Neurostructural correlates of strength decrease following total knee arthroplasty: A systematic review of the literature with meta-analysis

Abstract

Recent literature suggests that alterations in both neural and structural components of the neuromuscular system are major determinants of knee extensor muscle weakness after total knee arthroplasty (TKA). Therefore, the goal of this study was to investigate the maximal voluntary strength (MVS), voluntary muscle activation (VMA), and the cross-sectional area (CSA) of the muscle, up to 33 months after the TKA. We searched relevant scientific databases and literature for outcomes of interest, including quadriceps MVS, VMA, and CSA. Ten studies met the inclusion criteria and involved a total of 289 patients. The quality of the studies was evaluated by Methodological Index for Non-Randomized Studies (MINORS). Results showed that quadriceps MVS markedly declines in the early postoperative period, after which it slowly and linearly recovers over time. However, the same phenomenon was not observed for VMA and CSA, which were not significantly altered after the TKA. Furthermore, a meta-regression analysis revealed that the change in VMA accounted for 39% of the relative change in quadriceps strength (R 2 =0.39; p=0.015) in the early postoperative period. Patients treated with TKA had considerable weakness of the quadriceps muscle, which was detectable up to 3 months after surgery. Although the change in VMA largely explains quadriceps weakness, this change and CSA differences were not significant, suggesting that other neural correlates, such as hamstrings coactivation, might alter quadriceps muscle function. Thus, more attention should be paid to address VMA failure and coactivation of antagonist muscles. More comprehensive rehabilitation approaches may be required to target the whole neural circuit controlling the motor action.

Mental Simulation Practice Has Beneficial Effects on Patients’ Physical Function Following Lower Limb Arthroplasty: A Systematic Review and Meta-analysis

“…Two reviewers (AP and ZM) independently assessed study titles and abstracts to determine if they satisfied eligibility criteria, that were presented in accordance to PICOS (patients' population/problem, intervention, comparison, outcome, study design) guidelines. The following inclusion criteria were used: (1) Population: Studies recruiting male and female adults who underwent primary unilateral joint arthroplasty; (2) Intervention: Mental simulation intervention. Given the specificity of rehabilitation procedures and ethical issues, MSP was always delivered as an adjunct therapy to standard physical therapy (SPT) and was compared with SPT intervention.…”

“…Joint replacement surgery successfully relieves pain, corrects the deformity, and improves joint function, activities of daily living, and thus, the patient's quality of life in general. [2][3][4] Although peri-operative assessment of patients has considerably improved in the last few decades, 5,6 a considerable reduction in quadriceps strength and overall physical function persist a few months following major surgery. 2,7 Traditionally, post-rehabilitation practice consists of conventional methods of physical exercises that mechanically stress the musculoskeletal system.…”

“…[2][3][4] Although peri-operative assessment of patients has considerably improved in the last few decades, 5,6 a considerable reduction in quadriceps strength and overall physical function persist a few months following major surgery. 2,7 Traditionally, post-rehabilitation practice consists of conventional methods of physical exercises that mechanically stress the musculoskeletal system. 5,6 However, improved knowledge and use of contemporary technologies in recent years have yielded new evidence of fewer physically demanding methods that could be feasible for specific populations, such as orthopaedic patients, who cannot fully benefit and/or attend conventional physical therapies.…”

Home-based motor imagery intervention improves functional performance following total knee arthroplasty in the short term: a randomized controlled trial

“…Quadriceps strength is a major determinant of general physical function following TKA [6]. In the early post-surgery period, patients experience loss of more than half of their pre-surgery strength [7,8], a likely consequence of the alterations of motor control at a central level induced by surgery [7,9,10].…”

Females and Males Show Differences in Early-Stage Transcriptomic Biomarkers of Lung Adenocarcinoma and Lung Squamous Cell Carcinoma

“…The investigated problem setting was the binary classification problem. This study evaluated a binary classification model using the detection accuracy (Acc), sensitivity (Sn) and specificity (Sp), the same as in References [ 43 , 44 ]. A binary classification tried to build a classification model to discriminate the positive and negative samples.…”