Early Quadriceps Strength Loss After Total Knee Arthroplasty

Mizner, Ryan L.; Petterson, Stephanie C.; Stevens, Jennifer E.; Vandenborne, Krista; Snyder‐Mackler, Lynn

doi:10.2106/jbjs.d.01992

Cited by 341 publications

(186 citation statements)

References 23 publications

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“…27,32,39 One month after TKA, quadriceps strength drops to 60% of preoperative levels, even when traditional postoperative rehabilitation is initiated within 48 hours after surgery. 23,35 This quadriceps weakness persists years after surgery, based on comparisons with age-matched controls. 13 Similarly, functional performance declines precipitously by up to 88% in the first month after TKA, 2 and reduced function persists, with reports of 18% slower walking speed and 51% slower stair-climbing speed compared to age-matched controls at 12 months after TKA.…”

mentioning

confidence: 99%

Early High-Intensity Rehabilitation Following Total Knee Arthroplasty Improves Outcomes

Bade¹,

Stevens‐Lapsley²

2011

J Orthop Sports Phys Ther

143

128

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mentioning

confidence: 99%

Early High-Intensity Rehabilitation Following Total Knee Arthroplasty Improves Outcomes

Bade¹,

Stevens‐Lapsley²

2011

J Orthop Sports Phys Ther

143

128

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“…13,32,40 Another concern with some studies is the use of "ratio normalization" 7 of torque by simply dividing the torque measure by body mass 3,6,13 or body mass index (BMI). 29,32,48 This ratio normalization 7 fails to eliminate the confounding effects of a subject's body size and structure on the peak torque values for 2 reasons: it assumes (1) a linear relationship (in this case, one between peak torque and BMI or body mass), and (2) a y intercept of zero, which is rarely the case in biological experiments. 51 ANCOVA has been effective for treating body mass as a confounding factor of knee strength similar to those previously reported for individuals with moderate OA (grade 2-3).…”

mentioning

confidence: 99%

Knee Extension and Flexion Weakness in People With Knee Osteoarthritis: Is Antagonist Cocontraction a Factor?

Heiden¹,

Lloyd

Ackland

2009

J Orthop Sports Phys Ther

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flexion strength, 6,50 compared with similarly aged controls. There are 3 factors thought to contribute to knee extension and flexion weakness in those with knee OA: muscle atrophy, failure of voluntary muscle activity, and apparent weakness from increased antagonist muscle cocontraction. 5 Decreases in muscle cross-sectional area (CSA) have been established in subjects with early OA degenerative changes 22 and in those with severe knee OA. 10Ikeda et al 22 found that women with early degenerative changes in the knee joint had reductions in quadriceps CSA of up to 12%, compared with age-matched women without radiographic changes. Fink et al 10 found atrophy of type 2 fibers and type 1 fibers of the vastus medialis in patients undergoing total joint arthroplasty. Importantly, a smaller lean-muscle CSA in the diseased limb, compared to the contralateral limb, in subjects with OA contributes to muscle weakness but is not the only factor involved. 40Several investigators have examined failure of voluntary muscle activity as a contributing factor in reduced knee extension strength. 12,29,33,40,48 Failure of voluntary activity is the measure of an individual's ability to fully activate their muscles during maximal voluntary contractions. 20 Reductions in muscle activation are due to either an inability to recruit all motor units or a reduction in the motor unit discharge rate. 25 In healthy adults, simulated failure of voluntary activity by saline injection into the knee joint to cause effusion resulted in decreased isometric extension strength and knee extension torque during strength testing 23,31 and increased muscle cocon- Q uadriceps weakness is one of the most common and disabling impairments seen in individuals with knee osteoarthritis (OA).19 Sufficient quadriceps and hamstrings strength, both isometric and dynamic, is essential for undertaking basic activities of daily living such as standing and walking. 36 Muscle strength testing has revealed that those with knee OA have a 25% to 45% loss of knee extension strength 6,15,39 and a 19% to 25% loss of kneeControlled laboratory study, cross-sectional data.To investigate isometric knee flexion and extension strength, failure of voluntary muscle activation, and antagonist cocontraction of subjects with knee osteoarthritis (OA) compared with age-matched asymptomatic control subjects.Quadriceps weakness is a common impairment in individuals with knee OA. Disuse atrophy, failure of voluntary muscle activation, and antagonist muscle cocontraction are thought to be possible mechanisms underlying this weakness; but antagonist cocontraction has not been examined during testing requiring maximum voluntary isometric contraction.Fifty-four subjects with knee OA (mean SD age, 65.6 7.6 years) and 27 similarly aged control subjects (age, 64.2 5.1 years) were recruited for this study. Isometric knee flexion and extension strength were measured, and electromyographic data were recorded, from 7 muscles crossing the knee and used to calculate cocontraction ratios during maximal ef...

