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Segal NA, Nilges JM, Oo WM. Sex differences in osteoarthritis prevalence, pain perception, physical function and therapeutics. Osteoarthritis Cartilage 2024:S1063-4584(24)01150-6. [PMID: 38588890 DOI: 10.1016/j.joca.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Women have a higher prevalence of osteoarthritis (OA) and worse clinical courses than men. However, the underlying factors and therapeutic outcomes of these sex-specific differences are incompletely researched. This review examines the current state of knowledge regarding sex differences in OA prevalence, risk factors, pain severity, functional outcomes, and use and response to therapeutics. METHODS PubMed database was used with the title keyword combinations "{gender OR sex} AND osteoarthritis" plus additional manual search of the included papers for pertinent references, yielding 212 references. Additional references were added and 343 that were reviewed for appropriateness. RESULTS Globally, women account for 60% of people with osteoarthritis with a greater difference after age 40. The higher risk for women may be due to differences in joint anatomy, alignment, muscle strength, hormonal influences, obesity, and/or genetics. At the same radiographic severity, women have greater pain severity than men, which may be explained by biologically distinct pain pathways, differential activation of central pain pathways, differences in pain sensitivity, perception, reporting, and coping strategies. Women have greater limitations of physical function and performance than men independent of BMI, OA severity, injury history, amount of weekly exercise. Women also have greater use of analgesic medications than men but less use of arthroplasty and poorer prognosis after surgical interventions. CONCLUSIONS The recognition of sex differences in OA manifestations and management could guide tailoring of sex-specific treatment protocols, and analysis of sex as a biological variable in future research would enhance development of precision medicine.
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Affiliation(s)
- Neil A Segal
- University of Kansas Medical Center, Kansas City, KS, USA; The University of Iowa, Iowa City, IA, USA.
| | | | - Win Min Oo
- The University of Sydney, Sydney, Australia; University of Medicine, Mandalay, Mandalay, Myanmar.
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Ishimoto R, Mutsuzaki H, Shimizu Y, Yoshikawa K, Koseki K, Takeuchi R, Matsumoto S, Hada Y. Association between Obesity and Short-Term Patient-Reported Outcomes following Total Knee Arthroplasty: A Retrospective Cohort Study in Japan. J Clin Med 2024; 13:1291. [PMID: 38592115 PMCID: PMC10932041 DOI: 10.3390/jcm13051291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
Background: This study investigated the association between obesity and short-term patient-reported outcomes after total knee arthroplasty (TKA). Methods: The primary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index's (WOMAC) pain and function scores. Data were collected preoperatively and 2 and 4 weeks after surgery. Patients were stratified into three groups based on body mass index (BMI): normal weight (BMI < 24.99 kg/m2), overweight (25 ≤ BMI < 29.99 kg/m2), and obese (BMI ≥ 30 kg/m2). The associations between BMI and the WOMAC pain and function scores were assessed using generalized linear mixed models. Results: Among the 102 patients (median age: 75.0, women [85.3%]), 29.4%, 48.0%, and 22.5% were normal weight, overweight, and obese, respectively. The mean pain and function scores at baseline were similar across the BMI-stratified groups (p = 0.727 and 0.277, respectively). The pain score significantly improved 2 weeks post-surgery (p = 0.001). The function score improved significantly 4 weeks post-surgery (p < 0.001). The group and group-by-time interaction effects lacked statistical significance. Conclusions: All patients statistically and clinically showed relevant pain reduction and functional improvement shortly after TKA, irrespective of their obesity status. These data may help healthcare professionals discuss the expectations of pain amelioration and functional improvement with TKA candidates.
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Affiliation(s)
- Ryu Ishimoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8575, Japan;
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Yukiyo Shimizu
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Ryoko Takeuchi
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
| | - Shuji Matsumoto
- Department of Rehabilitation Medicine, Ibaraki Prefectural University of Health Sciences Hospital, Ami 300-0331, Japan
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ami 300-0394, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, Institute of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
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Lee DW, Han HS, Lee MC, Ro DH. Prediction of postoperative gait speed change after bilateral primary total knee arthroplasty in female patients using a machine learning algorithm. Orthop Traumatol Surg Res 2024:103842. [PMID: 38382881 DOI: 10.1016/j.otsr.2024.103842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND An important aim of total knee arthroplasty is to achieve functional recovery, which includes post-operative increase in walking speed. Therefore, predicting whether a patient will walk faster or slower after surgery is important in TKA, which has not been studied in previous literatures. Who walks faster and who walks slower after TKA? Can we predict these kinds of patients before surgery? HYPOTHESIS Whether or not a patient walk faster after total knee arthroplasty can be predicted with preoperative characteristics. PATIENTS AND METHODS In this retrospective cohort study, 128 female patients who underwent staged bilateral total knee arthroplasty were analyzed with gait analysis preoperatively and at postoperative two years. These patients were divided into three different groups according to the percentage of gait speed change after total knee arthroplasty: 1) V(+), more than 10% gait speed increase; 2) V(-), more than 10% gait speed decrease; and 3) V(0), those in-between. Gait parameters, mechanical axis angles, WOMAC pain score and Knee Society scores of the two groups (V(+) and V(-)) were compared. Furthermore, a classification model predicting whether a patient walks faster after total knee arthroplasty was designed using a machine learning algorithm. RESULTS After total knee arthroplasty, average gait speed increased by 0.07m/s from 0.87m/s to 0.94m/s (p<0.001) and gait speed increased in 43.8% of the patients (n=56). However, gait speed decreased in a significant number of patients (n=17, 13.3%). When V(+) and V(-) groups were compared, gait speed, cadence, sagittal/coronal knee range of motion, and Knee Society Function score were lower in the V(+) group before surgery, but became higher after surgery. Gait speed change could be predicted using three variables (preoperative gait speed, age, and the magnitude of mechanical axis angle). The area under the receiver operating characteristic curve of the machine learning model was 0.86. DISCUSSION After total knee arthroplasty, gait speed was maintained or increased in most patients. However, gait speed decreased in a significant number of patients. The machine learning classification model showed a good predictive performance, which could aid in the decision-making and the timing of total knee arthroplasty. LEVEL OF EVIDENCE III; retrospective cohort study.
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Affiliation(s)
- Do Weon Lee
- Department of Orthopedic Surgery, Korean Armed Forces Yangju Hospital, Kyunggi province, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea; CONNECTEVE Co., Ltd, Seoul, South Korea; Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea.
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4
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Choi W. Comparison of physical function, proprioception, muscle strength, postural balance, and walking in older women with and without total knee arthroplasty. Medicine (Baltimore) 2023; 102:e33034. [PMID: 37327270 PMCID: PMC10270506 DOI: 10.1097/md.0000000000033034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 06/18/2023] Open
Abstract
The benefit of total knee arthroplasty (TKA) is that it alleviates pain caused by osteoarthritis; however, other postoperative effects on physical function are unclear. This study aimed to investigate the differences in physical function, proprioception, muscle strength, postural balance, and walking in older women with and without TKA. A total of 36 participants were included in this study; the TKA group comprised older women who underwent TKA (n = 18) and the non TKA group comprised older women who did not undergo TKA (n = 18). All the participants were evaluated for physical function, proprioception, muscle strength, postural balance, and walking. The outcome measures were compared between the 2 groups using an independent t test. Correlations were assessed using Pearson correlation coefficients. Participants in the TKA group had significantly reduced physical function, postural balance, and walking ability compared with those in the non TKA group (P < .05). In the TKA group, physical function was statistically correlated with proprioception, postural balance, and walking (P < .05); in particular, it had a strong correlation with proprioception (R > .60). In the non TKA group, postural balance was significantly associated with muscle strength and walking (P < .05). In particular, it was strongly correlated with walking (R > .90). This study demonstrated that older women undergoing TKA need to actively perform interventions to improve physical function, postural balance, and walking compared with older women with osteoarthritis.
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Affiliation(s)
- Wonjae Choi
- Department of Physical Therapy, Joongbu University, Chungcheongnam-do, Republic of Korea
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Terao Y, Hosaka N, Otobe Y, Suzuki M, Kojima I, Yoshizawa K, Yamada M, Nakayama Y, Abo M. The impact of preoperative muscle strength on postoperative walking ability in patients undergoing total knee arthroplasty. Int J Rehabil Res 2023; 46:157-162. [PMID: 36867015 DOI: 10.1097/mrr.0000000000000572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Although knee extensor muscle strength is strongly associated with postoperative walking ability (PWA) in patients undergoing total knee arthroplasty (TKA), few studies have considered the impact of both knee extensor and flexor muscle strength. This study aimed to determine whether operative side knee flexor and extensor muscle strength before surgery affects the PWA of patients who undergo TKA while accounting for potential covariates. This multicenter retrospective cohort study involved four university hospitals, and patients who underwent unilateral primary TKA were included. The outcome measure was the 5-m maximum walking speed test (MWS), which was completed 12 weeks postoperatively. Muscle strength was measured as the maximum isometric muscle strength required for knee flexor and extensor. Three multiple regression models with a progressively larger number of variables were developed to determine the predictors of 5-m MWS at 12 weeks post-TKA surgery. One hundred thirty-one patients who underwent TKA were enrolled in the study (men, 23.7%; mean age, 73.4 ± 6.9 years). Age, sex, operative side knee flexor muscle strength before surgery, Japanese Orthopaedic Association knee score, and preoperative walking ability were significantly associated with PWA in the final model of the multiple regression analysis ( R2 = 0.35). The current findings suggest that the operative side knee flexor muscle strength before surgery is a robust modifiable predictor of improved PWA. We believe that further validation is needed to determine the causal relationship between preoperative muscle strength and PWA.
