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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2020

01-05-2020 | KNEE

Step descent strategy is altered bilaterally despite unilateral muscle strength impairment after total knee arthroplasty

Authors: Paul W. Kline, Cale A. Jacobs, Stephen T. Duncan, Brian Noehren

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 5/2020

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Abstract

Purpose

Muscle weakness and difficulty descending stairs are common after unilateral total knee arthroplasty (TKA), but the relationship between each is unclear. The purpose of this study was to compare lower extremity muscle strength, lower extremity support moments during step descent, and assess relationships between each.

Methods

The study included 40 subjects (20 post-TKA, 20 control). Knee extensor, hip abductor, and hip external rotator strength were measured and biomechanical analyses of step descent performed. Patients with TKA were assessed 3 and 6 months post-surgery.

Results

At 3 and 6 months post-TKA, operated limb hip external rotator and knee extensor strength were impaired compared to the non-operated limb (p < 0.01); however, no between-limb differences were observed during step descent. Compared to the control group, hip external rotator and knee extensor strength, total lower extremity support moment, and knee support moment during step descent were impaired post-TKA (p < 0.05). At 6 months post-TKA, knee extensor and hip external rotator strength correlated with total support moment during step descent (rs = 0.40, 0.41, p < 0.02). Hip abductor and external rotator strength negatively correlated with knee support moment during step descent (rs = − 0.35, − 0.39, p < 0.03).

