Top

Clinical Orthopaedics and Related Research®

Published in:

01-09-2010 | Clinical Research

Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty

Authors: Jennifer E. Stevens-Lapsley, PT, MPT, PhD, Jaclyn E. Balter, MS, Wendy M. Kohrt, PhD, Donald G. Eckhoff, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 9/2010

Abstract

Background/rationale

Although TKA reliably reduces pain from knee osteoarthritis, full recovery of muscle strength and physical function to normal levels is rare. We presumed that a better understanding of acute changes in hamstrings and quadriceps muscle performance would allow us to enhance early rehabilitation after TKA and improve long-term function.

Questions/purposes

The purposes of this study were to (1) evaluate postoperative quadriceps and hamstrings muscle strength loss after TKA and subsequent recovery using the nonoperative legs and healthy control legs for comparison, and (2) measure hamstrings coactivation before and after TKA during a maximal isometric quadriceps muscle contraction and compare with nonoperative and healthy control legs.

Methods

We prospectively followed 30 patients undergoing TKA at 2 weeks preoperatively and 1, 3, and 6 months postoperatively and compared patient outcomes with a cross-sectional cohort of 15 healthy older adults. Bilateral, isometric strength of the quadriceps and hamstrings was assessed along with EMG measures of hamstrings coactivation during a maximal isometric quadriceps contraction.

Results

There were no differences in strength loss or recovery between the quadriceps and hamstrings muscles of the operative leg throughout the followup, although differences existed when compared with nonoperative and healthy control legs. Hamstrings muscle coactivation in the operative leg during a maximal quadriceps effort was elevated at 1 month (144.5%) compared to the nonoperative leg.

Conclusions

Although quadriceps dysfunction after TKA typically is recognized and addressed in postoperative therapy protocols, hamstrings dysfunction also is present and should be addressed.

Clinical Relevance

Quadriceps and hamstrings muscle strengthening should be the focus of future rehabilitation programs to optimize muscle function and long-term outcomes.

Adili A, Bhandari M, Petruccelli D, De Beer J. Sequential bilateral total knee arthroplasty under 1 anesthetic in patients > or = 75 years old: complications and functional outcomes. J Arthroplasty. 2001;16:271–278.CrossRefPubMed

American Academy of Orthopaedic Surgeons. Most commonly performed musculoskeletal-related procedures. Available at: www.aaos.org/research/stats/top_hospitalization_visits.pdf. Accessed June 27, 2009.

Baratta R, Solomonow M, Zhou BH, Letson D, Chuinard R, D’Ambrosia R. Muscular coactivation: the role of the antagonist musculature in maintaining knee stability. Am J Sports Med. 1988;16:113–122.CrossRefPubMed

Benedetti MG, Catani F, Bilotta PW, Marcacci M, Mariani E, Giannini S. Muscle activation pattern and gait biomechanics after total knee replacement. Clin Biomech (Bristol, Avon). 2003;18:871–876.CrossRef

Berman AT, Bosacco SJ, Israelite C. Evaluation of total knee arthroplasty using isokinetic testing. Clin Orthop Relat Res. 1991;271:106–113.PubMed

Berth A, Urbach D, Awiszus F. Improvement of voluntary quadriceps muscle activation after total knee arthroplasty. Arch Phys Med Rehabil. 2002;83:1432–1436.CrossRefPubMed

Berth A, Urbach D, Neumann W, Awiszus F. Strength and voluntary activation of quadriceps femoris muscle in total knee arthroplasty with midvastus and subvastus approaches. J Arthroplasty. 2007;22:83–88.CrossRefPubMed

Bonutti PM, Mont MA, Kester MA. Minimally invasive total knee arthroplasty: a 10-feature evolutionary approach. Orthop Clin North Am. 2004;35:217–226.CrossRefPubMed

Busse ME, Wiles CM, van Deursen RW. Co-activation: its association with weakness and specific neurological pathology. J Neuroeng Rehabil. 2006;3:26.CrossRefPubMed

10.