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Affiliation(s)
- Yusuke Terao
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | - Naoki Hosaka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | - Yuhei Otobe
- Department of Rehabilitation Science, Physical Therapy Course, School of Medicine, Osaka Metropolitan University, Osaka
| | - Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | - Iwao Kojima
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | - Kazuya Yoshizawa
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo
| | | | - Yasuhide Nakayama
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Pua YH, Poon CLL, Seah FJT, Tan JWM, Woon EL, Chong HC, Thumboo J, Clark RA, Yeo SJ. Clinical Interpretability of Quadriceps Strength and Gait Speed Performance in Total Knee Arthroplasty: A Longitudinal Study. Am J Phys Med Rehabil 2023; 102:389-395. [PMID: 36728706 DOI: 10.1097/phm.0000000000002176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE After a total knee arthroplasty, physical assessments of quadriceps strength and gait speed performance are often undertaken during rehabilitation. Our study aimed to improve their clinical interpretability by examining trajectory curves across levels of self-reported walking and stair climbing function. DESIGN A sample of 2624 patients with primary total knee arthroplasty participated in this retrospective longitudinal study. Monthly, for 4 mos after surgery, quadriceps strength and gait speed were quantified. At the month-6 time point, self-reported walking and stair climbing function was measured. RESULTS All physical measures improved nonlinearly over time. In mixed-effects models, greater quadriceps strength and gait speed over time were associated with higher month-6 self-reported walking and stair climbing function ( P < 0.001). Steeper gains in quadriceps strength and gait speed were associated with higher levels of walking and stair-climbing function (interaction P < 0.001). Among female patients who had great difficulty with stair ascent and ambulation, quadriceps strength trajectory curves plateaued after 8 wks after total knee arthroplasty. CONCLUSIONS By stratifying trajectory curves across clinically interpretable functional levels, our findings potentially provide patients and clinicians a means to better interpret the continuous-scaled quadriceps strength and gait speed values. This information may be valuable when engaging patients in shared decision making and expectation setting. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Understand how self-reported walking and stair climbing abilities improved from baseline before total knee arthroplasty (total knee arthroplasty) to 6 mos postoperatively; (2) Describe the time course of the 2 performance-based measures of quadriceps strength and walking speed after a total knee arthroplasty; and (3) Relate the trajectories of post-total knee arthroplasty quadriceps strength and walking speed measurements across distinct levels of self-reported walking and stair climbing function. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Yong-Hao Pua
- From the Department of Physiotherapy, Singapore General Hospital, Singapore (Y-HP, CL-LP, JW-MT, E-LW); Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore (Y-HP, JT); Department of Physiotherapy, Sengkang General Hospital, Singapore (FJ-TS); Department of Physiotherapy, Changi General Hospital, Singapore (H-CC); Department of Rheumatology and Immunology, Singapore General Hospital, Singapore (JT); Health Services Research and Evaluation, Singhealth Office of Regional Health, Singapore (JT); Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia (RAC); and Department of Orthopaedic Surgery, Singapore General Hospital, Singapore (S-JY)
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Agarwal AR, Harris AB, Pearson ZC, Thakkar SC, Golladay GJ. A Novel Method for Stratification of 30-Day Major Complication Risk Using Body Mass Index Thresholds for Patients Undergoing Total Knee Arthroplasty: A National Cohort of 443,157 Patients. J Arthroplasty 2023; 38:1032-1036. [PMID: 36849012 DOI: 10.1016/j.arth.2023.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
INTRODUCTION Many organizations have utilized pre-established body mass index (BMI) cut-offs to guide surgical decision making. As there have been many improvements in patient optimization, surgical technique, and perioperative care over time, it is important to reassess these thresholds as well as contextualize them to total knee arthroplasty (TKA). The purpose of this study was to calculate data-driven BMI thresholds that predict significant differences in risk of 30-day major complications following TKA. METHODS Patients who underwent primary TKA from 2010 to 2020 were identified in a national database. Stratum-specific likelihood ratio (SSLR) methodology was utilized to determine data-driven BMI thresholds at which the risk of 30-day major complications increased significantly. These BMI thresholds were tested using multivariable logistic regression analyses. A total of 443,157 patients were included, who had a mean age of 67 (range, 18 to 89), mean BMI of 33 (range 19 to 59), and 11,766 (2.7%) of patients had a 30-day major complication RESULTS: SSLR analysis identified four BMI thresholds that were associated with significant differences in 30-day major complications: 19 to 33, 34 to 38, 39 to 50, and 51+. When compared to those who had a BMI between 19 and 33, the odds of sustaining a major complication sequentially and significantly increased by 1.1, 1.3, and 2.1 times (p<0.05 for all) for the other thresholds. CONCLUSION This study identified four data-driven BMI strata utilizing SSLR analysis that were associated with significant differences in the risk of 30-day major complications following TKA. These strata can be utilized to guide shared decision making in patients undergoing TKA.
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Affiliation(s)
- Amil R Agarwal
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zachary C Pearson
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA
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An J, Son YW, Lee BH. Effect of Combined Kinematic Chain Exercise on Physical Function, Balance Ability, and Gait in Patients with Total Knee Arthroplasty: A Single-Blind Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3524. [PMID: 36834218 PMCID: PMC9961064 DOI: 10.3390/ijerph20043524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Total knee arthroplasty (TKA) is an effective treatment for end-stage osteoarthritis. However, evidence of combined kinematic chain exercise (CCE) in early-phase rehabilitation after TKA remains lacking. This study investigated the effects of CCE training on physical function, balance ability, and gait in 40 patients who underwent TKA. Participants were randomly assigned to the CCE (n = 20) and open kinematic chain exercise (OKCE) groups (n = 20). The CCE and OKCE groups were trained five times a week (for 4 weeks) for 30 min per session. Physical function, range of motion (ROM), balance, and gait were assessed before and after the intervention. The time × group interaction effects and time effect as measured with the Western Ontario and McMaster Universities Osteoarthritis Index, ROM, Knee Outcome Survey-Activities of Daily Living, balancing ability (e.g., confidence ellipse area, path length, and average speed), and gait parameters (e.g., timed up-and-go test, gait speed, cadence, step length, and stride length) were statistically significant (p < 0.05). In the group comparison of pre- and postintervention measurements for all variables, the CCE group showed substantial improvements compared to the OKCE group (p < 0.05). Both groups showed significant within-group improvement from baseline to postintervention. Our results suggest that CCE training positively affects physical function, balance ability, and gait as an early intervention for patients undergoing TKA.
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Affiliation(s)
- Jungae An
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
| | - Young-Wan Son
- Graduate School of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
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Graber J, Juarez-Colunga E, Thigpen C, Waugh D, Bade M, Stevens-Lapsley J, Kittelson A. Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty. Disabil Rehabil 2022; 44:7535-7542. [PMID: 34751608 PMCID: PMC9306324 DOI: 10.1080/09638288.2021.1995054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/25/2021] [Accepted: 10/13/2021] [Indexed: 01/18/2023]
Abstract
Purpose: To develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD).Materials and Methods: We conducted a retrospective analysis of post-TKA quadriceps strength recovery in a longitudinal dataset consisting of both clinical and research HHD data. We created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape. We created reference charts from the models to display the recovery of population centiles over the first six postoperative months.Results: A total of 588 patient records with 1176 observations were analyzed. Reference charts for both sexes demonstrated a rapid increase in quadriceps strength over the first 60 postoperative days followed by a more gradual increase over the next 120 days. Males appeared to demonstrate faster recovery and greater strength on average compared to females. The quadriceps strength recovery of three female patient records was plotted on the reference chart to illustrate the charts' potential clinical utility.Conclusions: These reference charts provide normative data for quadriceps strength recovery after TKA as assessed by HHD. The reference charts may augment clinicians' ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.Implications for RehabilitationHandheld dynamometry (HHD) is an objective and clinically feasible method for assessing muscle strength, but normative HHD values are lacking for quadriceps strength recovery after total knee arthroplasty (TKA).We created sex-specific reference charts which provide normative quadriceps strength HHD values for the first 180 days after TKA.These reference charts may improve clinicians' ability to monitor and intervene upon post-TKA quadriceps strength deficits.
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Affiliation(s)
- Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | | | - Dawn Waugh
- ATI Physical Therapy, Greenville, SC, USA
| | - Michael Bade
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric, Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT
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Vij N, Leber C, Schmidt K. Current applications of gait analysis after total knee arthroplasty: A scoping review. J Clin Orthop Trauma 2022; 33:102014. [PMID: 36110510 PMCID: PMC9467867 DOI: 10.1016/j.jcot.2022.102014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/17/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction The biomechanics of the knee do not return to normal after knee replacement. The purpose of this scoping review is to summarize the current use of gait analysis in total knee arthroplasty and to identify the preoperative motion analysis parameters for which a systematic review aimed at determining the reliability and validity may be warranted. Materials and methods This IRB-exempt scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The 279 articles from the five search engines underwent a title/abstract and full-text screening. Included articles were categorized as either: the role of gait analysis as a research tool for operative decisions, other research applications for motion analysis in total knee arthroplasty, gait analysis as a tool in predicting radiologic outcomes, or gait analysis as a tool in predicting clinical outcomes. Results Eleven articles studied gait analysis as a research tool in studying operative decisions. Five articles studied other research applications for motion analysis in total knee arthroplasty. Other research applications for motion analysis currently include studying the role of the unicompartmental knee arthroplasty and novel physical therapy protocols aimed at optimizing post-operative care. Two articles studied motion analysis as a tool for predicting radiographic outcomes. 15 articles studied motion analysis in conjunction with clinical scores. Conclusions There is a broad range of research applications for motion analysis in knee reconstruction. Current limitations include vague definitions of 'gait analysis' or 'motion analysis' and a limited number of articles with preoperative and postoperative outcomes. Knee adduction moment, knee adduction impulse, total knee range of motion, varus angle, cadence, stride length, and velocity have the potential for integration into composite clinical scores. A systematic review to determine the psychometric properties of these variables is warranted.
