A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties

Bolanos, Alberto A.; Colizza, Wayne A.; McCann, Peter D; Gotlin, Robert S.; Wootten, Mary E.; Kahn, Barbara; Insall, John N.

doi:10.1016/s0883-5403(98)90198-x

Cited by 127 publications

(79 citation statements)

References 28 publications

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“…However, we believe our patients' pre-surgical conditions were similar to patients used in other prospective studies examining functional improvements after knee replacements. In those studies, patients' combined Knee Society scores were close to 100 and knee range of motion was around 120° [19][20][21][22]. In general, patients with end-stage knee OA experience joint pain and stiffness, which leads to functional limitations of performing daily activities such as walking, going up and down stairs, and rising from a sitting position.…”

Section: Discussionmentioning

confidence: 96%

Gait analysis of patients with an off-the-shelf total knee replacement versus customized bi-compartmental knee replacement

Wang

Foster

Franksen

et al. 2017

International Orthopaedics (SICOT)

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Introduction Newer TKR designs have been introduced to the market with the aim of overcoming common sizing problems with older TKR designs. Furthermore, since a sizable percentage of patients with OA present with disease limited to the medial/ lateral knee compartment in addition to the patellofemoral joint, for whom, a customized bi-compartmental knee replacement (BKR) is available as a treatment option. To date, there is very little information regarding knee strength and mechanics during gait for patients implanted with these modern TKR and BKR designs.The purpose of the study was to evaluate knee strength and mechanics during walking for patients with either a modern off the shelf TKR or a customized BKR and compare these findings to a cohort of healthy controls. Methods Twelve healthy controls, eight BKR, and nine TKR patients participated in the study. Maximal isometric knee strength was evaluated. 3D kinematic and kinetic analyses were conducted for level walking. Results The TKR knee exhibited less peak extensor torque when compared to, both the BKR and control limbs (p < 0.05). The TKR knee had less extensor moment at stance than both the BKR and control knees (p < 0.05). Both the BKR and control knees displayed larger internal rotation at stance than that of the TKR knee (p < 0.05). Discussion and conclusion This study suggests that, for patients that exhibit isolated OA of the tibiofemoral joint, using a customized BKR implant is a viable treatment option and may contribute to superior mechanical advantages.

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Section: Discussionmentioning

confidence: 96%

Gait analysis of patients with an off-the-shelf total knee replacement versus customized bi-compartmental knee replacement

Wang

Foster

Franksen

et al. 2017

International Orthopaedics (SICOT)

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“…In fact, beginning as early as the day of surgery, patients are encouraged to use the involved leg during ambulation and perform knee active range of motion and isometric exercises repeatedly throughout the day [3]. While healthy individuals almost always recover lOO(% of their muscle strength within 4-8 weeks of remobilization after a period of disuse [1,23], patients after TKA are unable to achieve comparable recovery, even years after surgery [2,9,11,28]. The results of the present study suggest that more vigorous exercise programs may be necessary to restore quadriceps strength in this population [13].…”

Section: Discussionmentioning

confidence: 99%

Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis

Stevens

Mizner

Snyder‐Mackler

2003

Journal Orthopaedic Research

346

312

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I/itroN'uc.tion:Patients with osteoarthritis (OA) of the knee have quadriceps weakness and arthrogenous muscle inhibition (AMI). While total knee arthroplasty (TKA) reliably reduces pain and improves function in patients with knee OA, quadriceps weakness persists after surgery. The purpose of this investigation was to assess contributions of AM1 to quadriceps weakness before and after TKA and to assess the effect of pain on AMI.Mdiod.7: Twenty-eight patients with unilateral, end-stage, primary knee OA were tested an average of 10 days before and 26 days after TKA. The mean age at time of operation was 63 years (range 49-82 years). Measurements on the involved and uninvolved knees were performed using the burst-superimposition technique, where supramaximal electrical stimulation is superimposed on a voluntary contraction. Knee pain during contraction was measured using a numeric rating scale. Rtwtlts:The involved quadriceps were significantly weaker than the uninvolved prior to T K A 0, < 0.05). Quadriceps strength decreased by 60'% (p < 0.001) and activation decreased 17% (p < 0.001 1 after TKA. Changes in muscle activation accounted for 6.5% of the variability in the change in quadriceps strength (Y: = 0.65) ( p < 0.001). Knee pain during muscle contraction accounted for a small, but significant portion of the change in voluntary activation (r' = 0.22) ( p = 0.006).Di.scussio~~: Exercise regimens that emphasize strong muscle contraction and clinical tools that facilitate muscle activation like biofeedback and neuromuscular electrical stimulation may be necessary to reverse the quadriceps activation failure and weakness in the patients with knee OA that worsens after TKA. The failure of current rehabilitation regimens to directly address activation deficits within the first months after surgery may explain the persistent quadriceps weakness in patients after TKA.

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“…Shortened stride length and limited knee excursion during weight acceptance is a common finding after TKA [3,4,6,7,11,17,33]. Patients with TKA rise from a chair more slowly than control groups and use higher hip and knee moments in the uninvolved leg compared to the involved leg to stand [31].…”

Section: Introductionmentioning

confidence: 99%

“…Several investigations have suggested that movement strategies used during functional tasks are due to quadriceps weakness, but they stop short of measuring this impairment [5,14,31]. To date, only three studies have included quadriceps strength assessment in conjunction with a motion analysis assessment for patients with TKA [4,29,33], but they did not report the relationship between quadriceps weakness and altered movement patterns.…”

Section: Introductionmentioning

confidence: 99%

Altered loading during walking and sit‐to‐stand is affected by quadriceps weakness after total knee arthroplasty

Mizner

Snyder‐Mackler

2005

Journal Orthopaedic Research

312

247

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Purpose: Total knee arthroplasty (TKA) successfully reduces pain, but has not achieved comparable improvements in function. We hypothesized that quadriceps strength affects performance by altering loading and movement patterns during functional tasks.Methods: Fourteen subjects with isolated, unilateral TKA were tested three months after surgery. Quadriceps strength was assessed isometrically and kinematics, kinetics, and EMG were collected during level walking and sit-to-stand (STS). Function was assessed using the timed up and go test (TUG), stair climbing test (SCT), and the 6 min walk test (6MW).Results: Functional performance was significantly related to the quadriceps strength of both legs, but was more strongly related to the uninvolved strength (involved rho = -0.43 with TUG; -0.65 with SCT; 0.64 with 6MW) (uninvolved rho = -0.63 with TUG; -0.68 with SCT; 0.77 with 6MW). During STS, subjects shifted weight away from the operated limb (p < 0.01). Quadriceps muscle activity and the extension moments at the knee and hip were smaller in the involved compared to the uninvolved (p < 0.05). The amount of asymmetry in knee excursion during weight acceptance in gait, the asymmetry in weight bearing from sit-to-stand, and the uninvolved hip extension moment during STS were related to the amount of asymmetry in quadriceps strength (rho > 0.56, p < 0.05).Conclusions: Quadriceps weakness in patients with TKA has a substantial impact on the movement patterns and performance of the knee during functionally important tasks.

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A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties

Cited by 127 publications

References 28 publications

Gait analysis of patients with an off-the-shelf total knee replacement versus customized bi-compartmental knee replacement

Gait analysis of patients with an off-the-shelf total knee replacement versus customized bi-compartmental knee replacement

Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis

Altered loading during walking and sit‐to‐stand is affected by quadriceps weakness after total knee arthroplasty

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