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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2013

Open Access 01-12-2013 | Research article

Knee extension range of motion and self-report physical function in total knee arthroplasty: mediating effects of knee extensor strength

Authors: Yong-Hao Pua, Peck-Hoon Ong, Hwei-Chi Chong, William Yeo, Celia Tan, Ngai-Nung Lo

Published in: BMC Musculoskeletal Disorders | Issue 1/2013

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Abstract

Background

Knee extensor strength and knee extension range of motion (ROM) are important predictors of physical function in patients with a total knee arthroplasty (TKA). However, the relationship between the two knee measures remains unclear. The purpose of this study was to examine whether changes in knee extensor strength mediate the association between changes in knee extension ROM and self-report physical function.

Methods

Data from 441 patients with a TKA were collected preoperatively and 6 months postoperatively. Self-report measure of physical function was assessed by the Short Form 36 (SF-36) questionnaire. Knee extensor strength was measured by handheld dynamometry and knee extension ROM by goniometry. A bootstrapped cross product of coefficients approach was used to evaluate mediation effects.

Results

Mediation analyses, adjusted for clinicodemographic measures, revealed that the association between changes in knee extension ROM and SF-36 physical function was mediated by changes in knee extensor strength.

Conclusions

In patients with TKA, knee extensor strength mediated the influence of knee extension ROM on physical function. These results suggest that interventions to improve the range of knee extension may be useful in improving knee extensor performance.
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Literature
1.
McNeil JM, Binette J: Prevalence of disabilities and associated health conditions among adults. Morb Mortal Wkly Rep. 2001, 50: 120-125.
2.
Guccione AA, Felson DT, Anderson JJ, Anthony JM, Zhang YQ, Wilson PWF, et al: The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health. 1994, 84: 351-358. 10.2105/AJPH.84.3.351.CrossRefPubMedPubMedCentral
3.
Ranawat CS, Ranawat AS, Mehta A: Total knee arthroplasty rehabilitation protocol: what makes the difference?. J Arthroplasty. 2003, 18: 27-30.CrossRefPubMed
4.
Bhave A, Mont M, Tennis S, Nickey M, Starr R, Etienne G: Functional problems and treatment solutions after total hip and knee joint arthroplasty. J Bone Joint Surg Am. 2005, 87 (Suppl 2): 9-21.CrossRefPubMed
5.
Franklin PD, Li W, Ayers DC: The Chitranjan Ranawat Award: functional outcome after total knee replacement varies with patient attributes. Clin Orthop. 2008, 466: 2597-2604. 10.1007/s11999-008-0428-8.CrossRefPubMedPubMedCentral
6.
Parent E, Moffet H: Preoperative predictors of locomotor ability two months after total knee arthroplasty for severe osteoarthritis. Arthritis Care Res. 2003, 49: 36-50. 10.1002/art.10906.CrossRef
7.
Zeni JA, Snyder-Mackler L: Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty. J Bone Joint Surg Am. 2010, 92: 1130-1136. 10.2106/JBJS.I.00299.CrossRefPubMedPubMedCentral
8.
Lingard EA, Katz JN, Wright EA, Sledge CB: Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am. 2004, 86-A: 2179-2186.PubMed
9.
Ritter MA, Lutgring JD, Davis KE, Berend ME, Pierson JL, Meneghini RM: The role of flexion contracture on outcomes in primary total knee arthroplasty. J Arthroplasty. 2007, 22: 1092-1096. 10.1016/j.arth.2006.11.009.CrossRefPubMed
10.
Devers BN, Conditt MA, Jamieson ML, Driscoll MD, Noble PC, Parsley BS: Does greater knee flexion increase patient function and satisfaction after total knee arthroplasty?. J Arthroplasty. 2011, 26: 178-186. 10.1016/j.arth.2010.02.008.CrossRefPubMed
11.
Meneghini RM, Pierson JL, Bagsby D, Ziemba-Davis M, Berend ME, Ritter MA: Is there a functional benefit to obtaining high flexion after total knee arthroplasty?. J Arthroplasty. 2007, 22: 43-46.CrossRefPubMed
12.
Mitsuyasu H, Matsuda S, Miura H, Okazaki K, Fukagawa S, Iwamoto Y: Flexion contracture persists if the contracture is more than 15 degrees at 3 months after total knee arthroplasty. J Arthroplasty. 2011, 26: 639-643. 10.1016/j.arth.2010.04.023.CrossRefPubMed
13.
Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN: Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?. J Arthroplasty. 2003, 18: 286-294. 10.1054/arth.2003.50046.CrossRefPubMed
14.
