Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty

Abstract

Background/rationale Although TKA reliably reduces pain from knee osteoarthritis, full recovery of muscle strength and physical function to normal levels is rare. We presumed that a better understanding of acute changes in hamstrings and quadriceps muscle performance would allow us to enhance early rehabilitation after TKA and improve long-term function. Questions/purposes The purposes of this study were to (1) evaluate postoperative quadriceps and hamstrings muscle strength loss after TKA and subsequent recovery using the nonoperative legs and healthy control legs for comparison, and (2) measure hamstrings coactivation before and after TKA during a maximal isometric quadriceps muscle contraction and compare with nonoperative and healthy control legs. Methods We prospectively followed 30 patients undergoing TKA at 2 weeks preoperatively and 1, 3, and 6 months postoperatively and compared patient outcomes with a cross-sectional cohort of 15 healthy older adults. Bilateral, isometric strength of the quadriceps and hamstrings was assessed along with EMG measures of hamstrings coactivation during a maximal isometric quadriceps contraction. Results There were no differences in strength loss or recovery between the quadriceps and hamstrings muscles of the operative leg throughout the followup, although differences existed when compared with nonoperative and healthy control legs. Hamstrings muscle coactivation in the operative leg during a maximal quadriceps effort was elevated at 1 month (144.5%) compared to the nonoperative leg. Conclusions Although quadriceps dysfunction after TKA typically is recognized and addressed in postoperative therapy protocols, hamstrings dysfunction also is present and should be addressed. Clinical Relevance Quadriceps and hamstrings muscle strengthening should be the focus of future rehabilitation programs to optimize muscle function and long-term outcomes.

Muscle Strength and Functional Recovery During the First Year After THA

“…Strength testing of the hip abductors was performed while participants were sidelying positioned in 0°of abduction/adduction and flexion/extension with a strap to stabilize the pelvis [26,36]. Maximal strength testing of the knee extensors and flexors was performed while patients were seated and stabilized with a shoulder harness and waist strap in 85°of hip flexion and 60°of knee flexion as previously described [31,47]. Data were sampled using a BiopacData Acquisition System at a sampling frequency of 2000 Hz (MP 150; Biodex Medical Systems, Inc, Shirley, NY, USA) and analyzed using AcqKnowledge software, Version 3.8.2 (Biodex Medical Systems, Inc).…”

“…All patients were given visual targets from the dynamometer's output and strong verbal encouragement during each trial. Maximal voluntary isometric contractions for all muscle groups were performed twice; however, if maximal torque during the first two trials differed by more than 5%, a third trial was performed, as previously described [18,[46][47][48]. The trial with the highest torque was normalized to body mass (kg) and used for analysis [1].…”

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

“…In their clinical study, Stevens-Lapsley et al [31] reported that quadriceps strength decreased by 52 % and hamstring strength by 48 % at one month after TKA. In the present sample, at two months after surgery, knee extension strength showed a decrease from preoperative values of 49 % in the exercise group and 55 % in the control group.…”

Effectiveness of Modified Quadriceps Femoris Muscle Setting Exercise for the Elderly in Early Rehabilitation after Total Knee Arthroplasty

“…Therefore, it will be necessary to study the effects of MQS on muscle strength and walking ability for the elderly with TKA for more than 4 weeks. Furthermore, a recent study 20) suggested that rehabilitation programs after TKA should focus on improving the strength of the quadriceps femoris and h a m s t r i n g m u s c l e s . I n t h i s r e g a r d , M Q S m a y simultaneously enhance the gluteus maximus muscles along with the quadriceps femoris and hamstring muscles; therefore, it may be appropriate for elderly persons' early rehabilitation after TKA.…”