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“…After surgery, Miyazaki et al 18) mentioned less invasion of the muscle and peripheral soft tissue during surgery resulted in more satisfactory improvements in muscle strength, particularly in the early period. Mizner et al 19) , reported that quadriceps strength at one month after TKA is correlated with improved functional performance. As such, quadriceps strength is an essential element of exercise therapy.…”

Section: Discussionmentioning

confidence: 99%

“…As such, quadriceps strength is an essential element of exercise therapy. Mizner et al 19) , reported that the influence of pain on muscle weakness is minimal at 1 month after TKA surgery, and that the cause is instead a reduction in voluntary neural firing. Therefore they recommended using methods such as biofeedback to promote neuromuscular unit firing rather than exercises to strengthen the quadriceps.…”

Section: Discussionmentioning

confidence: 99%

“…Mizner et al 8) stated that preoperative quadriceps strength has the greatest effect on physical function such as ascending and descending stairs and the timed up-and-go test. Moreover, Rossi et al 24) reported a significant correlation between knee extension strength and the timed up-and-go test following surgery, and Zeni et al 25) mentioned the importance of muscle strength in the non-operated leg 19) . For ascending and descending stairs, knee joint strength and knee ROM improved, and a handrail was unnecessary.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Changes in Knee Joint Function of Total Knee Arthroplasty Patients

et al. 2011

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Abstract.[Purpose] We investigated postoperative improvements in the knee joint function of 121 patients (17 males, 104 females) who received total knee arthroplasty (TKA). [Subjects and Methods] The evaluation criteria were: knee joint flexion range of motion, knee joint extension strength and flexion strength, pain in the knee joint, score on The Japanese Orthopedic Association knee criteria of "pain" and "ability to ascend and descend stairs", and 6-minute walking distance. The time points for the evaluations were: prior to surgery, at the time of discharge, 3 months postoperative, 6 months postoperative, and 1 year postoperative. In addition, the level of satisfaction 1 year after the operation was also assessed.[Results] In the results, 6-minute walking distance and ability to ascend and descend stairs were significantly better at 3 months postoperative than before surgery. Knee joint range of motion at 3 months postoperative had improved to its preoperative status, and was significantly improved at 1 year postoperative. Knee joint extension strength at 3 months postoperative had recovered to its preoperative status, and was significantly improved at 6 months postoperative. Knee joint pain was significantly ameliorated at the time of discharge compared to before surgery. Knee joint pain had completely disappeared in approximately 30% of patients by 1 year after surgery, and 90% of patients were satisfied with the results of their surgery. Nevertheless, many of the patients still complained of knee discomfort from TKA.[Conclusion] The results of this study show that knee joint pain was reduced at the time of discharge, and that 6-minute walking distance and ability to ascend and descend stairs were significantly improved at 3 months postoperative. Moreover, these results suggest that there are improvements in knee joint extension strength after 6 months, and in knee joint range of motion at 1 year postoperative. The results show that knee joint function after TKA improves over the year after surgery.

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Early Quadriceps Strength Loss After Total Knee Arthroplasty

Cited by 341 publications

References 23 publications

Early High-Intensity Rehabilitation Following Total Knee Arthroplasty Improves Outcomes

Early High-Intensity Rehabilitation Following Total Knee Arthroplasty Improves Outcomes

Knee Extension and Flexion Weakness in People With Knee Osteoarthritis: Is Antagonist Cocontraction a Factor?

Postoperative Changes in Knee Joint Function of Total Knee Arthroplasty Patients

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