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Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine - Phoenix, Department of Orthopedic Surgery, 475 N. 5th Street, Phoenix, AZ, 85012, USA
| | - Christian Leber
- University of Arizona College of Medicine - Phoenix, Department of Orthopedic Surgery, 475 N. 5th Street, Phoenix, AZ, 85012, USA
| | - Kenneth Schmidt
- University of Arizona College of Medicine - Phoenix, Department of Orthopedic Surgery, 475 N. 5th Street, Phoenix, AZ, 85012, USA
- Department of Orthopedic Surgery, Banner University College of Medicine Phoenix, 1320 N 10th St. Ste A, Phoenix, AZ, 85006, USA
- OrthoArizona, 033 N 44th St. Suite 100, Phoenix, AZ, 85008, USA
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11
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Graber J, Kittelson A, Juarez-Colunga E, Jin X, Bade M, Stevens-Lapsley J. Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty. J Am Med Inform Assoc 2022; 29:1899-1907. [PMID: 35903035 PMCID: PMC10161535 DOI: 10.1093/jamia/ocac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Prediction models can be useful tools for monitoring patient status and personalizing treatment in health care. The goal of this study was to compare the relative strengths and weaknesses of 2 different approaches for predicting functional recovery after knee arthroplasty: a neighbors-based "people-like-me" (PLM) approach and a linear mixed model (LMM) approach. MATERIALS AND METHODS We used 2 distinct datasets to train and then test PLM and LMM prediction approaches for functional recovery following knee arthroplasty. We used the Timed Up and Go (TUG)-a common test of mobility-to operationalize physical function. Both approaches used patient characteristics and baseline postoperative TUG values to predict TUG recovery from days 1-425 following surgery. We then compared the accuracy and precision of PLM and LMM predictions. RESULTS A total of 317 patient records with 1379 TUG observations were used to train PLM and LMM approaches, and 456 patient records with 1244 TUG observations were used to test the predictions. The approaches performed similarly in terms of mean squared error and bias, but the PLM approach provided more accurate and precise estimates of prediction uncertainty. DISCUSSION AND CONCLUSION Overall, the PLM approach more accurately and precisely predicted TUG recovery following knee arthroplasty. These results suggest PLM predictions may be more clinically useful for monitoring recovery and personalizing care following knee arthroplasty. However, clinicians and organizations seeking to use predictions in practice should consider additional factors (eg, resource requirements) when selecting a prediction approach.
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Affiliation(s)
- Jeremy Graber
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Elizabeth Juarez-Colunga
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado, USA
| | - Xin Jin
- Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado, USA
| | - Michael Bade
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Jennifer Stevens-Lapsley
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
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12
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Paravlic AH, Meulenberg CJ, Drole K. The Time Course of Quadriceps Strength Recovery After Total Knee Arthroplasty Is Influenced by Body Mass Index, Sex, and Age of Patients: Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:865412. [PMID: 35692543 PMCID: PMC9174520 DOI: 10.3389/fmed.2022.865412] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/14/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction For patients with osteoarthritis who have undergone total knee arthroplasty (TKA), quadriceps strength is a major determinant of general physical function regardless of the parameters adopted for functional assessment. Understanding the time course of quadriceps strength recovery and effectiveness of different rehabilitation protocols is a must. Therefore, the aim of this study was to: (i) determine the magnitude of maximal voluntary strength (MVS) loss and the time course of recovery of the quadriceps muscle following TKA, (ii) identify potential moderators of strength outcomes, and (iii) investigate whether different rehabilitation practices can moderate the strength outcomes following TKA, respectively. Design General scientific databases and relevant journals in the field of orthopedics were searched, identifying prospective studies that investigated quadriceps’ MVS pre-to post-surgery. Results Seventeen studies with a total of 832 patients (39% males) were included. Results showed that in the early post-operative days, the involved quadriceps’ MVS markedly declined, after which it slowly recovered over time in a linear fashion. Thus, the greatest decline of the MVS was observed 3 days after TKA. When compared to pre-operative values, the MVS was still significantly lower 3 months after TKA and did not fully recover up to 6 months following TKA. Furthermore, a meta-regression analysis identified that the variables, time point of evaluation, patient age, sex, and BMI, significantly moderate the MVS of the quadriceps muscle. Conclusion The analyzed literature data showed that the decrease in strength of the involved quadriceps muscles following TKA is considerable and lasts for several months post-surgery. Therefore, we recommend to specifically target the strengthening of knee extensor muscles, preserve motor control, and apply appropriate nutrition to ensure a holistic quadriceps muscle recovery. Since age, sex, and BMI were found to be moderating factors in patients’ recovery, further research should include specific analyses considering these moderators.
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Affiliation(s)
- Armin H. Paravlic
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sport Studies, Masaryk University, Brno, Czechia
- *Correspondence: Armin H. Paravlic,
| | - Cécil J. Meulenberg
- Institute for Kinesiology Research, Scientific Research Center Koper, Koper, Slovenia
| | - Kristina Drole
- Faculty of Sport, Institute of Kinesiology, University of Ljubljana, Ljubljana, Slovenia
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13
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Baghbani-Naghadehi F, Armijo-Olivo S, Prado CM, Gramlich L, Woodhouse LJ. Does obesity affect patient-reported outcomes following total knee arthroplasty? BMC Musculoskelet Disord 2022; 23:55. [PMID: 35039019 PMCID: PMC8764810 DOI: 10.1186/s12891-022-04997-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 12/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background There is an existing perception that obesity has a negative impact on complications following total knee arthroplasty (TKA). However, data on the impact of obesity levels on patient-reported outcomes (PROMs) is sparse. We investigated the association between different obesity classes with PROMs among patients who underwent TKA. Methods We performed retrospective secondary analyses on data extracted from the total joint replacement data repository (Alberta, Canada) managed by the Alberta Bone and Joint Health Institute (ABJHI). Patients had WOMAC and EQ5D scores measured at baseline in addition to 3 and/or 12 months following TKA. Patients were stratified according to the World Health Organization (WHO) classification, into five body mass index (BMI) groups of normal, overweight, BMI class I, BMI class II, and BMI class III. The association between BMI and mean changes in WOMAC subscales (pain, function, and stiffness) and EQ-5D-5L index over the time intervals of baseline to 3 months and 3 to 12 months following TKA was assessed. Linear mixed-effects models were used, and the models were adjusted for age, sex, length of surgery, comorbidities, year of surgery, and geographical zone where the surgery was performed. Results Mean age was 65.5 years (SD = 8.7). Postoperatively, there was a significant improvement (p < 0.001) in WOMAC subscales of patient-reported pain, function, and stiffness, as well as EQ-5D-5L regardless of BMI group. Although, patients in BMI class II and class III reported significantly improved pain 3 months after TKA compared to those with normal BMI, all BMI groups attained similar level of pain reduction at 12 months after TKA. The greatest improvement in all WOMAC subscales, as well as EQ5D index, occurred between baseline and 3 months (adjusted p < 0.0001). Conclusion The findings indicate that patients reported improved pain, function, and stiffness across all BMI groups following TKA. Patients with BMI classified as obese reported similar benefits to those with BMI classified as normal weight. These results may help health care providers to discuss expectations regarding the TKA recovery in terms of pain, function, and quality of life improvements with their TKA candidates. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-04997-4.
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Affiliation(s)
| | - Susan Armijo-Olivo
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Faculty of Business and Social Sciences, University of Applied Sciences, Osnabrück, Germany.,Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Carla M Prado
- Faculty of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Leah Gramlich
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Linda J Woodhouse
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.,Tufts University, School of Medicine, Department of Public Health & Community Medicine, Division of Physical Therapy, Boston, Massachusetts, USA
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14
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Influence of the Amount of Change in Quadriceps Tendon Young’s Modulus on Amount of Change in Walking Speed before and after Total Knee Arthroplasty. Medicina (B Aires) 2021; 57:medicina57121329. [PMID: 34946274 PMCID: PMC8705036 DOI: 10.3390/medicina57121329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Walking speed after total knee arthroplasty (TKA) is an important outcome. However, the effect of quadriceps tendon stiffness on walking speed remains unclear. This study aimed to clarify the influence of the amount of change in quadriceps tendon stiffness on the degree of change in walking speed before and after TKA. Materials and Methods: Sixteen patients who underwent TKA for knee osteoarthritis participated in this study (median age: 74.0 years (interquartile range: 64.5–75.8)). Shear-wave elastography was deployed to measure quadriceps tendon stiffness using Young’s modulus. A motion analysis system was used to assess kinematic parameters and walking speed. Participants’ knee circumference, range of motion, extension strength, one-leg standing time, walking pain level, and activity level were measured preoperatively and one year after TKA, and changes in values were calculated. We used path analysis to clarify the influence of the amount of change in the quadriceps tendon Young’s modulus on the change in walking speed. Results: The quadriceps tendon Young’s modulus negatively affected the knee flexion angle during swing (standardized partial regression coefficients (β) = −0.513, p = 0.042). The knee flexion angle during swing positively affected step length (β = 0.586, p = 0.017). Step length positively affected cadence (β = 0.733, p = 0.001). Step length and cadence positively affected walking speed (β = 0.563, p < 0.001, β = 0.502, p < 0.001, respectively). Conclusions: The amount of change in the quadriceps tendon Young’s modulus may affect the degree of change in walking speed after TKA through the amount of change in the knee flexion angle during swing, step length, and cadence. Clinically, reducing quadriceps tendon stiffness can be addressed in rehabilitation programs to increase walking speed after TKA.
