Do Interlimb Knee Joint Loading Asymmetries Persist throughout Stance during Uphill Walking Following Total Knee Arthroplasty?

Abstract

The purpose of this study was to determine differences in total (TCF), medial compartment (MCF), and lateral compartment (LCF) tibiofemoral joint compressive forces and related muscle forces between replaced and non-replaced limbs during level and uphill walking at an incline of 10°. A musculoskeletal modeling and simulation approach using static optimization was used to determine the muscle forces and TCF, MCF, and LCF for 25 patients with primary TKA. A statistical parametric mapping repeated-measures ANOVA was conducted on knee compressive forces and muscle forces using statistical parametric mapping. Greater TCF, MCF, and LCF values were observed throughout the loading response, mid-stance, and late stance during uphill walking. During level walking, knee extensor muscle forces were greater throughout the first 50% of the stance during level walking, yet greater during uphill walking during the last 50% of the stance. Conversely, knee flexor muscle forces were greater through the loading response and push-off phases of the stance. No between-limb differences were observed for compressive or muscle forces, suggesting that uphill walking may promote a more balanced loading of replaced and non-replaced limbs. Additionally, patients with TKA appear to rely on the hamstrings muscle group during the late stance for knee joint control, thus supporting uphill walking as an effective exercise modality to improve posterior chain muscle strength.

Preoperative high-intensity strength training combined with balance training can improve early outcomes after total knee arthroplasty

“…According to a large body of literature, however, the joint function does not improve after these exercises, and the intensity of training engaged in by the patients varies, with even less attention paid to the degree of improvement in knee strength [ 11 – 13 ]. It is believed that balance training is as important as muscle training, as patients need to adapt to the altered kinematics caused by the joint prosthesis when getting out of bed or during daily activities [ 14 , 15 ].…”