NMES should not be used after a total knee arthroplasty (TKA).

• A. True
• B. False
• C. Not recommended
• D. Unknown

Answer: (B)

After total knee arthroplasty, NMES is often used to help restore quadriceps strength and function. Surgery frequently causes a drop in voluntary quadriceps activation due to swelling, pain, and neural inhibition. An external NMES stimulus can drive a controlled quadriceps contraction even when the patient cannot fully recruit the muscle on their own, helping to preserve muscle size, improve knee extension, and support early functional recovery when combined with active exercises, range-of-motion work, and gait training.

In practice, NMES is applied with electrodes placed over the quadriceps motor points (typically targeting the vastus medialis and vastus lateralis). The goal is a comfortable, palpable or visible contraction, with parameters (frequency, pulse width, on/off cycling) chosen to produce a meaningful tetanic contraction without causing excessive discomfort. Start after the incision has sufficiently healed and as part of a supervised rehab plan, and adjust for skin integrity, pain, and swelling. Avoid use if there are active skin infections at the electrode sites, unhealed wounds, or any contraindications such as implanted electrical devices, and follow clinician guidance.

So the statement that NMES should not be used after a total knee arthroplasty is not correct; it is a common and beneficial component of post-op rehab when used appropriately.