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15
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Hamada R, Nankaku M, Murao M, Kawano T, Ito H, Nakamura S, Ikeguchi R, Matsuda S. Functional characteristics of female patients based on ambulatory ability 1 year after total knee arthroplasty. Knee 2021; 33:298-304. [PMID: 34739961 DOI: 10.1016/j.knee.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/12/2021] [Accepted: 10/10/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is commonly performed to reduce knee pain and improve physical function. Compared with the values for healthy, age-matched women, previous studies have reported large deficits in functional ability, such as muscle strength and ambulatory ability, in women 1 year post-TKA. Ambulatory ability is to move around, particularly by walking and is clinically assessed by the timed up and go test (TUG). AIM This study aimed to clarify the characteristics of knee functions in female patients whose ambulatory ability recovered to a normal level at 1 year after TKA. METHODS This cross-sectional study included 151 female patients who underwent TKA. The muscle strength of the lower extremity was measured, and the 2011 Knee Society Scoring (2011 KSS) system was used postoperatively. The TUG was conducted to assess ambulatory ability after TKA; then the patients were classified into the fast and slow ambulation groups based on previously reported gait-speed values of healthy female individuals. Then, we identified significant indicators of ambulatory ability at 1 year after TKA. RESULTS Forty-nine percent of patients after TKA achieved the level of ambulatory ability of a healthy female. Logistic regression analysis identified that the non-operative side knee extensor strength and the functional activity score, as assessed by the 2011 KSS, were variables significantly associated with the mid-term ambulatory ability after TKA. CONCLUSION Female patients with high non-operative knee extensor strength and a functional activity score at 1 year postoperatively can achieve better ambulatory ability than those of healthy, age-matched females.
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Affiliation(s)
- Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Masanobu Murao
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopedic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan; Department of Advanced Medicine for Rheumatic Diseases, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopedic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan; Department of Orthopedic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan; Department of Orthopedic Surgery, Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
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16
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Christensen JC, Capin JJ, Hinrichs LA, Aljehani M, Stevens-Lapsley JE, Zeni JA. Gait mechanics are influenced by quadriceps strength, age, and sex after total knee arthroplasty. J Orthop Res 2021; 39:1523-1532. [PMID: 33034899 PMCID: PMC8635453 DOI: 10.1002/jor.24878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 02/04/2023]
Abstract
Although most patients are satisfied with outcomes after total knee arthroplasty (TKA), many retain preoperative altered gait mechanics. Identifying patient characteristics associated with gait mechanics will improve rehabilitation strategies and enhance our understanding of movement disorders. Therefore, the purpose of this study was to identify which patient characteristics are related to gait mechanics in the surgical limb during walking post-TKA. Patient characteristics included age, body mass, sex, quadriceps strength, self-reported function, and knee pain. General linear regression was used to compare patient characteristics associated with gait mechanics, after controlling for gait speed, functional capacity and time from surgery. We tested 191 patients cross-sectionally at 6-24 months after primary, unilateral TKA. Quadriceps weakness in the surgical limb was associated with less peak vertical ground reaction force (PvGRF) (β = .245, p = .044), knee extension moment (β = .283, p = .049), and knee extension excursion (β = .298, p = .038). Older age (β = .168, p = .050) was associated with less PvGRF. Quadriceps strength in the nonsurgical limb (β = -.357, p = .021) was associated with greater knee extension excursion in the surgical limb. Females with TKA (β = -.276, p = .007) had less knee flexion excursion compared to males. Faster gait speed was also associated with greater PvGRF (β = .585, p < .001), knee extensor moment (β = .481, p < .001), and knee flexion excursion (β = .318, p < .001). Statement of Clinical Significance: This study showed quadriceps weakness, slower gait speed, older age and being female were related to altered gait mechanics post-TKA. These findings will help clinicians better educate patients and develop targeted interventions for improving care in patients post-TKA.
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Affiliation(s)
- Jesse C. Christensen
- Veterans AffairsSalt Lake City Health Care System, Department of Physical Medicine and Rehabilitation,University of Utah, Department of Physical Therapy & Athletic Training, 520 So. Wakara Way, Salt Lake City, UT, USA, 84108
| | - Jacob J. Capin
- Eastern Colorado Veterans Affairs, Geriatric Research Education and Clinical Center,University of Colorado, Department of Physical Medicine and Rehabilitation, 13001 E. 17th Pl., Aurora, CO, USA, 80045
| | - Lauren A. Hinrichs
- University of Colorado, Department of Physical Medicine and Rehabilitation, 13001 E. 17th Pl., Aurora, CO, USA, 80045
| | - Moiyad Aljehani
- Department of Physical Therapy, University of Delaware, 540 S. College Ave., Newark, DE, USA, 19713,Department of Physical Therapy, Umm Al-Qura University, P.O. Box 715, Makkah, 21421, Saudi Arabia
| | - Jennifer E. Stevens-Lapsley
- University of Colorado, Department of Physical Medicine and Rehabilitation, 13001 E. 17th Pl., Aurora, CO, USA, 80045
| | - Joseph A. Zeni
- Doctor of Physical Therapy – North, Department of Rehabilitation and Movement Science, School of Health Professions, Rutgers, The State University of New Jersey, 65 Bergen St. Suite 120, Newark, NJ, USA, 07107
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17
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Evaluation of the Efficacy and Safety of an Exercise Program for Persons with Total Hip or Total Knee Replacement: Study Protocol for a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136732. [PMID: 34201439 PMCID: PMC8268118 DOI: 10.3390/ijerph18136732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/17/2022]
Abstract
Total hip replacement (THR) and total knee replacement (TKR) are among the most common elective surgical procedures. There is a large consensus on the importance of physical activity promotion for an active lifestyle in persons who underwent THR or TKR to prevent or mitigate disability and improve the quality of life (QoL) in the long term. However, there is no best practice in exercise and physical activity specifically designed for these persons. The present protocol aims to evaluate the efficacy and safety of an exercise program (6 month duration) designed for improving quality of life in people who had undergone THR or TKR. This paper describes a randomized controlled trial protocol that involves persons with THR or TKR. The participant will be randomly assigned to an intervention group or a control group. The intervention group will perform post-rehabilitation supervised training; the control group will be requested to follow the usual care. The primary outcome is QoL, measured with the Short-Form Health Survey (SF-36); Secondary outcomes are clinical, functional and lifestyle measures that may influence QoL. The results of this study could provide evidence for clinicians, exercise trainers, and policymakers toward a strategy that ensures safe and effective exercise physical activity after surgery.
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18
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Devasenapathy N, Malhotra R, Mittal K, Garg B, Kumar V, Zodpey S, Dogra H, Maddison R, Belavy DL. Higher Disability in Women Than Men Scheduled for Total Knee Arthroplasty for Degenerative Osteoarthritis: A Cross-Sectional Analysis From India. ACR Open Rheumatol 2020; 2:309-319. [PMID: 32386129 PMCID: PMC7301870 DOI: 10.1002/acr2.11137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/24/2020] [Indexed: 01/27/2023] Open
Abstract
Objective Higher level impairments and activity limitation among those scheduled for total knee arthroplasty (TKA) is known. Sex differences in participation restriction which is the final domain of disablement pathway is not known. No data from developing countries exist on sex differences in disability levels at the time of TKA. Methods In a cross‐sectional analysis of 240 patients (188 women; 72 men) scheduled for TKA, impairment (pain, symptoms, quadricep muscle strength, and knee range of motion [ROM]), activity limitation (self‐reported and objective performance‐based measurements), and participation restriction were compared. Multivariable regression analyses were used to adjust for key sociodemographic and clinical characteristics. Associations between impairments and participation restriction were analyzed. Results Compared with men, women were more likely to have higher levels of impairment (knee injury and osteoarthritis outcome pain score adjusted mean difference [aMD]: −6.9 [95% confidence interval {CI} −13.7 to −0.18]; flexion ROM of less than 100° adjusted odds ratio: 5.7 [95% CI 1.6‐20.3]; and 36% lower muscle strength [95% CI 24%‐49%]) and lower objectively measured functional ability (walking speed aMD: −0.12 m/s [95% CI −0.23 to −0.02]; stair climbing time aMD: 9.5 s [95% CI 1.5‐17.5]). Participation restriction was higher in women compared with men. Of the impairment measures (pain, ROM, and muscle strength), pain contributed to participation restriction in both sexes. Conclusion This study demonstrated higher levels of disability in women than in men at the time of TKA. Effect of pain on participation restriction was higher compared with muscle strength and ROM. Evidence of delay in decision‐making to undergo TKA and reasons for delay need to be studied specifically in the context of lower middle–income countries.
