were assessed at six weeks before surgery (T0), just before surgery (T1), four weeks (T2) and finally 12 weeks (T3) after TKA. RESULTS: Of 98 patients included in our study, 10 individuals withdrew from the study at different stages. Finally, 44 patients were allocated to the intervention group and 44 patients to the control group. When comparing the changes from baseline to the primary test points at T1, T2, and T3, we found a significant group difference in favor of the intervention group for quadriceps strength (<0.001, 0.001, 0.009), 20-meter walk test (<0.001, 0.023, 0.032), 30-second chair stand test (0.001, <0.001, <0.001) and all patient-reported outcomes WOMAC (<0.001, 0.001, 0.007) except from KOOS that showed significant difference only at T1 (<0.001) at T2 (0.048) but not at T3 (0.087). CONCLUSIONS: Our study demonstrated that a six-week preoperative physiotherapy training program supervised by a physiotherapist before TKA is efficacious for decreasing knee pain, improving knee function, and enhancing daily living activities.