Short-term outcomes for total knee arthroplasty patients with active extension lag

McGinn, Tanner; Etcheson, Jennifer I.; Gwam, Chukwuweike U.; George, Nicole E.; Mohamed, Nequesha S.; Ananaba, Ugochi; Bhave, Anil

doi:10.21037/atm.2018.05.38

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…This limitation has been associated with progressive degenerative changes in knee arthritis. Soft tissue and bone damage during TKA can contribute to the development of active extension lag due to pain-induced inhibition of active muscle motor units [ 24 ]. In the context of this study, which focuses on OWHTO rather than TKA, there may be an impact on the impaired knee extensor mechanism and alterations in neuromuscular function due to knee arthritis, particularly in the early postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Single-Joint Type Hybrid Assistive Limb for Knee Training in the Acute Postoperative Phase After Opening Wedge High Tibial Osteotomy: A Feasibility and Safety Trial

Soma,

Yoshioka,

Kubota

et al. 2024

Cureus

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Background and objective: Opening wedge high tibial osteotomy (OWHTO) influences the knee extensor mechanism, the range of passive motion of knee extension and persistent quadriceps, and anterior knee pain and weakness. Rehabilitation should focus on quadriceps strength and improving joint mobility. The single-joint hybrid assistive limb device (HAL-SJ) is a wearable exoskeleton cyborg. In this study, we investigated the feasibility and safety of HAL-SJ training after the early postoperative period following OWHTO and whether the use of this device can improve functional outcomes, including knee muscle extensor strength and knee extension range of motion without knee pain. Methods: Patients who had been diagnosed with knee osteoarthritis and had undergone OWHTO were assessed for eligibility in this prospective trial conducted at our institution between June 2015 and November 2020. The participants were split into two groups, i.e., 10 patients in the hybrid assistive limb (HAL) group and eight patients in the control group. We initiated HAL-SJ therapy on postoperative day 8 and continued it until the patient's discharge. During the hospitalization period, patients engaged in HAL-SJassisted knee extension exercises. This exercise routine encompassed five sets, each comprising 10 repetitions, and was conducted twice a week. We conducted assessments aimed at detecting any potential adverse events that could be linked to HAL training. Assessment of the knee extension angle via the visual analog scale (VAS) and strength assessments using a hand-held dynamometer (HHD) were conducted. To compare clinical outcomes before and after OWHTO, knee extension angle, the VAS, HHD, Japanese Orthopaedics Association (JOA) score, and the Japanese Knee Osteoarthritis Measure (JKOM) were assessed at four distinct time points.Results: No adverse events were observed during the study. The assessment of clinical outcomes before and after OWHTO demonstrated a gradual improvement in outcomes. Conclusion:The single-joint hybrid assistive limb device in patients who underwent OWHTO appears to be potentially safe. It contributed to enhanced muscle activity efficiency by reducing knee pain and improving knee extension angles in the early postoperative phase.

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Section: Discussionmentioning

confidence: 99%

Single-Joint Type Hybrid Assistive Limb for Knee Training in the Acute Postoperative Phase After Opening Wedge High Tibial Osteotomy: A Feasibility and Safety Trial

Soma,

Yoshioka,

Kubota

et al. 2024

Cureus

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“…Because muscle hypertrophy from resistance training was observed after 7-12 weeks [14] , the intervention span in this study was considered too short for muscle hypertrophy. Previous studies have shown that muscle activation failure, also known as arthrogenic muscle inhibition (AMI), occurs after TKA and is associated with knee pain [3][4][5] . Due to structural damage, AMI is caused by swelling, in ammation, and reduced output from articular sensory receptors and occurs after knee surgery [15] .…”

Section: Discussionmentioning

confidence: 99%

“…Surgical invasion of the knee extension mechanism leads to a remarkable reduction in quadricep strength, especially in the acute phase after surgery [3] . This dysfunction, expressed as knee extension lag (EL), is primarily caused by failure of voluntary muscle activation [3][4][5] . Although clinical guidelines from the American Physical Therapy Association recommend performing highintensity strength exercises in the acute phase after TKA to improve muscle function [6] , this is not easy to practice because patients experience moderate to severe knee pain during this period [1] .…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Effect of Knee Extension Exercise with Single-Joint Hybrid Assistive Limb Following Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial