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Affiliation(s)
- Niveditha Devasenapathy
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, New Delhi, India, and Deakin University, Geelong, Victoria, Australia
| | | | - Kanchan Mittal
- All India Institute of Medical Sciences, New Delhi, India
| | - Bhavuk Garg
- All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Kumar
- All India Institute of Medical Sciences, New Delhi, India
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Kornuijt A, de Kort GJL, Das D, Lenssen AF, van der Weegen W. Recovery of knee range of motion after total knee arthroplasty in the first postoperative weeks: poor recovery can be detected early. Musculoskelet Surg 2019; 103:289-297. [PMID: 30628029 DOI: 10.1007/s12306-019-00588-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE The aim of this study was to analyze in detail how knee flexion and extension progress in the first 8 weeks after primary total knee arthroplasty (TKA). The secondary goal was to compare knee range of motion (ROM) recovery patterns between patients with normal and delayed ROM recovery 8 weeks after TKA. METHODS This prospective clinical trial included all patients who underwent a primary unilateral TKA between February and December 2016 with weekly ROM data documented by the treating outpatient physical therapists (n = 137). Goniometry was used to measure knee ROM preoperatively, postoperatively on day 1 and weekly until follow-up at the orthopedic clinic 8 weeks after surgery. ROM recovery patterns were compared between patients with sufficient (≥ 90°) or insufficient (< 90°) knee flexion 8 weeks after TKA. RESULTS Knee flexion recovered from a median of 80° in the first postoperative week to 110° 8 weeks after surgery and knee extension from a mean of - 10.7° to - 3.2°. Recovery was nonlinear, with greatest improvements in the first 4 weeks for knee flexion. In contrast to patients with sufficient knee flexion 8 weeks postoperatively, the insufficient group (n = 8, 5.8%) had poor knee flexion on the first postoperative day and from week 4 to week 8 almost no improvement or even worsening of knee flexion. CONCLUSIONS Both knee flexion and extension recover in a nonlinear manner after TKA surgery. Poor postoperative knee function can be detected early, using ROM data from the first postoperative day up to the fourth week.
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Affiliation(s)
- A Kornuijt
- Department of Physiotherapy, St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands.
| | - G J L de Kort
- Department of Orthopedic Surgery, St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | - D Das
- Department of Orthopedic Surgery, St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | - A F Lenssen
- Department of Physiotherapy, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - W van der Weegen
- Department of Orthopedic Surgery, St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
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20
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Effectiveness of ultrasonographic skeletal muscle assessment in patients after total knee arthroplasty. Osteoporos Sarcopenia 2019; 5:94-101. [PMID: 31728427 PMCID: PMC6838742 DOI: 10.1016/j.afos.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/17/2019] [Accepted: 09/06/2019] [Indexed: 12/29/2022] Open
Abstract
Objectives This study aimed to characterize the skeletal muscles of patients who underwent total knee arthroplasty (TKA) using ultrasonography in order to investigate the effectiveness of ultrasonographic skeletal muscle assessment after TKA. Methods This study included 50 TKA patients (TKA group) and 41 residents with osteoarthritis who have not received TKA (non-TKA group). Ultrasonography was used to assess the characteristics of several different muscles. Various postoperative outcomes were evaluated. Muscle thickness (MT) and echo intensity (EI) results were compared among operated knees in the TKA group, nonoperated knees in the TKA group, and more severely affected knees in the non-TKA group. For the TKA group, multiple regression was conducted to examine the association between skeletal muscle characteristics of operated knees and postoperative outcomes. Results The MTs of the vastus medialis, vastus intermedius, and rectus femoris (RF) were significantly smaller and the RF-EI was significantly greater for both operated and nonoperated knees in the TKA group compared with the non-TKA group (P < 0.017). Several parameters of physical function were significantly poorer in the TKA group than in the non-TKA group (P < 0.05). Multiple regression demonstrated that RF-MT was associated with knee range of motion, knee strength, and physical functional performance in the TKA group (P < 0.05). Conclusions The quantity and quality of skeletal muscles were lower in the TKA group than in the non-TKA group. Ultrasonography may be useful for assessing skeletal muscles in TKA patients because MT assessed with ultrasonography was associated with various parameters of physical function.
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Rosso F, Cottino U, Olivero M, Bonasia DE, Bruzzone M, Rossi R. Medium-term follow-up of 149 mobile-bearing total knee arthroplasties and evaluation of prognostic factors influencing outcomes. J Orthop Surg (Hong Kong) 2019; 26:2309499017754092. [PMID: 29382294 DOI: 10.1177/2309499017754092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the medium-term outcomes of a posterior-stabilized mobile-bearing total knee arthroplasty (PS-MB-TKA) and the role of different prognostic factors. METHODS Patients indicated for a primary cemented PS-MB-TKA between 2002 and 2010 were included and prospectively evaluated using the Knee Society Scoring System (KSS) and the Hospital for Special Surgery (HSS) knee scores. The Knee Society Roentgenographic Evaluation form was used for the radiological evaluation. Different variables were collected and divided into patient- and surgery-related. Logistic regression was used to analyze the correlation between these variables and implants outcomes and survivorship. RESULTS In total, 149 cases were included (67.8% female, average age 70.4 years, SD ±9.4). The patella was resurfaced in 12.1% of the cases. All the implants were cemented. The average follow-up was 87.3 months (SD ±21.2). Postoperatively, there was a statistically significant improvement in all the scores. The cumulative survival was 96.2% (SD ±0.02%). At the regression analysis, female gender was associated to worse satisfaction KSS (OR = 0.26), functional KSS (OR = 0.22), and HSS (OR = 0.37) scores. Patellar resurfacing and subsequent contralateral procedures were associated to better functional KSS score (OR = 4.13, OR = 2.21), as well as varus preoperative alignment (OR = 2.12). On contrary, valgus preoperative alignment was associated to worse objective KSS score (OR = 0.23). No variables were correlated to failure or presence of radiolucent lines. CONCLUSION Good medium-term outcomes were obtained using PS-MB-TKA, with a cumulative survivorship of 96.5%. Female gender and valgus preoperative alignment were associated to worse objective and subjective outcomes. Conversely, patellar replacement, subsequent contralateral TKA, and varus preoperative alignment were associated to better functional outcomes.
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Affiliation(s)
- Federica Rosso
- 1 Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
| | - Umberto Cottino
- 1 Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
| | | | | | - Matteo Bruzzone
- 1 Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
| | - Roberto Rossi
- 1 Department of Orthopaedics and Traumatology, AO Mauriziano Umberto I, Torino, Italy
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Loyd BJ, Stackhouse SK, Hogan C, Dayton MR, Stevens-Lapsley JE, Kittelson AJ. Peripheral Nociception Is Associated with Voluntary Activation Deficits and Quadriceps Weakness Following Total Knee Arthroplasty. J Bone Joint Surg Am 2019; 101:1539-1545. [PMID: 31483396 PMCID: PMC7406143 DOI: 10.2106/jbjs.18.01457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Quadriceps weakness is a hallmark of total knee arthroplasty and is driven by reduced voluntary muscle activation following the surgical procedure. The mechanisms underlying postoperative activation deficits are not well established, although nociception has been implicated via both spinal reflex and supraspinal pathways. The purpose of this study was to assess the role of nociception in postoperative recovery of strength and activation. METHODS A total of 53 participants were assessed prior to total knee arthroplasty and at 6 weeks postoperatively. Quadriceps strength was measured by maximum voluntary isometric contraction, and activation was measured by the doublet interpolation technique. The pressure-pain threshold was used to measure local sensitization (at the knee joint) and systemic sensitization (at the forearm). Changes in outcomes (strength and activation) were regressed against pressure-pain threshold measurements. Mediation analyses were planned for significant associations to investigate whether deficits in voluntary activation were implicated on a causal pathway between pressure-pain threshold measures and postoperative strength loss. RESULTS Knee pressure-pain threshold measures were significantly associated with reduced voluntary quadriceps activation (beta = -0.04; p = 0.009) and diminished quadriceps strength after total knee arthroplasty (beta = -0.07; p = 0.001). There was also a mediation effect of voluntary activation on the relationship between the knee pressure-pain threshold and quadriceps strength. After correcting for multiple comparisons, relationships between the forearm pressure-pain threshold and strength and activation did not reach significance. CONCLUSIONS The measures of local nociceptor sensitization were related to reduced strength and activation following total knee arthroplasty. This is consistent with a causal pathway linking increased firing of knee joint nociceptors to reduced activation and reduced strength. Future randomized studies should investigate whether peripherally directed pain therapies reduce pain while also promoting the recovery of quadriceps strength via an improved capacity for voluntary activation. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Brian J. Loyd
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado,Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah
| | | | - Craig Hogan
- Department of Orthopedics, University of Colorado, Aurora, Colorado
| | | | - Jennifer E. Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado,Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado
| | - Andrew J. Kittelson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado
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Iwata A, Sano Y, Wanaka H, Yamamoto S, Yano Y, Iwata H. Different improvement trends in gait function and quadriceps strength early after total knee arthroplasty. J Phys Ther Sci 2019; 31:57-62. [PMID: 30774206 PMCID: PMC6348170 DOI: 10.1589/jpts.31.57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/07/2018] [Indexed: 01/12/2023] Open
Abstract
[Purpose] Improved quadriceps strength is a primary target of rehabilitation early after total knee arthroplasty. However, patients demonstrate varying improvement trends in gait function and quadriceps strength. This study evaluated the relationship between improvements in quadriceps strength and gait function. [Participants and Methods] The study included 49 patients who were scheduled to undergo unilateral total knee arthroplasty. Gait function, bilateral quadriceps strength, and pain were assessed in all patients. All assessments were performed preoperatively and at 2 and 3 weeks postoperatively. [Results] A significant correlation between gait function and the quadriceps strength on the operated side was observed preoperatively and 3 weeks postoperatively. The quadriceps strength on the non-operated side was significantly correlated with gait function at all time points. Multiple regression analysis showed that the quadriceps strength on the non-operated side was significantly associated with gait function, except the gait speed at 2 weeks. However, the quadriceps strength on the operated side was not observed to be an independent variable at all time points. [Conclusion] The quadriceps strength on the operated side is not an important determinant of gait function. It may be necessary to reconsider typical rehabilitation programs by focusing on the quadriceps strength on the operated side in patients undergoing total knee arthroplasty.
