Contribution of Hip Abductor Strength to Physical Function in Patients With Total Knee Arthroplasty

Piva, Sara R.; Teixeira, Paulo E.P.; Almeida, Gustavo J.; Gil, Alexandra B.; DiGioia, Anthony M.; Levison, Timothy J.; Fitzgerald, G. Kelley

doi:10.2522/ptj.20100122

Cited by 97 publications

(93 citation statements)

References 26 publications

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“…Maximal voluntary isometric strength of the hip flexors and extensors was performed while participants were supine with the hip flexed to 40°using a strap around the waist to stabilize the pelvis [26]. Strength testing of the hip abductors was performed while participants were sidelying positioned in 0°of abduction/adduction and flexion/extension with a strap to stabilize the pelvis [26,36]. Maximal strength testing of the knee extensors and flexors was performed while patients were seated and stabilized with a shoulder harness and waist strap in 85°of hip flexion and 60°of knee flexion as previously described [31,47].…”

Section: Strength Testing Proceduresmentioning

confidence: 99%

Muscle Strength and Functional Recovery During the First Year After THA

Judd¹,

Dennis

Thomas³

et al. 2013

Clin Orthop Relat Res

146

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Background Patients undergoing total hip arthroplasty (THA) often are satisfied with the decrease in pain and improvement in function they achieve after surgery. Even so, strength and functional performance deficits persist after recovery, but these remain poorly characterized; knowledge about any ongoing strength or functional deficits may allow therapists to design rehabilitation programs to optimize recovery after THA. Questions/purposes The purposes of this study were to (1) evaluate postoperative muscle strength, function, and quality of life during the first year after THA; and (2) compare strength and function in patients 1 year after THA with a cohort of healthy peers. Methods Twenty-six patients undergoing THA were assessed 1, 3, 6, and 12 months postoperatively, and 19 adults with no hip pathology were tested as a control group. Isometric muscle strength (hip flexors, extensors, abductors, knee extensors, and flexors), functional performance (stair climbing, five times sit-to-stand, timed-up-and-go, 6-minute walk, and single-limb stance tests), and selfreported function (Hip Disability and Osteoarthritis Score, SF-36, and UCLA activity score) were compared. Results One month after THA, patients had 15% less hip flexor and extensor torque, 26% less abductor torque, 14% less knee extensor and flexor torque, and worse performance on the stair climbing, timed-up-and-go, single-limb stance, and 6-minute walk. Compared with healthy adults, patients 12 months after THA had 17% less knee extensor and 23% less knee flexor torque; however, the functional testing (including stair climbing, five times sit-to-stand, and the 6-minute walk) showed no significant differences with the patient numbers available between individuals undergoing THA and healthy control subjects. SF-36 Physical Component Scores, although significantly improved from preoperative levels, were significantly worse than healthy adults 1 year after THA (p \ 0.01).

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Section: Strength Testing Proceduresmentioning

confidence: 99%

Muscle Strength and Functional Recovery During the First Year After THA

Judd¹,

Dennis

Thomas³

et al. 2013

Clin Orthop Relat Res

146

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“…Functionality, joint pain and quality of life are relevant outcomes in the recovery process for the patients. Three studies made use of WOMAC scale to quantify the functional evolution 6,11,15 Nevertheless, these three studies differ in the use of functional tests. Kramer et al 12 used 6MWD as well as sit down and stand up, Lenine et al 11 Applied get up-and-go test and finally Ko et al 6 used 6MWD as well as quadriceps lag (extensor lag).…”

Section: Discussionmentioning

confidence: 99%

“…Ko et al 6 described this item inconclusively, resulting in uncertain risk of bias. Three studies 8,15,16 did not describe this item clearly, resulting in high risk of bias. Finally, four studies 6,11,13 did not seem to have other sources of bias.…”

Section: Study Characteristicsmentioning

confidence: 99%

Comparison of Supervised and Unsupervised Models of Physical Therapy in Total Knee Arthroplasty: Systematic Review

Pesavento¹

2017

IPMRJ

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“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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], fear of movement [15], reduced proprioception [16], leg length discrepancy [17], obesity [18][19][20], pain [7,21,22], time since TKA surgery [13,23], age [24], and habitual gait patterns [1].…”

mentioning

confidence: 99%

Peak Knee Flexion Angles During Stair Descent in TKA Patients

Bjerke

Öhberg

Nilsson

et al. 2014

The Journal of Arthroplasty

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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...

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Contribution of Hip Abductor Strength to Physical Function in Patients With Total Knee Arthroplasty

Cited by 97 publications

References 26 publications

Muscle Strength and Functional Recovery During the First Year After THA

Muscle Strength and Functional Recovery During the First Year After THA

Comparison of Supervised and Unsupervised Models of Physical Therapy in Total Knee Arthroplasty: Systematic Review

Peak Knee Flexion Angles During Stair Descent in TKA Patients

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