Conclusions

Persistent operative limb knee extensor and hip external rotator muscle weakness are noted following unilateral TKA. Despite unilateral weakness, bilateral alterations in step descent strategy occur following TKA. Patients with TKA utilize hip musculature to reduce knee muscle demand during step descent, possibly contributing to limitations in long-term step descent performance.
Literature
1.
Alnahdi AH, Zeni JA, Snyder-Mackler L (2014) Hip abductor strength reliability and association with physical function after unilateral total knee arthroplasty: a cross-sectional study. Phys Ther 94:1154–1162CrossRef
2.
Benedetti MG, Merlo A, Leardini A (2013) Inter-laboratory consistency of gait analysis measurements. Gait Posture 38:934–939CrossRef
3.
Bjerke J, Ohberg F, Nilsson KG, Foss OA, Stensdotter AK (2014) Peak knee flexion angles during stair descent in TKA patients. J Arthroplast 29:707–711CrossRef
4.
Camomilla V, Cereatti A, Cutti AG, Fantozzi S, Stagni R, Vannozzi G (2017) Methodological factors affecting joint moments estimation in clinical gait analysis: a systematic review. Biomed Eng Online 16:106CrossRef
5.
Christensen JC, LaStayo PC, Mizner RL, Marcus RL, Pelt CE, Stoddard GJ et al (2017) Joint mechanical asymmetries during low- and high-demand mobility tasks: comparison between total knee arthroplasty and healthy-matched peers. Gait Posture 60:104–110CrossRef
6.
Christiansen CL, Bade MJ, Judd DL, Stevens-Lapsley JE (2011) Weight-bearing asymmetry during sit-stand transitions related to impairment and functional mobility after total knee arthroplasty. Arch Phys Med Rehabil 92:1624–1629CrossRef
7.
Claiborne TL, Timmons MK, Pincivero DM (2009) Test-retest reliability of cardinal plane isokinetic hip torque and EMG. J Electromyogr Kinesiol 19:e345–e352CrossRef
8.
de Araujo Ribeiro Alvares JB, Rodrigues R, de Azevedo Franke R, da Silva BG, Pinto RS, Vaz MA et al (2015) Inter-machine reliability of the Biodex and Cybex isokinetic dynamometers for knee flexor/extensor isometric, concentric and eccentric tests. Phys Ther Sport 16:59–65CrossRef
9.
DeJong G, Tian W, Smout RJ, Horn SD, Putman K, Smith P et al (2009) Use of rehabilitation and other health care services by patients with joint replacement after discharge from skilled nursing and inpatient rehabilitation facilities. Arch Phys Med Rehabil 90:1297–1305CrossRef
10.
Della Croce U, Leardini A, Chiari L, Cappozzo A (2005) Human movement analysis using stereophotogrammetry. Part 4: assessment of anatomical landmark misplacement and its effects on joint kinematics. Gait Posture 21:226–237CrossRef
11.
Drouin JM, Valovich-mcLeod TC, Shultz SJ, Gansneder BM, Perrin DH (2004) Reliability and validity of the Biodex system 3 pro isokinetic dynamometer velocity, torque and position measurements. Eur J Appl Physiol 91:22–29CrossRef
12.
Eichelberger P, Ferraro M, Minder U, Denton T, Blasimann A, Krause F et al (2016) Analysis of accuracy in optical motion capture—a protocol for laboratory setup evaluation. J Biomech 49:2085–2088CrossRef
13.
Fritz JM, Hunter SJ, Tracy DM, Brennan GP (2011) Utilization and clinical outcomes of outpatient physical therapy for medicare beneficiaries with musculoskeletal conditions. Phys Ther 91:330–345CrossRef
14.
Gaffney BM, Harris MD, Davidson BS, Stevens-Lapsley JE, Christiansen CL, Shelburne KB (2016) Multi-joint compensatory effects of unilateral total knee arthroplasty during high-demand tasks. Ann Biomed Eng 44:2529–2541CrossRef
15.
16.
Hong SW, Wang TM, Lu TW, Li JD, Leu TH, Ho WP (2014) Redistribution of intra- and inter-limb support moments during downhill walking on different slopes. J Biomech 47:709–715CrossRef
17.
Kline PW, Morgan KD, Johnson DL, Ireland ML, Noehren B (2015) Impaired quadriceps rate of torque development and knee mechanics after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 43:2553–2558CrossRef
18.
Loyd BJ, Jennings JM, Judd DL, Kim RH, Wolfe P, Dennis DA et al (2017) Influence of hip abductor strength on functional outcomes before and after total knee arthroplasty: post hoc analysis of a randomized controlled trial. Phys Ther 97:896–903CrossRef
19.
Manal K, McClay I, Stanhope S, Richards J, Galinat B (2000) Comparison of surface mounted markers and attachment methods in estimating tibial rotations during walking: an in vivo study. Gait Posture 11:38–45CrossRef
20.
McClelland JA, Feller JA, Menz HB, Webster KE (2014) Patterns in the knee flexion-extension moment profile during stair ascent and descent in patients with total knee arthroplasty. J Biomech 47:1816–1821CrossRef
21.
McClelland JA, Feller JA, Webster KE (2018) Sex differences in gait after total knee arthroplasty. J Arthroplast 33:897–902CrossRef
22.
Nakahara H, Okazaki K, Mizu-Uchi H, Hamai S, Tashiro Y, Matsuda S et al (2015) Correlations between patient satisfaction and ability to perform daily activities after total knee arthroplasty: why aren’t patients satisfied? J Orthop Sci 20:87–92CrossRef
23.
Oatis CA, Li W, DiRusso JM, Hoover MJ, Johnston KK, Butz MK et al (2014) Variations in delivery and exercise content of physical therapy rehabilitation following total knee replacement surgery: a cross-sectional observation study. Int J Phys Med Rehabil Suppl 5:002PubMedPubMedCentral
24.
Papakostidou I, Dailiana ZH, Papapolychroniou T, Liaropoulos L, Zintzaras E, Karachalios TS et al (2012) Factors affecting the quality of life after total knee arthroplasties: a prospective study. BMC Musculoskelet Disord 13:116CrossRef
25.
Parvizi J, Nunley RM, Berend KR, Lombardi AV Jr, Ruh EL, Clohisy JC et al (2014) High level of residual symptoms in young patients after total knee arthroplasty. Clin Orthop Relat Res 472:133–137CrossRef
26.
Paterson KL, Sosdian L, Hinman RS, Wrigley TV, Kasza J, Dowsey M et al (2017) The influence of sex and obesity on gait biomechanics in people with severe knee osteoarthritis scheduled for arthroplasty. Clin Biomech (Bristol, Avon) 49:72–77CrossRef
27.
Pinzone O, Schwartz MH, Thomason P, Baker R (2014) The comparison of normative reference data from different gait analysis services. Gait Posture 40:286–290CrossRef
28.
Piva SR, Teixeira PE, Almeida GJ, Gil AB, DiGioia AM 3rd, Levison TJ et al (2011) Contribution of hip abductor strength to physical function in patients with total knee arthroplasty. Phys Ther 91:225–233CrossRef
29.
Pozzi F, Marmon AR, Snyder-Mackler L, Zeni J Jr (2016) Lower leg compensatory strategies during performance of a step up and over task in patient six-months after total knee arthroplasty. Gait Posture 49:41–46CrossRef
30.
Pozzi F, Snyder-Mackler L, Zeni J Jr (2015) Relationship between biomechanical asymmetries during a step up and over task and stair climbing after total knee arthroplasty. Clin Biomech (Bristol, Avon) 30:78–85CrossRef
31.
Rasnick R, Standifird T, Reinbolt JA, Cates HE, Zhang S (2016) Knee joint loads and surrounding muscle forces during stair ascent in patients with total knee replacement. PLoS ONE 11:e0156282CrossRef
32.
Ren L, Jones RK, Howard D (2008) Whole body inverse dynamics over a complete gait cycle based only on measured kinematics. J Biomech 41:2750–2759CrossRef
33.
Schache MB, McClelland JA, Webster KE (2014) Lower limb strength following total knee arthroplasty: a systematic review. Knee 21:12–20CrossRef
34.
Sveikata T, Porvaneckas N, Kanopa P, Molyte A, Klimas D, Uvarovas V et al (2017) Age, sex, body mass index, education, and social support influence functional results after total knee arthroplasty. Geriatr Orthop Surg Rehabil 8:71–77CrossRef
35.
Winter DA (2005) Biomechanics and motor control of human movement, 3rd edn. Wiley, Hoboken
36.
Zeni JA, Higginson JS (2011) Knee osteoarthritis affects the distribution of joint moments during gait. Knee 18:156–159CrossRef
37.
Zeni JA Jr, Flowers P, Bade M, Cheuy V, Stevens-Lapsley J, Snyder-Mackler L (2019) Stiff knee gait may increase risk of second total knee arthroplasty. J Orthop Res 37:397–402CrossRef
Metadata
Title
Step descent strategy is altered bilaterally despite unilateral muscle strength impairment after total knee arthroplasty
Authors
Paul W. Kline
Cale A. Jacobs
Stephen T. Duncan
Brian Noehren
Publication date
01-05-2020
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 5/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05554-8

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