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Affiliation(s)
- Akira Iwata
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino city, Osaka 583-8555, Japan
| | - Yuki Sano
- Department of Rehabilitation, Osaka General Medical Center, Japan
| | - Hideyuki Wanaka
- Department of Rehabilitation, Osaka General Medical Center, Japan
| | - Saki Yamamoto
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino city, Osaka 583-8555, Japan
| | - Yuki Yano
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University: 3-7-30 Habikino, Habikino city, Osaka 583-8555, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Japan
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24
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Liptak MG, Theodoulou A, Kaambwa B, Saunders S, Hinrichs SW, Woodman RJ, Krishnan J. The safety, efficacy and cost-effectiveness of the Maxm Skate, a lower limb rehabilitation device for use following total knee arthroplasty: study protocol for a randomised controlled trial. Trials 2019; 20:36. [PMID: 30630494 PMCID: PMC6329189 DOI: 10.1186/s13063-018-3102-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/04/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Physical rehabilitation is required to enhance functional outcomes and overall recovery following total knee arthroplasty (TKA). However, there are no universally accepted clinical guidelines available to consistently structure rehabilitation for TKA patients. A common method is rehabilitation provided in an outpatient setting, on a one-to-one treatment basis. This method is resource-intensive and outcomes must be compared to less costly alternatives such as home-based rehabilitation. The current study will analyse a novel home-based rehabilitation program. The Maxm skate is a portable, lower-limb, postoperative, rehabilitation exercise device for individual use in a hospital or home-based setting. This study was developed to compare the safety, efficacy and cost-effectiveness of the Maxm Skate rehabilitation program to standard rehabilitative care following TKA. The primary outcome is the range of motion (ROM) achieved by patients who received the Maxm Skate program compared to standard care at three months post TKA. Secondary outcomes include patient-reported outcomes, costs and functional evaluations which will be collected at multiple time-points up to 12 months after TKA. METHODS This is a single-blinded, randomised controlled trial (RCT) in which 116 eligible participants consented for primary TKA will be randomly allocated to receive either the Maxm Skate rehabilitation program or standard rehabilitative care. Fifty-eight participants per group will provide 90% power (α = 0.05) to detect 10° of difference in ROM between groups at three months after TKA, assuming a within-group standard deviation of 16° and allowing for 5% loss to follow-up. Participants randomised to the Maxm Skate group will use the skate device and accompanying iOS App and sensors to complete rehabilitation exercises, as outlined in the Maxm Skate Rehabilitation Guide. Outcomes will be compared to those receiving standard rehabilitative care. A blinded physiotherapist will evaluate functional outcomes preoperatively and at 2, 4, 6, 12, 26 and 52 weeks after TKA. The functional assessment will include measures of knee ROM, pain, isometric knee strength, balance and knee/thigh circumference. Limited measures will also be assessed at day 2 postoperatively by an alternate, unblinded physiotherapist. Clinical outcome measures will be administered preoperatively and at 6, 12 and 52 weeks postoperatively. An economic evaluation will be conducted and participants will be screened for adverse event occurrences from the time of consent to 12 months postoperatively. DISCUSSION This RCT will be the first to investigate the safety, efficacy and cost-effectiveness of the home-based Maxm Skate Rehabilitation program, in comparison to standard rehabilitative care following primary TKA. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616001081404p . Registered on 11 August 2016.
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Affiliation(s)
| | - Annika Theodoulou
- The International Musculoskeletal Research Institute Inc., Adelaide, South Australia Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Billingsley Kaambwa
- Health Economics Unit, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | | | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, College of Medicine, Flinders University, Adelaide, Australia
| | - Jeganath Krishnan
- The International Musculoskeletal Research Institute Inc., Adelaide, South Australia Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Kornuijt A, Das D, Sijbesma T, de Vries L, van der Weegen W. Manipulation under anesthesia following total knee arthroplasty: a comprehensive review of literature. Musculoskelet Surg 2018; 102:223-230. [PMID: 29546693 DOI: 10.1007/s12306-018-0537-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 03/08/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The etiology of the stiff knee after total knee arthroplasty (TKA) is largely unknown, although excessive scar tissue due to arthrofibrosis is an important reason for a limited range of motion (ROM) after this procedure. Persistent limited ROM after TKA results in poor patient-reported outcomes and is increasingly becoming a more prominent reason for TKA revision surgery. METHODS A narrative review of current literature on manipulation under anesthesia (MUA) after TKA analyzing etiology and risk factors for stiffness after TKA, effectiveness of MUA and what is known about rehabilitation after MUA. RESULTS Literature describes numerous risk factors for insufficient knee ROM after TKA, but a comprehensive valid risk model is lacking. MUA is an effective treatment option with evidence suggesting better outcomes if performed within the first 3 months after TKA. The wide variety in both the indication and timing for MUA, and the lack of scientific evidence on how to rehabilitate patients after MUA, complicates the interpretation of available literature. This is even more so the case on the reporting of one versus two or more MUAs after TKA. CONCLUSION Future comparative trials, preferably with a randomized study design, should be conducted to elude more clear indications for MUA, to give clinical guidance on correct timing for MUA and on how to rehabilitate patients afterward.
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Affiliation(s)
- A Kornuijt
- Department of Physiotherapy, St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | - D Das
- Department of Orthopedic Surgery, St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | - T Sijbesma
- Department of Orthopedic Surgery, St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | - L de Vries
- Department of Orthopedic Surgery, Westfriesgasthuis Hospital, Maelsonstraat 3, 1624 NP, Hoorn, The Netherlands
| | - W van der Weegen
- Department of Orthopedic Surgery, St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands.
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26
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Giesinger JM, Loth FL, MacDonald DJ, Giesinger K, Patton JT, Simpson AHRW, Howie CR, Hamilton DF. Patient-reported outcome metrics following total knee arthroplasty are influenced differently by patients' body mass index. Knee Surg Sports Traumatol Arthrosc 2018; 26:3257-3264. [PMID: 29417168 PMCID: PMC6208940 DOI: 10.1007/s00167-018-4853-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 01/29/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE This study investigated the impact of body mass index (BMI) on improvement in patient outcomes (pain, function, joint awareness, general health and satisfaction) following total knee arthroplasty (TKA). METHODS Data were obtained for primary TKAs performed at a single centre over a 12-month period. Data were collected pre-operatively and 12-month postoperatively with the Oxford Knee Score (OKS) measuring pain and function, the EQ-5D-3L measuring general health status, the Forgotten Joint Score-12 (FJS-12) measuring joint awareness and a single question on treatment satisfaction. Change in scores following surgery was compared across the BMI categories identified by the World Health Organization (< 25.0, 25.0-29.9, 30.0-34.9, 35.0-39.9 and ≥ 40.0). Differences in postoperative improvement between the BMI groups were analysed with an overall Kruskal-Wallis test, with post hoc pairwise comparisons between BMI groups with Mann-Whitney tests. RESULTS Of 402 patients [mean age 70.7 (SD 9.2); 55.2% women] 15.7% were normal weight (BMI < 25.0), 33.1% were overweight (BMI 25.0-29.9), 28.2% had class I obesity (BMI 30.0-34.9), 16.2% had class II obesity (BMI 35.0-39.9), and 7.0% had class III obesity (BMI ≥ 40.0). Postoperative change in OKS (n.s.) and EQ-5D-3L (n.s.) was not associated with BMI. Higher BMI group was associated with less improvement in FJS-12 scores (p = 0.010), reflecting a greater awareness of the operated joint during activity in the most obese patients. Treatment satisfaction was associated with BMI category (p = 0.029), with obese patients reporting less satisfaction. CONCLUSIONS In TKA patients, outcome parameters are influenced differently by BMI. Our study showed a negative impact of BMI on postoperative improvement in joint awareness and satisfaction scores, but there was no influence on pain, function or general health scores. This information may be useful in terms of setting expectations expectation in obese patients planning to undergo TKA. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- J M Giesinger
- Innsbruck Institute of Patient-centered Outcome Research (IIPCOR), Innsbruck, Austria
| | - F L Loth
- University of Innsbruck, Innsbruck, Austria
| | - D J MacDonald
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - K Giesinger
- Department of Orthopaedics, Kantonsspital, St. Gallen, St Gallen, Switzerland
| | - J T Patton
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - A H R W Simpson
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - C R Howie
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - David F Hamilton
- Department of Orthopaedics and Trauma, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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Hsu WH, Fan CH, Yu PA, Chen CL, Kuo LT, Hsu RWW. Effect of high body mass index on knee muscle strength and function after anterior cruciate ligament reconstruction using hamstring tendon autografts. BMC Musculoskelet Disord 2018; 19:363. [PMID: 30305072 PMCID: PMC6180445 DOI: 10.1186/s12891-018-2277-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 09/24/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Increased body mass index (BMI) has been associated with poorer function in patients who have undergone anterior cruciate ligament (ACL) reconstruction. However, the effect of high BMI on muscle strength in these patients remained unclear. The current study aimed to compare knee muscle strength and Knee injury and Osteoarthritis Outcome Score (KOOS) in ACL-reconstructed patients with a variety of different BMIs. METHODS From November 2013 to March 2016, we prospectively enrolled 30 patients who underwent ACL reconstruction (18-60 years of age). Anthropometric parameters, body compositions, isokinetic muscle strength and KOOS were assessed preoperatively, and at post-operative 16th week and 28th week. The patients were stratified into two groups by BMI, i.e. normal BMI (18.5-24.9 kg/m2) and high BMI (≥25.0 kg/m2). RESULTS Twelve patients in the normal BMI group completed the follow-up, while sixteen patients did so in the high BMI group. In comparison of muscle strength between baseline and 28th week follow-up, the normal BMI group had significant increases in overall knee muscle strength, while the high BMI group only had increases in extensors of uninjured knee and flexors of the injured knee. However, there were significant increases in all KOOS subscales for the high BMI group. The high BMI patients reported increased KOOS, which may reflect the contribution of ligament stability in the presence of inadequate muscle strength. CONCLUSIONS The normal BMI patients had improvement in all knee muscle strength following ACL reconstruction, while high BMI patients only had increases in certain knee muscles. High BMI patients had a decreased quadriceps muscle symmetry index, as compared to their normal BMI counterparts. Increases in quadriceps muscle strength of the uninjured knee and ACL reconstruction were associated with improvements in KOOS in high BMI patients.