Maeda,

Sasaki,

Kasai

et al. 2023

Preprint

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The single-joint hybrid assistive limb (HAL-SJ), an exoskeletal robotic suit, offers functional improvement. In this prospective randomized controlled trial, we investigated the therapeutic effects of knee extension exercises using the HAL-SJ after total knee arthroplasty (TKA). Seventy-six patients with knee osteoarthritis were randomly assigned to HAL-SJ or conventional physical therapy (CPT) groups. The HAL-SJ group underwent exercise using the HAL-SJ for 10 days postoperatively, in addition to CPT; the CPT group underwent only CPT. Pain intensity and active and passive knee extension angles were evaluated preoperatively and on postoperative days 1–10 and weeks 2 and 4. Performance tests and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were evaluated preoperatively and at postoperative weeks 2 and 4. Statistical analysis showed that the HAL-SJ group significantly reduced pain intensity and improved active and passive knee extension angles compared with the CPT group. The HAL-SJ group showed immediate improvement in knee extension angle through day 5. There were no significant differences in results between the performance tests and KOOS. Knee extension exercises with the HAL-SJ improved knee pain and the angle of extension in the acute phase after TKA.

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“…Quadriceps lag (Q-lag) is the latency in the active extension caused by muscle weakness. It is defined as the patient's inability to extend the knee to the last 15 degrees of extension 2 .…”

Section: Introductionmentioning

confidence: 99%

Comparative Effects of Daily Adjustable Progressive Resistance Exercises Technique & Close Kinetic Chain Exercises on Extensor Lag in Post-Operative Knee Stiffness

Tanveer¹,

Noor²,

Afzal³

et al. 2022

PJMHS

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Background: Post-operative knee stiffness is caused by arthrofibrosis and functional limitation. Extensor lag is commonly prevalent after knee surgery. There are different approaches to treat this condition. Close kinetic chain exercises are hypothesized as one of effective treatment. DAPRE technique has remarked effects. Aim: To determine effects of DAPRE technique and close kinetic chain exercises on pain intensity, ROM, function, strength among post-operative knee stiffness. Study Design: Randomized control trial. Methodology: Total of 22 patients with post-operative knee stiffness were recruited and divided in two groups. One group received DAPRE technique and other group received close kinetic chain exercises were participated by using a Non-probability convenience sampling technique. Results: The result showed statistically significant difference in both groups in terms of NPRS, WOMAC index, ROM and strength with P-value less than 0.05. Conclusion: It was concluded that Close kinetic chain exercises was more effective than the Daily adjustable progressive resistance exercises on extensor lag for post-operative knee joint stiffness to improving the pain, physical function, range of motion and strength. Keywords: Knee Stiffness, Extensor Lag, Kinetic Chain Exercise, DAPRE and Resistance Exercises.

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Short-term outcomes for total knee arthroplasty patients with active extension lag

Abstract: There was no significant difference in readmission rates; however, patients with Q-lag experienced a clinically significant higher pain level. Since this is the first study of its kind, we suggest further investigations on the effect of Q-lag on patient outcomes following primary TKA.

Cited by 7 publications

References 28 publications

Single-Joint Type Hybrid Assistive Limb for Knee Training in the Acute Postoperative Phase After Opening Wedge High Tibial Osteotomy: A Feasibility and Safety Trial

Single-Joint Type Hybrid Assistive Limb for Knee Training in the Acute Postoperative Phase After Opening Wedge High Tibial Osteotomy: A Feasibility and Safety Trial

Therapeutic Effect of Knee Extension Exercise with Single-Joint Hybrid Assistive Limb Following Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial

Comparative Effects of Daily Adjustable Progressive Resistance Exercises Technique & Close Kinetic Chain Exercises on Extensor Lag in Post-Operative Knee Stiffness

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