Comprehensive gait analysis in posterior-stabilized knee arthroplasty

Wilson, Stephen; McCann, Peter D; Gotlin, Robert S.; Ramakrishnan, H.K.; Wootten, Mary E.; Insall, John N.

doi:10.1016/s0883-5403(96)80023-4

Cited by 117 publications

(76 citation statements)

References 36 publications

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“…Shortened stride length and limited knee excursion during weight acceptance is a common finding after TKA [3,4,6,7,11,17,33]. Patients with TKA rise from a chair more slowly than control groups and use higher hip and knee moments in the uninvolved leg compared to the involved leg to stand [31].…”

Section: Introductionmentioning

confidence: 99%

“…The involved knee and hip joints also perform proportionally less work than the uninvolved while negotiating a curb [5]. Even patients considered to be fully rehabilitated with excellent self-assessment scores have smaller sagittal plane knee ranges of motion, angular velocities, and maximum knee moments in the operated limb during loaded knee extension than control subjects during stair climbing and chair transfers [14,33].…”

Section: Introductionmentioning

confidence: 99%

“…Several investigations have suggested that movement strategies used during functional tasks are due to quadriceps weakness, but they stop short of measuring this impairment [5,14,31]. To date, only three studies have included quadriceps strength assessment in conjunction with a motion analysis assessment for patients with TKA [4,29,33], but they did not report the relationship between quadriceps weakness and altered movement patterns.…”

Section: Introductionmentioning

confidence: 99%

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Altered loading during walking and sit‐to‐stand is affected by quadriceps weakness after total knee arthroplasty

Mizner

Snyder‐Mackler

2005

Journal Orthopaedic Research

301

242

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Purpose: Total knee arthroplasty (TKA) successfully reduces pain, but has not achieved comparable improvements in function. We hypothesized that quadriceps strength affects performance by altering loading and movement patterns during functional tasks.Methods: Fourteen subjects with isolated, unilateral TKA were tested three months after surgery. Quadriceps strength was assessed isometrically and kinematics, kinetics, and EMG were collected during level walking and sit-to-stand (STS). Function was assessed using the timed up and go test (TUG), stair climbing test (SCT), and the 6 min walk test (6MW).Results: Functional performance was significantly related to the quadriceps strength of both legs, but was more strongly related to the uninvolved strength (involved rho = -0.43 with TUG; -0.65 with SCT; 0.64 with 6MW) (uninvolved rho = -0.63 with TUG; -0.68 with SCT; 0.77 with 6MW). During STS, subjects shifted weight away from the operated limb (p < 0.01). Quadriceps muscle activity and the extension moments at the knee and hip were smaller in the involved compared to the uninvolved (p < 0.05). The amount of asymmetry in knee excursion during weight acceptance in gait, the asymmetry in weight bearing from sit-to-stand, and the uninvolved hip extension moment during STS were related to the amount of asymmetry in quadriceps strength (rho > 0.56, p < 0.05).Conclusions: Quadriceps weakness in patients with TKA has a substantial impact on the movement patterns and performance of the knee during functionally important tasks.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Altered loading during walking and sit‐to‐stand is affected by quadriceps weakness after total knee arthroplasty

Mizner

Snyder‐Mackler

2005

Journal Orthopaedic Research

301

242

View full text Add to dashboard Cite

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“…In patients with degenerative knee disease the quadriceps activity drops by up to 50% [2] decreasing joint pressures and creating an abnormal walking pattern [1,20,23]. Berman et al [2] found that the maximum force momentum in flexion with advanced gonarthrosis is 68% and in extension 59% of the value in the healthy knee, and that there were no significant variations 6 months after arthroplasty [21].…”

Section: Discussionmentioning

confidence: 99%

Muscular function and bone mass after knee arthroplasty

Anchuela

Gomez-Pellico

Ferrer-Blanco

et al. 2001

International Orthopaedics (SICOT)

