Quadriceps/hamstrings co-activation increases early after total knee arthroplasty

Abstract

Quadriceps and hamstrings weakness and co-activation present following total knee arthroplasty (TKA) and may impair functional performance. How surgery and post-operative rehabilitation influence muscle activation during walking early after surgery is unclear. Purpose Examine muscle strength and activation during walking before and one and 6-months post-TKA. Methods Ten patients (n=6 female; age:64.7±7.9years; body mass index[BMI]:29.2±2.5kg/m2) and 10 healthy adults (n=6 female; age:60.6±7.4years; BMI:25.5±4.0kg/m2) participated. The patients underwent bilateral quadriceps and hamstrings strength assessment and assessment of quadriceps/hamstrings co-activation and on/off timing using surface electromyography during a six-minute walk test (6MW). Groups, limbs, and changes with TKA surgery were compared. Results Patients reported greater 6MW knee pain pre- versus post-TKA and compared to controls (P<0.05). Patients had weaker surgical limb hamstrings (P<0.05) and bilateral quadriceps (P<0.05) than controls pre- and post-TKA. Before and 1-month post-TKA, patients had side-to-side differences in quadriceps and hamstrings strength (P<0.05). Controls walked farther than patients (P<0.01). Patients demonstrated greater surgical limb co-activation pre-operatively than controls (P<0.05). Co-activation was higher bilaterally one-month post-TKA compared to controls (P<0.05). Patients turned off their quadriceps later during stance than controls before and 1-month post-TKA (P<0.05). Conclusions Muscle strength, co-activation, and timing differed between patients and controls before and early after surgery. Rehabilitation to improve strength and muscle activation seems imperative to restore proper muscle firing patterns early after surgery.

Comparison of Antagonist Muscle Activity During Walking Between Total Knee Replacement and Control Subjects Using Unnormalized Electromyography

“…Such an index provides additional information about muscle function not available through separate analysis of external moments or unnormalized sEMG. While researchers have defined co-contraction indices to investigate TKR agonist-antagonist muscle pair activity [8–10] , none of these studies used unnormalized EMG data and sagittal plane moments to characterize deviations from normal. Increased co-contraction has been proposed as a compensation for perceived instability yet recent neurophysiological studies have suggested an alternative hypothesis for altered muscle activation patterns found in persons with knee OA [11, 12] .…”

Comparison of Pain and Functional State and Quality of Life of Total Knee Replacement Patient

“…After TKR surgery, muscle strength of lower extremities and co-activation of extensor and flexor of knee is important factor for early rehabilitation stage after surgery. And this factor influences the activity pattern of the muscles (Thomas et al, 2014). Also, the strong muscle group showed more stable balance ability than the weak muscle group (Butler et al, 2008).…”

Relationship between Co-contraction of the Knee Joint Muscle during One Foot Standing and Balance Function in Patients with Total Knee Arthroplasty

“…要旨： 〔目的〕片脚立位動作課題を用いて，人工膝関節全置換術(total knee arthroplasty：TKA)後患者の膝関節周 囲筋の同時収縮とバランス機能との関連について検討した． 〔対象と方法〕TKA 後 4 週が経過した 9 名と健常高齢者 10 名とした．片脚立位動作を姿勢移行時と保持時に区分し， 各区間における膝関節周囲筋の co-contraction index(CI) を測定した． 〔結果〕TKA 群と健常群の CI の比較について，有意な差を認めた．CI とバランス機能の関連について， TKA 群では移行時の CI と functional reach test に有意な負の相関が認められた． 〔結語〕TKA 患者において，姿勢変 化を伴う重心移動には膝の同時収縮が影響する可能性が示唆された． キーワード：人工膝関節全置換術，同時収縮，バランス機能 1) 札幌中央病院 リハビリテーション科：北海道札幌市中央区南 9 条西 10 丁目 1-50 (〒 064-0809) TEL 011-513-0111 2) 北海道千歳リハビリテーション大学 健康科学部 リハビリテーション学科 理学療法学専攻 3) 北海道整形外科記念病院 リハビリテーション科 4) NTT 東日本札幌病院 リハビリテーションセンター…”