Outcomes Before and After Total Knee Arthroplasty Compared to Healthy Adults

Abstract

STUDY DESIGN Prospective cohort study. OBJECTIVES To measure changes in muscle strength, range of motion, and function from 2 weeks before to 6 months after total knee arthroplasty (TKA) and compare outcomes with data from a control group consisting of healthy adults. BACKGROUND Total knee arthroplasty successfully alleviates pain from knee osteoarthritis, but deficits in function can persist long term. How impairments and functional limitations change over the first 6 months after TKA, compared to data from healthy adults, has not been well reported in the literature. METHODS Twenty-four patients who underwent a primary unilateral TKA were compared to healthy adults (n = 17). All patients participated in a standardized rehabilitation program following surgery. Isometric quadriceps torque was assessed using an electromechanical dynamometer. Range of motion was measured actively and passively. Functional performance was assessed using the stair-climbing test, timed up-and-go test, 6-minute walk test, and single-limb stance time. Patients underwent testing at 2 weeks preoperatively and at 1, 3, and 6 months postoperatively. RESULTS Compared to healthy older adults, patients performed significantly worse at all times for all measures (P<.05), except for single-limb stance time at 6 months (P>.05). One month postoperatively, patients experienced significant losses from preoperative levels in all outcomes. Patients recovered to preoperative levels by 6 months postoperatively on all measures, except knee flexion range of motion, but still exhibited the same extent of limitation they did prior to surgery. CONCLUSION The persistent impairments and functional limitations 6 months after TKA with standard rehabilitation suggest that more intensive therapeutic approaches may be necessary to restore function of patients following TKA to the levels of healthy adults.

Gait analysis of patients with an off-the-shelf total knee replacement versus customized bi-compartmental knee replacement

“…However, we believe our patients' pre-surgical conditions were similar to patients used in other prospective studies examining functional improvements after knee replacements. In those studies, patients' combined Knee Society scores were close to 100 and knee range of motion was around 120° [19][20][21][22]. In general, patients with end-stage knee OA experience joint pain and stiffness, which leads to functional limitations of performing daily activities such as walking, going up and down stairs, and rising from a sitting position.…”

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

“…To our knowledge, there is no agreed-upon clinically important difference in quadriceps strength for this population. Nevertheless, quadriceps weakness is a hallmark of TKA [4,34,52]. Although other measures of physical function typically recover over the first 3 postoperative months, quadriceps strength appears to take the better part of a year to recover to preoperative levels (and may fail to fully recover for many patients) [4,34].…”

“…Nevertheless, quadriceps weakness is a hallmark of TKA [4,34,52]. Although other measures of physical function typically recover over the first 3 postoperative months, quadriceps strength appears to take the better part of a year to recover to preoperative levels (and may fail to fully recover for many patients) [4,34]. Early postoperative deficits in quadriceps strength may be particularly problematic because there is reason to believe that early strength loss, occurring primarily through deficits in voluntary muscle activation [36], may actually exacerbate long-term weakness [24].…”

Effect of total knee replacement surgery and postoperative 12 month home exercise program on gait parameters

“…Total knee arthroplasty (TKA) is an effective treatment to reduce pain and subjective disability in patients with osteoarthrosis of the knee, but several studies have shown that muscle strength deficiency [1][2][3] and functional limitations may persist for several years after the operation [4][5][6].…”