Relationship between biomechanical asymmetries during a step up and over task and stair climbing after total knee arthroplasty

Pozzi, Federico; Snyder‐Mackler, Lynn; Zeni, Joseph A.

doi:10.1016/j.clinbiomech.2014.11.001

Cited by 30 publications

(19 citation statements)

References 37 publications

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“…[5, 36] However, they also raise the possibility that a potentially modifiable cause of the "spread" of OA among lower extremity joints is related to symptom and neuromuscular control adaptations by persons with OA in one joint who alter movement strategies in a way that results in asymmetric loading and an increased risk of damage in other lower extremity joints. [13, 17, 19] [37] In persons with unilateral severe hip OA leading to joint replacement, increased loading occurs in the unaffected or less affected limb both before and after surgery, [37–42] including significantly higher peak external knee adduction moments and peak medial compartment loads in the contralateral knee. [13] [19] Changes in lower extremity joint loading have also been observed in symptomatic hip OA prior to the development of endstage disease.…”

Section: Discussionmentioning

confidence: 99%

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Do persons with asymmetric hip pain or radiographic hip OA have worse pain and structure outcomes in the knee opposite the more affected hip? Data from the Osteoarthritis Initiative

Joseph

Hilton

Jungmann³

et al. 2016

Osteoarthritis and Cartilage

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Purpose to determine if asymmetry between hips in pain or radiographic osteoarthritis (RHOA) is associated with worse pain and joint space narrowing (JSN) at baseline and longitudinally in knees contralateral to more affected hips. Methods We studied 279 participants in the Osteoarthritis Initiative with baseline asymmetry between hips in pain and 483 with asymmetry in RHOA none of whom had a hip replacement for ≥4 years after baseline. RHOA assessed from pelvis radiographs was categorized as none, possible or definite and hip pain on most days of a month in the past year as present/absent. Knee pain (WOMAC scale) and JSN (fixed flexion radiographs) were categorized as none, mild and moderate-severe. We compared knees contralateral and ipsilateral to more affected hips on baseline knee pain and JSN using clustered multinomial regression and on change in knee pain and JSN over 4–5 years using generalized linear and logistic estimating equations. Results Knees contralateral to painful hips had less baseline pain (“moderate-severe” vs. “none”, relative risk ratio [RRR]: 0.39, 95% CI = 0.27–0.57), but greater baseline JSN (“moderate-severe” vs. “none”, RRR: 1.62, 95% CI = 1.09–2.38) and greater worsening of pain during follow-up (p = 0.001). Knees contralateral to hips with worse RHOA had nonsignificant trends for greater baseline JSN (p = 0.10) and JSN progression (p = 0.17). Conclusion These findings provide limited support for the hypothesis that early asymmetry in hip pain and RHOA is associated with worse pain and structural outcomes in knees contralateral to the more affected hip.

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Section: Discussionmentioning

confidence: 99%

“…[5–8] It is possible that OA or pain in either joint can alter the hip-knee-ankle kinetic chain in a way that influences the risk of both symptoms and structural changes in the other lower extremity joints. [9–17]…”

Section: Introductionmentioning

confidence: 99%

Do persons with asymmetric hip pain or radiographic hip OA have worse pain and structure outcomes in the knee opposite the more affected hip? Data from the Osteoarthritis Initiative

Joseph

Hilton

Jungmann³

et al. 2016

Osteoarthritis and Cartilage

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“…Stiff‐legged patterns are characterized by reduced knee flexion and extension excursion during stance . While the underlying cause for adopting a stiff‐legged gait pattern is not clear, it may be an attempt to reduce the use of the operated limb during the shock absorption and propulsion phases of stance, which may result in greater reliance on the non‐operated side to complete bilateral weight bearing tasks . However, lower joint excursions were also found in the contralateral knees of individuals who went on to have second TKA.…”

