Inspiratory Muscle Training Before Total Joint Arthroplasty to Improve Postoperative Outcomes: Protocol for a Randomized Controlled Trial.

Background: Total joint arthroplasty (TJA) is among the most common elective surgeries performed in the United States, 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 such as TJA, where hospital stays are already brief, remains unknown. Objective: This study aims to investigate whether preoperative IST prior to TJA surgery alters respiratory strength, lung function, and functional mobility. We hypothesize that preoperative IST is feasible and effective in increasing inspiratory strength and promoting the return of early postoperative respiratory function and functional mobility before hospital discharge. Methods: The study hypothesis will be tested using a randomized, prospective design at a single urban academic health system. Adults scheduled for TJA surgery will be randomized to either undergo daily IST (dIST), complete an acute IST (aIST) session in the preoperative area, 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 before surgery and will be repeated on the day of surgery. Postoperative changes will be evaluated through the first 24 hours across 3 aims: to evaluate the feasibility and effectiveness of dIST for increasing preoperative respiratory strength (aim 1), to compare the effects of dIST and aIST on postoperative respiratory strength measures and lung function (aim 2), and to evaluate 24-hour functional outcomes (aim 3). Results: The study was funded in September 2023 and received institutional review board and safety officer approvals in December 2023. Enrollment began in March 2024, and as of May 2026, a total of 31 participants have been enrolled. Data analysis and publication of primary results are expected in 2027. Conclusions: This trial will provide the first controlled investigation of preoperative IST in TJA, offering early evidence on whether a low-cost, nonpharmacological intervention can preserve respiratory strength and accelerate functional recovery in this high-volume surgical population.