Multimodal rehabilitation in patients with persistent pain and functional disability after primary or revision total knee arthroplasty

Larsen, Jesper Bie; Mogensen, L; Arendt‐Nielsen, Lars; Madeleine, Pascal

doi:10.1016/j.joca.2019.02.476

Cited by 1 publication

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“…5 These compensatory patterns could be attenuated using well tar-geted neuromuscular rehabilitation. 10 But before exploring such approach, a more fundamental question must be asked: is this suboptimal control detrimental in any way for the patient? Suboptimal control is metabolically less efficient, but this is unlikely to be a problem for the population of interest.…”

Section: Introductionmentioning

confidence: 99%

Effect of Suboptimal Neuromuscular Control on the Risk of Massive Wear in Total Knee Replacement

et al. 2021

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The optimal neuromuscular control (muscle activation strategy that minimises the consumption of metabolic energy) during level walking is very close to that which minimises the force transmitted through the joints of the lower limbs. Thus, any suboptimal control involves an overloading of the joints. Some total knee replacement patients adopt suboptimal control strategies during level walking; this is particularly true for patients with co-morbidities that cause neuromotor control degeneration, such as Parkinson’s Disease (PD). The increase of joint loading increases the risk of implant failure, as reported in one study in PD patients (5.44% of failures at 9 years follow-up). One failure mode that is directly affected by joint loading is massive wear of the prosthetic articular surface. In this study we used a validated patient-specific biomechanical model to estimate how a severely suboptimal control could increase the wear rate of total knee replacements. Whereas autopsy-retrieved implants from non-PD patients typically show average polyethylene wear of 17 mm3 per year, our simulations suggested that a severely suboptimal control could cause a wear rate as high as of 69 mm3 per year. Assuming the risk of implant failure due to massive wear increase linearly with the wear rate, a severely suboptimal control could increase the risk associated to that failure mode from 0.1% to 0.5%. Based on these results, such increase would not be not sufficient to justify alone the higher incidence rate of revision in patients affected by Parkinson’s Disease, suggesting that other failure modes may be involved.

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Section: Introductionmentioning

confidence: 99%