Davies JM, Mayston MJ, Newham DJ. Electrical and mechanical output of the knee muscles during isometric and isokinetic activity in stroke and healthy adults. Disabil Rehabil. 1996;18:83–90.CrossRefPubMed

11.

Fisher NM, Pendergast DR, Gresham GE, Calkins E. Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis. Arch Phys Med Rehabil. 1991;72:367–374.PubMed

12.

Forrest G, Fuchs M, Gutierrez A, Girardy J. Factors affecting length of stay and need for rehabilitation after hip and knee arthroplasty. J Arthroplasty. 1998;13:186–190.CrossRefPubMed

13.

Huang CH, Cheng CK, Lee YT, Lee KS. Muscle strength after successful total knee replacement: a 6- to 13-year followup. Clin Orthop Relat Res. 1996;328:147–154.CrossRefPubMed

14.

Hubley-Kozey C, Deluzio K, Dunbar M. Muscle co-activation patterns during walking in those with severe knee osteoarthritis. Clin Biomech (Bristol, Avon). 2008;23:71–80.CrossRef

15.

Hurley MV. The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am 1999;5:283–298.CrossRefPubMed

16.

Kennedy DM, Stratford PW, Riddle DL, Hanna SE, Gollish JD. Assessing recovery and establishing prognosis following total knee arthroplasty. Phys Ther. 2008;88:22–32.CrossRefPubMed

17.

Krishnan C, Williams GN. Evoked tetanic torque and activation level explain strength differences by side. Eur J Appl Physiol. 2009;106:769–774.CrossRefPubMed

18.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.CrossRefPubMed

19.

Lewek MD, Rudolph KS, Snyder-Mackler L. Control of frontal plane knee laxity during gait in patients with medial compartment knee osteoarthritis. Osteoarthritis Cartilage. 2004;12:745–751.CrossRefPubMed

20.

Lewek MD, Rudolph KS, Snyder-Mackler L. Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis. J Orthop Res. 2004;22:110–115.CrossRefPubMed

21.

Lorentzen JS, Petersen MM, Brot C, Madsen OR. Early changes in muscle strength after total knee arthroplasty: a 6-month follow-up of 30 knees. Acta Orthop Scand. 1999;70:176–179.CrossRefPubMed

22.

Lutz GE, Palmitier RA, An KN, Chao EY. Comparison of tibiofemoral joint forces during open-kinetic-chain and closed-kinetic-chain exercises. J Bone Joint Surg Am. 1993;75:732–739.PubMed

23.

McArdle A, Vasilaki A, Jackson M. Exercise and skeletal muscle ageing: cellular and molecular mechanisms. Ageing Res Rev. 2002;1:79–93.CrossRefPubMed

24.

Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005;35:424–436.PubMed

25.

Mizner RL, Petterson SC, Stevens JE, Axe MJ, Snyder-Mackler L. Preoperative quadriceps strength predicts functional ability one year after total knee arthroplasty. J Rheumatol. 2005;32:1533–1539.PubMed

26.

Mizner RL, Petterson SC, Stevens JE, Vandenborne K, Snyder-Mackler L. Early quadriceps strength loss after total knee arthroplasty: the contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005;87:1047–1053.CrossRefPubMed

27.

Mizner RL, Snyder-Mackler L. Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res. 2005;23:1083–1090.CrossRefPubMed

28.

Mizner RL, Stevens JE, Snyder-Mackler L. Voluntary activation and decreased force production of the quadriceps femoris muscle after total knee arthroplasty. Phys Ther. 2003;83:359–365.PubMed

29.

Moffet H, Collet JP, Shapiro SH, Paradis G, Marquis F, Roy L. Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: a single-blind randomized controlled trial. Arch Phys Med Rehabil. 2004;85:546–556.CrossRefPubMed

30.

Newham DJ, Hsiao SF. Knee muscle isometric strength, voluntary activation and antagonist co-contraction in the first six months after stroke. Disabil Rehabil. 2001;23:379–386.CrossRefPubMed

31.

