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Keywords:total knee arthroplasty gait analysis range of motion kinematics Reduced peak knee flexion during stair descent (PKSD) is demonstrated in subjects with total knee arthroplasty (TKA), but the underlying factors are not well studied. 3D gait patterns during stair descent, peak passive knee flexion (PPKF), quadriceps strength, pain, proprioception, demographics, and anthropometrics were assessed in 23 unilateral TKA-subjects~19 months post-operatively, and in 23 controls. PKSD, PPKF and quadriceps strength were reduced in the TKA-side, but also in the contralateral side. A multiple regression analysis identified PPKF as the only predictor (57%) to explain the relationship with PKSD. PPKF was, however sufficient for normal PKSD. Deficits in quadriceps strength in TKA-group suggest that strength is also contributing to smaller PKSD. Increased hip adduction at PKSD may indicate both compensatory strategy and reduced hip strength.© 2013 Elsevier Inc. All rights reserved.Studies show that total knee arthroplasty (TKA) gives rise to various movement abnormalities, such as gait asymmetries including reduced knee flexion [1]. Functional performance following knee arthroplasty may be assessed in stair gait [2]. Descending stairs requires more knee flexion than ascending stairs [3], and there is evidence of reduced knee flexion in stair descent after TKA [4,5]. Although it is concluded that flexion in the prosthetic knee is reduced during stair descent [2,[4][5][6], the underlying mechanisms are uncertain. Although knee flexion is restricted due to the mechanics of the prosthesis [7], stair studies show that the range of motion (ROM) leaves a margin of 6°-16°, theoretically permitting sufficient knee flexion for normal stair descent [4][5][6]. There are, however also other qualities with TKA that may be important to consider, such as reduced or increased sagittal laxity in the prosthetic knee joint [8][9][10]. In posterior cruciate retaining knee prostheses a paradoxical forward slide instead of a normal rollback of the tibio-femoral contact point occurs with increasing flexion. This suggests that TKA related factors other than reduced ROM, may be responsible for reduced knee flexion in stair descent [7]. Also factors outside joint mechanics may be considered, such as weakness of the knee and hip muscles [11][12][13][14] Studies on level walking propose that asymmetrical gait after TKAsurgery is retained from the pre-surgery gait and characterized by a specific walking pattern, presumably for unloading the affected knee [1]. Asymmetrical gait patterns are shown to be retained up to 18 months after surgery in spite of little or no pain [21]. Similarly, subjects with osteoarthritis have demonstrated decreased knee flexion during stair descent compared to knee-healthy subjects [25]. Asymmetrical gait patterns after a TKA may predispose the individual to contralateral joint degeneration [1], and the risk of the contralateral knee to progress to TKA due to osteoarthritis has been estimated to be 37.2% within 10 years [26...

Background The organisation of health care services for older adults varies within and between countries. In Norway, primary care physiotherapy services offer home-based rehabilitation to older adults. The aim of this study was to compare patients’ characteristics and treatment outcomes in three working models of home-based rehabilitation. Methods Patients referred to home-based rehabilitation in a large municipality in Norway were invited to participate in this prospective observational study. The three working models, early intervention, reablement and regular physiotherapy, were organised according to the patients’ function and degree of independence. The older adults (≥ 65 years) were allocated to the different models by either a multidisciplinary group of health care personnel or by direct referral. Patients’ demographic and clinical characteristics, including physical function (Patient-specific functional scale, PSFS), physical performance (Short Physical Performance Battery, SPPB) and health-related quality of life (EQ-5D) were registered at baseline and follow-up (maximum 6 months after baseline). One-way ANOVA was used to analyse group differences in clinical characteristics and paired t-tests to analyse changes from baseline to follow-up. Results In total, 603 and 402 patients (median (interquartile range) age: 84 (77–88) years) completed baseline and follow-up assessments, respectively. Patients in all three working models had an increased risk for functional decline. Patients receiving early intervention (n = 62) had significantly (p < 0.001) better physical performance and health-related quality of life (SPPB mean 7.9, SD 2.7; EQ-5D:mean 0.59, SD 0.19), than patients receiving reablement (n = 132) (SPPB: mean 5.5, SD 2.6; EQ-5D: mean 0.50, SD 0.15) and regular physiotherapy (n = 409) (SPPB: mean 5.6, SD 2.8; EQ-5D: mean 0.41, SD 0.22). At follow-up, the three working models showed significantly improvements in physical function (PSFS: mean change (95 % CI): 2.5 (1.9 to 3.2); 1.8 (0.5 to 3.1); 1.7 (0.8 to 2.6), for regular physiotherapy, reablement, and early intervention, respectively). Patients receiving regular physiotherapy and reablement also significantly improved physical performance and health-related quality of life. Conclusions While older adults receiving reablement and regular physiotherapy showed similar patient characteristics and treatment outcomes, early intervention identified older patients at risk of functional decline at an earlier stage. These results are relevant for policy makers when designing and improving prevention and rehabilitation strategies in primary health care.

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