Savelberg HH, Meijer K: The effect of age and joint angle on the proportionality of extensor and flexor strength at the knee joint. J Gerontol A Biol Sci Med Sci. 2004, 59: 1120-1128. 10.1093/gerona/59.11.1120.CrossRefPubMed
15.
Anderson DE, Madigan ML, Nussbaum MA: Maximum voluntary joint torque as a function of joint angle and angular velocity: model development and application to the lower limb. J Biomech. 2007, 40: 3105-3113. 10.1016/j.jbiomech.2007.03.022.CrossRefPubMed
16.
Nadeau S, McFadyen BJ, Malouin F: Frontal and sagittal plane analyses of the stair climbing task in healthy adults aged over 40 years: what are the challenges compared to level walking?. Clin Biomech (Bristol, Avon). 2003, 18: 950-959. 10.1016/S0268-0033(03)00179-7.CrossRef
17.
Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN: The self-administered comorbidity questionnaire: A new method to assess comorbidity for clinical and health services research. Arthritis Care Res. 2003, 49: 156-163. 10.1002/art.10993.CrossRef
18.
Ware JE, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992, 30: 473-483. 10.1097/00005650-199206000-00002.CrossRefPubMed
19.
Thumboo J, Fong KY, Machin D, Chan SP, Leon KH, Feng PH, et al: A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore. Qual Life Res. 2001, 10: 175-188. 10.1023/A:1016701514299.CrossRefPubMed
20.
Martin HJ, Yule V, Syddall HE, Dennison EM, Cooper C, Aihie SA: Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? A comparison with the gold standard Bodex dynamometry. Gerontology. 2006, 52: 154-159. 10.1159/000091824.CrossRefPubMed
21.
Stratford PW, Balsor BE: A comparison of make and break tests using a hand-held dynamometer and the Kin-Com. J Orthop Sports Phys Ther. 1994, 19: 28-CrossRefPubMed
22.
Pua YH: Allometric analysis of physical performance measures in older adults. Phys Ther. 2006, 86: 1263-1270. 10.2522/ptj.20060034.CrossRefPubMed
23.
Jaric S, Radosavljevic-Jaric S, Johansson H: Muscle force and muscle torque in humans require different methods when adjusting for differences in body size. Eur J Appl Physiol. 2002, 87: 304-307. 10.1007/s00421-002-0638-9.CrossRefPubMed
24.
25.
Arnold CM, Warkentin KD, Chilibeck PD, Magnus CR: The reliability and validity of handheld dynamometry for the measurement of lower-extremity muscle strength in older adults. J Strength Cond Res. 2010, 24: 815-824. 10.1519/JSC.0b013e3181aa36b8.CrossRefPubMed
26.
Cibere J, Bellamy N, Thorne A, Esdaile JM, McGorm KJ, Chalmers A, et al: Reliability of the knee examination in osteoarthritis: effect of standardization. Arthritis Rheum. 2004, 50: 458-468. 10.1002/art.20025.CrossRefPubMed
27.
Preacher KJ, Hayes AF: Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008, 40: 879-891. 10.3758/BRM.40.3.879.CrossRefPubMed
28.
McGrath MS, Mont MA, Siddiqui JA, Baker E, Bhave A: Evaluation of a custom device for the treatment of flexion contractures after total knee arthroplasty. Clin Orthop. 2009, 467: 1485-1492. 10.1007/s11999-009-0804-z.CrossRefPubMedPubMedCentral
29.
Bonutti PM, Marulanda GA, McGrath MS, Mont MA, Zywiel MG: Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2010, 18: 194-199. 10.1007/s00167-009-0947-1.CrossRefPubMed
30.
Pollard H, Ward G, Hoskins W, Hardy K: The effect of a manual therapy knee protocol on osteoarthritic knee pain: a randomised controlled trial. J Can Chiropr Assoc. 2008, 52: 229-242.PubMedPubMedCentral
31.
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
32.
Lamb SE, Frost H: Recovery of mobility after knee arthroplasty: expected rates and influencing factors. J Arthroplasty. 2003, 18: 575-582. 10.1016/S0883-5403(03)00110-4.CrossRefPubMed
33.
Park KK, Chang CB, Kang YG, Seong SC, Kim TK: Correlation of maximum flexion with clinical outcome after total knee replacement in Asian patients. J Bone Joint Surg Br. 2007, 89: 604-608. 10.1302/0301-620X.89B5.18117.CrossRefPubMed
34.
MacKinnon DP: Introduction to statistical mediation analysis. 2008, Mahwah, NJ: Erlbaum Psych Press
35.
Stratford PW, Kennedy DM, Maly MR, Macintyre NJ: Quantifying self-report measures’ overestimation of mobility scores postarthroplasty. Phys Ther. 2010, 90: 1288-1296. 10.2522/ptj.20100058.CrossRefPubMed
Metadata
Title
Knee extension range of motion and self-report physical function in total knee arthroplasty: mediating effects of knee extensor strength
Authors
Yong-Hao Pua
Peck-Hoon Ong
Hwei-Chi Chong
William Yeo
Celia Tan
Ngai-Nung Lo
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2013
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-14-33

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