Factors predicting weight-bearing asymmetry 1month after unilateral total knee arthroplasty: a cross-sectional study.

UNLABELLED Factors predicting weight-bearing asymmetry (WBA) after unilateral total knee arthroplasty (TKA) are not known. However, identifying modifiable and non-modifiable predictors of WBA is needed to optimize rehabilitation, especially since WBA is negatively correlated to poor functional performance. The purpose of this study was to identify factors predictive of WBA during sit-stand transitions for people 1month following unilateral TKA. METHODS Fifty-nine people were tested preoperatively and 1month following unilateral TKA for WBA using average vertical ground reaction force under each foot during the Five Times Sit-to-Stand Test. Candidate variables tested in the regression analysis represented physical impairments (strength, muscle activation, pain, and motion), demographics, anthropometrics, and movement compensations. RESULTS WBA, measured as the ratio of surgical/non-surgical limb vertical ground reaction force, was 0.69 (0.18) (mean (SD)) 1month after TKA. Regression analysis identified preoperative WBA (β=0.40), quadriceps strength ratio (β=0.31), and hamstrings strength ratio (β=0.19) as factors predictive of WBA 1month after TKA (R(2)=0.30). CONCLUSION Greater amounts of WBA 1month after TKA are predicted by modifiable factors including habitual movement pattern and asymmetry in quadriceps and hamstrings strength.

[1]  S. White,et al.  Altering asymmetric limb loading after hip arthroplasty using real-time dynamic feedback when walking. , 2005, Archives of physical medicine and rehabilitation.

[2]  F. Guillemin,et al.  Total hip or knee replacement for osteoarthritis: Mid‐ and long‐term quality of life , 2010, Arthritis care & research.

[3]  D. Lewallen,et al.  Predictors of moderate-severe functional limitation after primary Total Knee Arthroplasty (TKA): 4701 TKAs at 2-years and 2935 TKAs at 5-years. , 2010, Osteoarthritis and cartilage.

[4]  L. Snyder-Mackler,et al.  Functional and biomechanical outcomes after using biofeedback for retraining symmetrical movement patterns after total knee arthroplasty: a case report. , 2012, The Journal of orthopaedic and sports physical therapy.

[5]  L. Snyder-Mackler,et al.  Voluntary activation and decreased force production of the quadriceps femoris muscle after total knee arthroplasty. , 2003, Physical therapy.

[6]  C. Christiansen,et al.  Weight-bearing asymmetry in relation to measures of impairment and functional mobility for people with knee osteoarthritis. , 2010, Archives of physical medicine and rehabilitation.

[7]  Janet A. Kneiss,et al.  Analysis of vertical ground reaction force variables during a Sit to Stand task in participants recovering from a hip fracture. , 2011, Clinical biomechanics.

[8]  Nico Verdonschot,et al.  Sit-to-Stand Movement as a Performance-Based Measure for Patients With Total Knee Arthroplasty , 2010, Physical Therapy.

[9]  Mauricio Silva,et al.  Knee strength after total knee arthroplasty. , 2003, The Journal of arthroplasty.

[10]  E. Isakov Gait rehabilitation: a new biofeedback device for monitoring and enhancing weight-bearing over the affected lower limb. , 2007, Europa medicophysica.

[11]  O. Mahoney,et al.  Biomechanical differences exhibited during sit-to-stand between total knee arthroplasty designs of varying radii. , 2006, The Journal of arthroplasty.

[12]  Alex Stacoff,et al.  Ground reaction forces on stairs. Part II: knee implant patients versus normals. , 2007, Gait & posture.

[13]  U P Arborelius,et al.  The effects of armrests and high seat heights on lower-limb joint load and muscular activity during sitting and rising. , 1992, Ergonomics.

[14]  S. Piva,et al.  Quadriceps activation failure as a moderator of the relationship between quadriceps strength and physical function in individuals with knee osteoarthritis. , 2004, Arthritis and rheumatism.

[15]  W. Kohrt,et al.  Early neuromuscular electrical stimulation to optimize quadriceps muscle function following total knee arthroplasty: a case report. , 2007, The Journal of orthopaedic and sports physical therapy.

[16]  James G Wright,et al.  Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review. , 2008, Canadian journal of surgery. Journal canadien de chirurgie.

[17]  L. Snyder-Mackler,et al.  Altered loading during walking and sit‐to‐stand is affected by quadriceps weakness after total knee arthroplasty , 2005, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  Lynn Snyder-Mackler,et al.  Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis , 2003, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[19]  Kenton R Kaufman,et al.  Sit-to-stand 3 months after unilateral total knee arthroplasty: comparison of self-selected and constrained conditions. , 2009, Gait & posture.

[20]  T. Andriacchi,et al.  Knee pain and joint loading in subjects with osteoarthritis of the knee , 2000, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[21]  J. Singh,et al.  Predictors of moderate-severe functional limitation 2 and 5 years after revision total knee arthroplasty. , 2010, The Journal of arthroplasty.

[22]  Lynn Snyder-Mackler,et al.  Persistence of Altered Movement Patterns During a Sit-to-Stand Task 1 Year Following Unilateral Total Knee Arthroplasty , 2008, Physical Therapy.

[23]  W. Kohrt,et al.  Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty , 2010, Clinical orthopaedics and related research.

[24]  Mark S Redfern,et al.  Clinical measurement of sit-to-stand performance in people with balance disorders: validity of data for the Five-Times-Sit-to-Stand Test. , 2005, Physical therapy.

[25]  Y. Toyama,et al.  Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. , 2010, The Journal of arthroplasty.

[26]  M. O’Connor Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women? , 2011, Clinical orthopaedics and related research.

[27]  M. Bade,et al.  Weight-bearing asymmetry during sit-stand transitions related to impairment and functional mobility after total knee arthroplasty. , 2011, Archives of physical medicine and rehabilitation.

[28]  N Verdonschot,et al.  How to quantify knee function after total knee arthroplasty? , 2008, The Knee.

[29]  W. Kohrt,et al.  Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength After Total Knee Arthroplasty: A Randomized Controlled Trial , 2011, Physical Therapy.