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Affiliation(s)
- Wei-Hsiu Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan. .,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan. .,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | - Chun-Hao Fan
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan
| | - Pei-An Yu
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan
| | - Chi-Lung Chen
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan.,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Liang-Tseng Kuo
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan.,School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Robert Wen-Wei Hsu
- Sports Medicine Center, Chang Gung Memorial Hospital at Chia Yi, Chia Yi, Taiwan.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Chia Yi, No 6 West section, Chia Pu Road, Puzih, Chia Yi Hsien, 613, Taiwan
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28
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Sano Y, Iwata A, Wanaka H, Matsui M, Yamamoto S, Koyanagi J, Iwata H. An easy and safe training method for trunk function improves mobility in total knee arthroplasty patients: A quasi-randomized controlled trial. PLoS One 2018; 13:e0204884. [PMID: 30286130 PMCID: PMC6171877 DOI: 10.1371/journal.pone.0204884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/14/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Total knee arthroplasty (TKA) is aimed mainly at reducing pain and restoring mobility. However, mobility deficits can persist even longer than 1 year. The trunk function and movement velocity of any region have been recently recognized to be critical for determining mobility in older people. Therefore, the main goal of this quasi-randomized trial is to clarify the effectiveness of a novel training method, the seated side tapping (SST) training, for improving mobility by focusing on movement velocity of trunk function in the short term after TKA. Methods SST training consists of side trunk movements repeated as quickly as possible in a seated position. All participants after TKA were randomly assigned to the SST training group (n = 37) or control training group (n = 38). The participants in the SST group performed SST training plus the standard rehabilitation program 5 days per week for 3 weeks after TKA, while the control group performed only the standard rehabilitation programs. The primary outcome was the effect of SST training on mobility, indicated by gait speed and the timed up and go test (TUG) time. Measurements were performed before and 1, 2, and 3 weeks after surgery. Results At all-time points, the patients in the SST group showed significantly better mobility, despite that knee function, represented by muscle strength, range of motion, and degree of pain at the knee joint, was similar in both groups. The difference in gait speed between the groups was >0.1 m/s at all time points, which is clinically significant. Conclusion SST training significantly improved patients’ mobility within 3 weeks after TKA, despite that no additional benefit was observed in knee function. The findings in this study indicate that SST training may be considered as a part of the rehabilitation program after TKA, although further evaluation of its long-term effectiveness is needed. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; UMIN000027909).
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Affiliation(s)
- Yuki Sano
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Akira Iwata
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- * E-mail:
| | - Hideyuki Wanaka
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Mina Matsui
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Saki Yamamoto
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| | - Junichiro Koyanagi
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Shadyab AH, Li W, Eaton CB, LaCroix AZ. General and Abdominal Obesity as Risk Factors for Late-Life Mobility Limitation After Total Knee or Hip Replacement for Osteoarthritis Among Women. Arthritis Care Res (Hoboken) 2018; 70:1030-1038. [PMID: 28973836 PMCID: PMC5882615 DOI: 10.1002/acr.23438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/26/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate associations of body mass index (BMI), waist circumference (WC), and waist/hip ratio (WHR) with survival to age 85 years with mobility limitation or death before age 85 years among older women with total knee replacement (TKR) or total hip replacement (THR) for osteoarthritis (OA). METHODS This was a prospective study of women (ages 65-79 years at baseline) from the Women's Health Initiative, recruited during 1993-1998 and followed through 2012. Women's Health Initiative data were linked to Medicare claims data to determine TKR (n = 1,867) and THR (n = 944) for OA. Women were followed for up to 18 years after undergoing THR or TKR to determine mobility status at age 85 years. RESULTS Compared with normal-weight women, overweight, obese I, and obese II women with THR had significantly increased risk of survival to age 85 years with mobility limitation (P < 0.001 for linear trend), with the strongest risk among obese II women (odds ratio [OR] 4.37 [95% confidence interval (95% CI) 1.96-9.74]). Obese II women with THR also had increased risk of death before age 85 years. Women with THR and WC >88 cm relative to ≤88 cm had increased risk of survival to age 85 years with mobility limitation (OR 1.65 [95% CI 1.17-2.33]) but not death before age 85 years. High BMI, WC, and WHR were associated with significantly increased risk of late-life mobility limitation and death among women with TKR for OA. CONCLUSION Among older women who underwent THR or TKR for OA, baseline general and abdominal obesity were associated with increased risk of late-life mobility limitation.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/trends
- Arthroplasty, Replacement, Knee/trends
- Female
- Humans
- Mobility Limitation
- Obesity/diagnosis
- Obesity/surgery
- Obesity, Abdominal/diagnosis
- Obesity, Abdominal/epidemiology
- Obesity, Abdominal/surgery
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/surgery
- Prospective Studies
- Risk Factors
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Affiliation(s)
- Aladdin H. Shadyab
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Wenjun Li
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Charles B. Eaton
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island and Department of Family Medicine, Warren Alpert Medical School, Brown University, Pawtucket, RI, USA
| | - Andrea Z. LaCroix
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
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30
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Pua YH, Seah FJT, Poon CLL, Tan JWM, Alan Clark R, Liaw JSC, Chong HC. Age- and sex-based recovery curves to track functional outcomes in older adults with total knee arthroplasty. Age Ageing 2018; 47:144-148. [PMID: 28985252 DOI: 10.1093/ageing/afx148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/02/2017] [Indexed: 11/13/2022] Open
Abstract
Background older adults with total knee arthroplasty (TKA) frequently undergo rehabilitation to address limited knee flexion range-of-motion, quadriceps weakness and gait speed limitations. This study aimed to develop age- and sex-specific recovery curves of knee flexion range-of-motion, quadriceps strength and fast gait speed post-TKA. Methods a population-based sample of 2,987 patients undergoing primary TKA participated, of whom 2015 (68%) were 65 years of age or older. At 4, 8 and 12 weeks post surgery, knee flexion range-of-motion, quadriceps strength and fast gait speed were quantified. Quantile regression was used to determine the percentiles of the knee and gait measures. Results the various knee and gait measures improved nonlinearly over time, with substantial improvements observed in the 1st 8-10 weeks post surgery. Age-specific, sex-specific recovery curves were developed to show the recovery patterns at multiple percentile levels. A web interface was created to facilitate easy computation of the percentile rank for a given outcome value. Conclusions we have provided reference percentile values for knee flexion range-of-motion, quadriceps strength and gait speed recovery post-TKA. Such information may assist rehabilitation professionals in interpreting outcomes and quantifying deviations from the expected recovery pattern.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | | | | | | | - Ross Alan Clark
- Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia
| | | | - Hwei-Chi Chong
- Department of Physiotherapy, Singapore General Hospital, Singapore
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31
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Ishii Y, Noguchi H, Sato J, Ishii H, Yamamoto T, Sakurai T, Toyabe SI. Clinical relevance of active straight leg raising, standing up, and walking after total knee arthroplasty in a cross-sectional study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:947-953. [DOI: 10.1007/s00590-017-2100-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 11/24/2022]
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32
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Wong SE, Pitcher AA, Ding DY, Cashman N, Zhang AL, Ma CB, Feeley BT. The effect of patient gender on outcomes after reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26:1889-1896. [PMID: 28911814 DOI: 10.1016/j.jse.2017.07.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/01/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Gender differences may exist for patients undergoing shoulder arthroplasty. Limited data suggest that women may have worse preoperative disability and outcomes. Our objective was to determine whether gender influences preoperative disability and patient-reported outcomes after reverse total shoulder arthroplasty. METHODS Data were prospectively collected for patients who underwent reverse total shoulder arthroplasty for rotator cuff arthropathy or osteoarthritis with a rotator cuff tear at a single institution between 2009 and 2015. Range of motion, visual analog scale, 12-Item Short Form Health Survey (SF-12), and American Shoulder and Elbow Surgeons (ASES) scores were collected at the preoperative, 1-year, and 2-year postoperative time points. Data were analyzed using multivariate mixed-effect regression analysis. RESULTS There were 117 patients included. Men and women had similar demographics, preoperative range of motion, pain, and function. Length of stay was similar (men, 2.32 days; women, 2.58 days; P = .18). Controlling for patient variables, men achieved higher ASES function (P = .009) and SF-12 Physical Component Summary (P = .008) scores compared with women. There was no difference between men and women in ASES pain and SF-12 Mental Component Summary scores, visual analog scale score, or range of motion. CONCLUSION Improvements in pain and range of motion were similar in men and women; however, men achieved higher ASES function and SF-12 Physical Component Summary scores. Women may be more functionally impaired on the basis of differences in activities of daily living. These results may be used to guide discussion about expected benefits after reverse shoulder arthroplasty.