Section: Discussionmentioning

confidence: 99%

Stiff knee gait may increase risk of second total knee arthroplasty

Zeni

Flowers

Bade

et al. 2018

Journal Orthopaedic Research

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Osteoarthritis (OA) progression in the contralateral limb after unilateral total knee arthroplasty (TKA) may be related to altered and asymmetrical movement patterns that overload the contralateral joints. The purpose of this study was to determine if biomechanical factors after unilateral TKA were associated with future contralateral TKA. One hundred and fifty-eight individuals who underwent unilateral TKA completed three dimensional motion analysis 6-24 months after unilateral TKA (baseline). Subjects were re-contacted for follow-up (mean 5.89 years after baseline testing) to determine if they had undergone a contralateral TKA. Biomechanical variables from gait at baseline were compared between those who did and did not undergo contralateral TKA at followup using one-way ANOVAs. Odds ratios were calculated for variables found to be significant in the ANOVA models. Individuals who underwent contralateral TKA had less knee flexion excursion (10.5˚vs. 12.1˚; p ¼ 0.032) and less knee extension excursion (8.2˚vs. 9.6˚; p ¼ 0.035) at baseline on the operated side during walking. Individuals who underwent contralateral TKA also had less knee flexion excursion on the contralateral limb at baseline (11.9˚vs. 14.0˚; p ¼ 0.017). For every additional degree of knee flexion excursion on the contralateral knee at baseline, there was a 9.1% reduction in risk of future contralateral TKA. Individuals who walked with stiffer gait patterns were more likely to undergo future contralateral TKA. Clinical Significance: Altered movement patterns after surgery may increase the risk for contralateral TKA. Knee excursion is an important metric to include in outcome studies and may serve as a target of rehabilitation after TKA. ß

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“…The M K was also computed to more specifically compare the inter‐limb asymmetry at the joint level. Inter‐limb asymmetry of the M T and M K have been studied as logical outcome measures and shown to be effective for assessing coordination between the lower limb joints …”

Section: Methodsmentioning

confidence: 99%

Quadriceps weakness preferentially predicts detrimental gait compensations among common impairments after total knee arthroplasty

Christensen

Mizner

Foreman

et al. 2018

Journal Orthopaedic Research

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Patients with total knee arthroplasty (TKA) have large deficits in physical performance in comparison to their healthy age-matched peers. Limb asymmetry stemming from less relative load borne by the surgical limb during daily mobility is associated with diminished performance and worsens with greater mobility demands. How common targets of postoperative care, such as muscle weakness, lower limb extension power, residual knee pain, and poor balance confidence can influence asymmetrical limb loading remains unclear. Forty-six patients with unilateral TKA underwent testing of impairments and motion analysis during 10° decline walking at 3 and 6 months postoperatively. At 3 months, only quadriceps femoris strength asymmetry was found to be significantly related to both total support moment (M ) (β = 0.431; p < 0.001) and knee extensor moment (M ) (β = 0.493; p < 0.001) asymmetry. Again at 6 months, only quadriceps strength asymmetry was related to M (β = 0.432; p < 0.001) and M (β = 0.534; p < 0.001) asymmetry. Quadriceps strength significantly improved over time in both limbs, however, deficits between limbs remained. Persistent quadriceps weakness is a key factor associated with walking compensation patterns that are limiting the capacity for greater physical performance of patients with TKA. The pronounced asymmetry in limb and knee loading at 3 months remains unchanged until at least 6 months after surgery, and its association with quadriceps strength asymmetry does not substantially change over time. While other factors may also prompt gait compensations, emphasis on improved quadriceps strength should be a focus of efforts to resolve gait compensations and enhance physical performance outcomes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2355-2363, 2018.

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Relationship between biomechanical asymmetries during a step up and over task and stair climbing after total knee arthroplasty

Cited by 30 publications

References 37 publications

Do persons with asymmetric hip pain or radiographic hip OA have worse pain and structure outcomes in the knee opposite the more affected hip? Data from the Osteoarthritis Initiative

Do persons with asymmetric hip pain or radiographic hip OA have worse pain and structure outcomes in the knee opposite the more affected hip? Data from the Osteoarthritis Initiative

Stiff knee gait may increase risk of second total knee arthroplasty

Quadriceps weakness preferentially predicts detrimental gait compensations among common impairments after total knee arthroplasty

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