Quadriceps weakness preferentially predicts detrimental gait compensations among common impairments after total knee arthroplasty

Abstract

Patients with total knee arthroplasty (TKA) have large deficits in physical performance in comparison to their healthy age-matched peers. Limb asymmetry stemming from less relative load borne by the surgical limb during daily mobility is associated with diminished performance and worsens with greater mobility demands. How common targets of postoperative care, such as muscle weakness, lower limb extension power, residual knee pain, and poor balance confidence can influence asymmetrical limb loading remains unclear. Forty-six patients with unilateral TKA underwent testing of impairments and motion analysis during 10° decline walking at 3 and 6 months postoperatively. At 3 months, only quadriceps femoris strength asymmetry was found to be significantly related to both total support moment (M ) (β = 0.431; p < 0.001) and knee extensor moment (M ) (β = 0.493; p < 0.001) asymmetry. Again at 6 months, only quadriceps strength asymmetry was related to M (β = 0.432; p < 0.001) and M (β = 0.534; p < 0.001) asymmetry. Quadriceps strength significantly improved over time in both limbs, however, deficits between limbs remained. Persistent quadriceps weakness is a key factor associated with walking compensation patterns that are limiting the capacity for greater physical performance of patients with TKA. The pronounced asymmetry in limb and knee loading at 3 months remains unchanged until at least 6 months after surgery, and its association with quadriceps strength asymmetry does not substantially change over time. While other factors may also prompt gait compensations, emphasis on improved quadriceps strength should be a focus of efforts to resolve gait compensations and enhance physical performance outcomes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2355-2363, 2018.

Preoperative quadriceps weakness preferentially predicts postoperative aberrant movement patterns during high-demand mobility following total knee arthroplasty

“…Alternatively, movement symmetry retraining is rarely prescribed in standard rehabilitation practice and may provide an alternative intervention to incorporate pre- and post-TKA to maximize lower limb function, particularly in restoring quadriceps strength. Studies are showing promising evidence that movement symmetry retraining is beneficial in improving aberrant movement patterns following TKA [44–46]. However, further prospective longitudinal designs are needed to determine long-term retention of improved movement quality and how motor retraining influences muscle function.…”

Potential Instability and Malfunction of Knee Joints with Vastus Medialis Impairment after Total Knee Arthroplasty

“…2 n = repetition count of the test for each specimen. 3 Vastus medialis (VM) muscle force was set to zero (VM: 0 N; RF/VI: 49 N; VL: 45 N). 4 VM muscle force was set to normal muscle force (VM: 31 N; RF/VI: 49 N; VL: 45 N).…”

“…TKA survival rates reportedly exceed 95% at 10 years and 90% at 15 years [1,2]. The Fourth American Joint Replacement Registry reported that TKAs were performed for approximately 0.5 million people in the USA in 2016 and will be performed in approximately 3 million people annually worldwide after 2030 [3][4][5]. However, TKA continues to exhibit failures generally related to pain, infection, osteolysis, wear, aseptic loosening, periprosthetic fracture, instability, or malalignment [5].…”

“…They identified that the extension moment was generally 20% lower in knee joints after TKA than in knee joints that had not undergone TKA. Furthermore, Christensen et al reported that the TKA-related quadriceps impairment produced an asymmetry extension moment, which limited the physical function of the knee joint [3]. Sharkey et al, Cavaignac et al, and Lee et al have reported that extensor impairment caused by quadriceps impairment led to a greater risk of posterior instability in knee joints that had undergone TKA [9,19,20].…”

Changes in Maximal Isometric Quadriceps Strength after the Application of Ultrasound-Guided Percutaneous Neuromodulation of the Femoral Nerve: A Case Series

“…[4][5][6] The early restoration of the muscle contraction properties of the quadriceps is essential to ensure appropriate recovery and facilitate the return to the activities of daily living, as well as to work and/ or sports activities. [7][8][9] Among the various types of muscle contraction, maximal isometric strength (MIS, or maximal isometric voluntary contraction [MIVC]), is an essential parameter of strength for the correct functioning of the muscle motor unit. [10][11][12] Conditioned muscle inhibition can effectively decrease this variable.…”