Nichols AW. Achilles tendinitis in running athletes. J Am Board Fam Pract. 1989;2:196–203.PubMed

32.

Noble PC, Gordon MJ, Weiss JM, Reddix RN, Conditt MA, Mathis KB. Does total knee replacement restore normal knee function? Clin Orthop Relat Res. 2005;431:157–165.CrossRefPubMed

33.

O’Reilly SC, Jones A, Muir KR, Doherty M. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis. 1998;57:588–594.CrossRefPubMed

34.

Ostenberg A, Roos E, Ekdahl C, Roos H. Isokinetic knee extensor strength and functional performance in healthy female soccer players. Scand J Med Sci Sports. 1998;8:257–264.CrossRefPubMed

35.

Perhonen M, Komi PV, Hakkinen K, Von Bonsdorf H, Partio H. Strength training and neuromuscular function in elderly people with total knee endoprosthesis. Scand J Med Sci Sports. 1982;2(4):234–243.CrossRef

36.

Petterson SC, Mizner RL, Stevens JE, Raisis L, Bodenstab A, Newcomb W, Snyder-Mackler L. Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum. 2009;61:174–183.CrossRefPubMed

37.

Scuderi GR, Tenholder M, Capeci C. Surgical approaches in mini-incision total knee arthroplasty. Clin Orthop Relat Res. 2004;428:61–67.CrossRefPubMed

38.

Sharma L, Dunlop DD, Cahue S, Song J, Hayes KW. Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Ann Intern Med. 2003;138:613–619.PubMed

39.

Silva M, Shepherd EF, Jackson WO, Pratt JA, McClung CD, Schmalzried TP. Knee strength after total knee arthroplasty. J Arthroplasty. 2003;18:605–611.CrossRefPubMed

40.

Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, Wolinsky FD. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med. 1997;127:97–104.PubMed

41.

Stevens JE, Mizner RL, Snyder-Mackler L. Quadriceps strength and volitional activation before and after total knee arthroplasty for osteoarthritis. J Orthop Res. 2003;21:775–779.CrossRefPubMed

42.

Stevens JE, Mizner R, Snyder-Mackler L. Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series. J Orthop Sports Phys Ther. 2004;34:21–29.PubMed

43.

Stevens-Lapsley JE, Petterson SC, Mizner RL, Snyder-Mackler L. Impact of body mass index on functional performance after total knee arthroplasty. J Arthroplasty. 2009 Oct 29 [Epub ahead of print].

44.

Walsh M, Woodhouse LJ, Thomas SG, Finch E. Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects. Phys Ther. 1998;78:248–258.PubMed

45.

Watters JM, Clancey SM, Moulton SB, Briere KM, Zhu JM. Impaired recovery of strength in older patients after major abdominal surgery. Ann Surg. 1993;218:380–390.CrossRefPubMed

Title: Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty
Authors: Jennifer E. Stevens-Lapsley, PT, MPT, PhD
Jaclyn E. Balter, MS
Wendy M. Kohrt, PhD
Donald G. Eckhoff, MD
Publication date: 01-09-2010
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 9/2010
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-009-1219-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty

Abstract

Background/rationale

Questions/purposes

Methods

Results

Conclusions

Clinical Relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background/rationale

Questions/purposes

Methods

Results

Conclusions

Clinical Relevance

Please log in to get access to this content

Other articles of this Issue 9/2010

Early Experience with a Novel Nonmetallic Cable in Reconstructive Hip Surgery

Case Report: Soft Tissue Metastasis from Immature Teratoma of the Testis: Second Case Report and Review of the Literature

Early Active Motion versus Immobilization after Tendon Transfer for Foot Drop Deformity: A Randomized Clinical Trial

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

2010 Nicolas Andry Award: Multipotent Adult Stem Cells from Adipose Tissue for Musculoskeletal Tissue Engineering

Routine Surveillance of Modular PFC TKA Shows Increasing Failures after 10 Years