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We report a study of 28 women with severe primary gonarthrosis followed for 1 year. Variations in bone mineral density and in functional behaviour of knee extensors and flexors were studied before and after implantation of uncemented total knee prosthesis. A functional deficit was noted in the extensor apparatus, which increased in the first 6 months following surgery. This strength was not improved 1 year following the arthroplasty, but it was more efficient as shown by the reduction of muscle fatigue. Flexor strength was conserved and a pathological muscle balance was maintained, reaching maximum efficiency over a smaller joint range.Résumé Etude des variations de la densité minérale osseuse et du comportement des extenseurs et fléchisseurs du genou avant et après implantation d'une prothèse totale non cimentée chez 28 femmes souffrant d'une gonarthrose primaire sévère et suivies pendant une année. Un déficit fonctionnel de l'appareil de l'extenseur à été noté avant l'intervention et a augmenté dans les six premiers mois suivant la chirurgie. La force d'extension n'était pas améliorée une année après l'arthroplastie, mais l'action était meilleure à cause d'une moindre fatiguabilité du muscle. La force des fléchisseurs a été conservée et un équilibre musculaire a été maintenu, en arrivant à l'efficacité maximale sur une plus petite amplitude articulaire.

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“…Unfortunately, the literature is largely observational, with cross-sectional comparisons of patients and healthy peers. Still, three studies assessed patients after knee arthroplasty (Benedetti et al, 2003;Hubley-Kozey et al, 2010;Wilson et al, 1996), some studies followed patients before and after high tibial osteotomy (Briem et al, 2007;Kean et al, 2009;Ramsey et al, 2007aRamsey et al, , 2007b, and a few studies used reversible experimental manipulations (Ramsey et al, 2007a;Schmitt and Rudolph, 2008).…”

Section: Introductionmentioning

confidence: 99%

Determinants of co-contraction during walking before and after arthroplasty for knee osteoarthritis

Fallah-Yakhdani¹,

Bafghi²,

Meijer³

et al. 2012

Clinical Biomechanics

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Background: Knee osteoarthritis patients co-contract in knee-related muscle pairs during walking. The determinants of this co-contraction remain insufficiently clear. Methods: A heterogeneous group of 14 patients was measured before and one year after knee arthroplasty, and compared to 12 healthy peers and 15 young subjects, measured once. Participants walked on a treadmill at several imposed speeds. Bilateral activity of six muscles was registered electromyographically, and cocontraction time was calculated as percentage of stride cycle time. Local dynamic stability and variability of sagittal plane knee movements were determined. The surgeon's assessment of alignment was used. Preoperatively, multivariate regressions on co-contraction time were used to identify determinants of cocontraction. Post-operatively it was assessed if predictor variables had changed in the same direction as co-contraction time. Findings: Patients co-contracted longer than controls, but post-operatively, differences with the healthy peers were no longer significant. Varus alignment predicted co-contraction time. No patient had post-operative varus alignment. The patients' unaffected legs were more unstable, and instability predicted co-contraction time in both legs. Post-operatively, stability normalised. Longer unaffected side co-contraction time was associated with reduced affected side kinematic variability. Post-operatively, kinematic variability had further decreased. Interpretations: Varus alignment and instability are determinants of co-contraction. The benefits of cocontraction in varus alignment require further study. Co-contraction probably increases local dynamic stability, which does not necessarily decrease the risk of falling. Unaffected side co-contraction contributed to decreasing affected side variability, but other mechanisms than co-contraction may also have played a role in decreasing variability.

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Comprehensive gait analysis in posterior-stabilized knee arthroplasty

Cited by 117 publications

References 36 publications

Altered loading during walking and sit‐to‐stand is affected by quadriceps weakness after total knee arthroplasty

Altered loading during walking and sit‐to‐stand is affected by quadriceps weakness after total knee arthroplasty

Muscular function and bone mass after knee arthroplasty

Determinants of co-contraction during walking before and after arthroplasty for knee osteoarthritis

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