Bilateral Total Knee Arthroplasty Increases the Propensity to Trip on an Obstacle

Mauer, Andreas C.; Draganich, Louis F.; Pandya, Nirav K.; Hofer, Jennifer; Piotrowski, Gary A

doi:10.1097/01.blo.0000150569.93262.64

Cited by 17 publications

(21 citation statements)

References 44 publications

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“…This is in agreement with studies reporting successful single-stage total hip or total knee replacement. 18,19,21 Although not proven in our study, the data suggests that this may be associated with significant socioeconomic benefits. This is particularly important because functional gain was significantly higher for patients undergoing single-stage treatment in our series.…”

Section: Parameters Measured * Pre-operative Post-operative Differenccontrasting

confidence: 50%

“…Some reports have found that single-stage bilateral total knee and hip arthroplasty is associated with a higher morbidity and mortality rate because of thromboembolic complications. 2,[18][19][20][21] To our knowledge, there are no reports of single-stage TSA in the literature. Nor are there established indications or contraindications for single-stage TSA.…”

Section: Discussionmentioning

confidence: 99%

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Single-stage bilateral total shoulder arthroplasty

Gerber

Lingenfelter

Reischl

et al. 2006

The Journal of Bone and Joint Surgery. British volume

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We compared six patients with a mean age of 70 years (49 to 80) with severe bilateral, painful glenohumeral joint destruction who underwent a single-stage bilateral total shoulder replacement, with eight patients of mean age 61 years (22 to 89) who underwent bilateral total shoulder replacement in two stages, at a mean interval of 18 months (6 to 43). The overall function, pain and strength improved significantly in both groups. The subjective shoulder value, relative Constant score, active external rotation and the strength were improved significantly more in the single-stage group. Active elevation, abduction and overall function improved, significantly more in the single-stage group. Both the total duration of hospitalisation and the time off work per shoulder were substantially shorter in the single-stage group. The overall rate of complication was lower in the single-stage group. Our findings indicated that single-stage bilateral total shoulder replacement yielded significantly better clinical results with shorter hospitalisation and rehabilitation than staged replacement, and was not associated with any increase in complications.

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Section: Parameters Measured * Pre-operative Post-operative Differenccontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Single-stage bilateral total shoulder arthroplasty

Gerber

Lingenfelter

Reischl

et al. 2006

The Journal of Bone and Joint Surgery. British volume

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“… Significant improvement in WOMAC post-TKR Less strength and poorer proprioception for the EG post-TKR compared with the CG Mandeville et al [ 32 ] EG: n= 19(14F) Age: 64.0±7.74. CG: n=21(13F) Age: 63.1±4.26 Inclusion: end-stage OA undergoing TKR VAS; WOMAC; obstacle overcoming; kinematic displacement on force platform during gait Within 2 pre-TKR weeks and 6-month post-TKR Improvement in WOMAC post-surgery Impaired dynamic balance in EG vs controls Poorer gait stability in EG (smaller displacement COM/COG) than CG EG and CG cross obstacles similarly Mauer et al [ 33 ] EG: n=29(19F) Age 72, 6±5,4, bilateral (BL) TKR. CG: n=27(17F) Age 70, 6±5,5.…”

Section: Methodsmentioning

confidence: 99%

The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review

Moutzouri

Gleeson

Billis³

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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PurposeDespite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature.MethodsA systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool.ResultsThirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III.ConclusionsFindings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II–III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place.

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“…Knee stiVness may further contribute to forward falls by interfering with the rapid knee Xexion movements that are required to avoid tripping over obstacles (Pijnappels et al 2005). Indeed, patients with bilateral total knee arthroplasty have a reduced ability to negotiate obstacles, and this increases their risk of tripping (Mauer et al 2005).…”

Section: Discussionmentioning

confidence: 99%

The influence of knee rigidity on balance corrections: a comparison with responses of cerebellar ataxia patients

et al. 2008

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Knee rigidity due to aging or disease is associated with falls. A causal relationship between instability and knee rigidity has not been established. Here, we examined whether insufficient knee movement due to knee rigidity could underlie poor balance control in patients. We addressed this by examining the effect of artificially "locking" the knees on balance control in 18 healthy subjects, tested with and without individually fitted knee casts on both legs. Subjects were exposed to sudden rotations of a support surface in six different directions. The primary outcome measure was body centre of mass (COM) movement, and secondary outcome measures included biomechanical responses of the legs, pelvis and trunk. Knee casts caused increased backward COM movement for backward perturbations and decreased vertical COM movement for forward perturbations, and caused little change in lateral COM movement. At the ankles, dorsiflexion was reduced for backward perturbations. With knee casts, there was less uphill hip flexion and more downhill hip flexion. A major difference with knee casts was a reversed pelvis pitch movement and an increased forward trunk motion. These alterations in pitch movement strategies and COM displacements were similar to those we have observed previously in patients with knee rigidity, specifically those with spinocerebellar ataxia (SCA). Pelvis roll and uphill arm abduction were also increased with the casts. This roll movement strategy and minor changes in lateral COM movement were not similar to observations in patients. We conclude that artificial knee rigidity increases instability, as reflected by greater posterior COM displacement following support surface tilts. Healthy controls with knee casts used a pitch movement strategy similar to that of SCA patients to offset their lack of knee movement in regaining balance following multidirectional perturbations. This similarity suggests that reduced knee movements due to knee rigidity may contribute to sagittal plane postural instability in SCA patients and possibly in other patient groups. However in the roll plane, healthy controls rapidly compensate by adjusting arm movements and hip flexion to offset the effects of knee rigidity.

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Bilateral Total Knee Arthroplasty Increases the Propensity to Trip on an Obstacle

Cited by 17 publications

References 44 publications

Single-stage bilateral total shoulder arthroplasty

Single-stage bilateral total shoulder arthroplasty

The effect of total knee arthroplasty on patients’ balance and incidence of falls: a systematic review

The influence of knee rigidity on balance corrections: a comparison with responses of cerebellar ataxia patients

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