Total Knee Arthroplasty: Muscle Impairments, Functional Limitations, and Recommended Rehabilitation Approaches

Abstract

MD 4 PT, PhD, CHT 5 muscle impairments are not well defined and are an understudied area of postoperative care.1 Of particular interest to rehabilitation professionals is the acute profound postoperative deficit in quadriceps muscle strength 5,42,52,55,67,70,79,85 ( ) that fails to completely resolve even years after surgery 5,6,29,71,72,85 ( 2). Hamstring strength deficits have also been reported after TKA surgery 5,29,42,51,72 ; however, the focus on the quadriceps is due to the association of the quadricepsThe number of total knee arthroplasty (TKA) surgeries performed each year is predicted to steadily increase. Following TKA surgery, self-reported pain and function improve, though individuals are often plagued with quadriceps muscle impairments and functional limitations. Postoperative rehabilitation approaches either are not incorporated or incompletely address the muscular and functional deficits that persist following surgery. While the reason for quadriceps weakness is not well understood in this patient population, it has been suggested that a combination of muscle atrophy and neuromuscular activation deficits contribute to residual strength impairments. Failure to adequately address the chronic muscle impairments has the potential to limit the long-term functional gains that may be possible following TKA.Postoperative rehabilitation addressing quadriceps strength should mitigate these impairments and ultimately result in improved functional outcomes. The purpose of this paper is to describe these quadriceps muscle impairments and to discuss how these impairments can contribute to the related functional limitations following TKA. We will also describe the current concepts in TKA rehabilitation and provide recommendations and clinical guidelines based on the current available evidence.Therapy, level 5.

Preoperative Predictors of Persistent Impairments During Stair Ascent and Descent After Total Knee Arthroplasty

“…Persons who undergo total knee arthroplasty report an increase in functional ability in comparison with their preoperative condition 2 . Nevertheless, some physical limitations continue after surgery 3 . As demonstrated by Walsh et al, individuals continue to report difficulty ascending and descending stairs when compared with an age-matched group of healthy individuals without knee pain or osteoarthritis 4 .…”

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

“…Quadriceps muscle strength has been stated to be an important factor in softening the heel contact during the gait cycle [33]. Furthermore, quadriceps strength deficits before TKA are greatly compounded early after the operation and slowly recover to levels only slightly better than the preoperative values [34]. In addition, isometric quadriceps strength has been stated to improve 10 % to 20 % from preoperative levels during at least the first two years following TKA with ordinary living without any exercise intervention (85-95 Nm) [1,35].…”

Economic evaluation of multidisciplinary rehabilitation after primary total knee arthroplasty based on a randomized controlled trial

“…However, when interpreting the results of the present study, one can question whether the program was too complex, which undoubtedly raised the cost of the intervention. On the basis of the latest findings and suggestions (6,7,9), one can also question whether the exercises lacked optimal intensity and progression, which could have af-fected the results of the achieved improvement and recovery, i.e., effectiveness. The rehabilitation program lasted 10 days over a period of 2 weeks, which may have been too short a period, considering the original aim of the program.…”

“…Comparison of the results of previous studies is complicated due to the heterogeneity of their content, outcome measurements, and study design. Recent studies have questioned the intensity and progression of previously used postoperative exercise programs (7,9,10), and more progressive, high-intensity exercises have been recommended to augment the return to near-normal levels of activity and function after surgery (7). Limited health care resources have created a demand for more efficient delivery of care.…”