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Affiliation(s)
- Stephanie E Wong
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA.
| | - Austin A Pitcher
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
| | - David Y Ding
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
| | - Nicola Cashman
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
| | - Alan L Zhang
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
| | - C Benjamin Ma
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
| | - Brian T Feeley
- Department of Orthopaedics, University of California, San Francisco, San Francisco, CA, USA
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Tibial Eminence Involvement With Tibial Plateau Fracture Predicts Slower Recovery and Worse Postoperative Range of Knee Motion. J Orthop Trauma 2017. [PMID: 28633149 DOI: 10.1097/bot.0000000000000833] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine 1-year functional and clinical outcomes in patients with tibial plateau fractures with tibial eminence involvement. DESIGN Retrospective analysis of prospectively collected data. SETTING Academic Medical Center. PATIENTS/PARTICIPANTS All patients who presented with a tibial plateau fracture (Orthopaedic Trauma Association (OTA) 41-B and 41-C). INTERVENTION Patients were divided into fractures with a tibial eminence component (+TE) and those without (-TE) cohorts. All patients underwent similar surgical approaches and fixation techniques for fractures. No tibial eminence fractures received fixation specifically. MAIN OUTCOME MEASUREMENTS Short musculoskeletal functional assessment (SMFA), pain (Visual Analogue Scale), and knee range-of-motion (ROM) were evaluated at 3, 6, and 12 months postoperatively and compared between cohorts. RESULTS Two hundred ninety-three patients were included for review. Patients with OTA 41-C fractures were more likely to have an associated TE compared with 41-B fractures (63% vs. 28%, P < 0.01). At 3 months postoperatively, the +TE cohort was noted to have worse knee ROM (75.16 ± 51 vs. 86.82 ± 53 degree, P = 0.06). At 6 months, total SMFA and knee ROM was significantly worse in the +TE cohort (29 ± 17 vs. 21 ± 18, P ≤ 0.01; 115.6 ± 20 vs. 124.1 ± 15, P = 0.01). By 12 months postoperatively, only knee ROM remained significantly worse in the +TE cohort (118.7 ± 15 vs. 126.9 ± 13, P < 0.01). Multivariate analysis revealed that tibial eminence involvement was a significant predictor of ROM at 6 and 12 months and SFMA at 6 months. Body mass index was found to be a significant predictor of ROM and age was a significant predictor of total SMFA at all time points. CONCLUSION Knee ROM remains worse throughout the postoperative period in the +TE cohort. Functional outcome improves less rapidly in the +TE cohort but achieves similar results by 1 year. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Association between rehabilitation attendance and physical function following discharge after total knee arthroplasty: prospective cohort study. Osteoarthritis Cartilage 2017; 25:462-469. [PMID: 27810379 DOI: 10.1016/j.joca.2016.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/20/2016] [Accepted: 10/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rehabilitation is widely advocated and provided as a standard of care for patients with total knee arthroplasty (TKA) but its effects on intermediate- to longer-term physical function is unclear. Also unknown is the relationship between the number of rehabilitation sessions attended and functional outcomes. METHODS We conducted a prospective cohort study of 1540 patients who had undergone TKA and were referred for rehabilitation. Physical function was indexed by the Short-Form 36 (SF-36) physical function score at 6 months post-TKA. We used multivariable linear regression to assess the association between rehabilitation attendance and Month-6 physical function. Among patients who attended rehabilitation, multivariable linear regression was used to examine the dose-response association between the number of sessions attended and Month-6 physical function. RESULTS Of the 1540 patients, 68 patients did not attend rehabilitation, 86 patients attended one session, and 1386 patients attended two or more sessions. Adjusted for the propensity to attend rehabilitation, rehabilitation attendance was independently associated with better Month-6 SF-36 physical function (point estimate, 5.0 points; 95% CI, 0.5-9.5; P = 0.028 compared with patients with no rehabilitation). Among patients who attended rehabilitation, attending five sessions was associated with a 3.6-point increase in SF-36 scores (95% CI, 0.8-6.5; P = 0.01) relative to patients who attended one session. CONCLUSIONS Rehabilitation attendance post-TKA is associated with an increase in self-report physical function. Among patients who attended rehabilitation, a modest dose-response relationship was observed between the number of sessions and functional outcomes.
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Factors associated with gait speed recovery after total knee arthroplasty: A longitudinal study. Semin Arthritis Rheum 2017; 46:544-551. [DOI: 10.1016/j.semarthrit.2016.10.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/27/2016] [Accepted: 10/27/2016] [Indexed: 11/22/2022]
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Clark RA, Seah FJT, Chong HC, Poon CLL, Tan JWM, Mentiplay BF, Pua YH. Standing balance post total knee arthroplasty: sensitivity to change analysis from four to twelve weeks in 466 patients. Osteoarthritis Cartilage 2017; 25:42-45. [PMID: 27577930 DOI: 10.1016/j.joca.2016.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 08/05/2016] [Accepted: 08/20/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Little is known about how static standing balance changes post total knee arthroplasty (TKA). The primary aim of this study was to examine the sensitivity to change and redundancy of center of pressure (COP) variables post-TKA. The secondary aim was to compare the sensitivity of these measures to standard clinical assessments of one repetition maximum knee extension strength and fast pace gait speed. DESIGN 466 participants performed instrumented double-limb standing balance tests with eyes open at 4 and 12 weeks post-TKA. Measures of COP standard deviation, amplitude, root mean square (RMS), path length, detrended fluctuation analysis (DFA) and signal frequency content for the medial-lateral (ML) and anterior-posterior (AP) axes were examined. RESULTS Significant decreases in total path length, ML variables related to sway velocity and AP signal complexity and frequency were observed. Inter-session Cohen's d effect size (ES) revealed the strongest effect was for high velocity ML path length, with a 12% decrease in this rapid sway. This variable, along with AP mean instantaneous frequency and AP DFA, were the only ones significantly different with effect sizes >0.20 and non-redundant (Spearman's rho <0.75). The ES of COP-derived variables (maximum = 0.45) were lower than gait speed (1.40) and knee extensor strength (1.54). CONCLUSION Increased high velocity ML sway is present at four compared to 12 weeks post-TKA. This augmented rapid sway may provide increased challenges to the postural control system at a time coinciding with reduced strength levels, which could have implications for physical function during activities of daily living.
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Affiliation(s)
- R A Clark
- School of Health and Sports Science, University of the Sunshine Coast, Australia.
| | - F J-T Seah
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - H-C Chong
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - C L-L Poon
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - J W-M Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - B F Mentiplay
- School of Health and Sports Science, University of the Sunshine Coast, Australia
| | - Y-H Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore
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Husted H, Jørgensen CC, Gromov K, Kehlet H. Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty? Acta Orthop 2016; 87:466-72. [PMID: 27347785 PMCID: PMC5016904 DOI: 10.1080/17453674.2016.1203477] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. Patients and methods - This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting. Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. Results - Median length of stay (LOS) was 2 (IQR: 2-3) days in all BMI groups. 30-day re-admission rates were around 6% for both THA (6.1%) and TKA (5.9%), without any statistically significant differences between BMI groups in univariate analysis (p > 0.4), but there was a trend of a protective effect of overweight for both THA (p = 0.1) and TKA (p = 0.06). 90-day re-admission rates increased to 8.6% for THA and 8.3% for TKA, which was similar among BMI groups, but there was a trend of lower rates in overweight and obese TKA patients (p = 0.08 and p = 0.06, respectively). When we adjusted for preoperative comorbidity, high BMI in THA patients (very obese and morbidly obese patients only) was associated with a LOS of >4 days (p = 0.001), but not with re-admission. No such relationship existed for TKA. Interpretation - A fast-track setting resulted in similar length of hospital stay and re-admission rates regardless of BMI, except for very obese and morbidly obese THA patients.
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Affiliation(s)
- Henrik Husted
- Orthopedics Department, Copenhagen University Hospital Hvidovre, Copenhagen;,The Lundbeck Foundation Center for Fast-track Hip and Knee Replacement;,Correspondence:
| | - Christoffer C Jørgensen
- The Lundbeck Foundation Center for Fast-track Hip and Knee Replacement;,Section for Surgical Pathophysiology, Righospitalet, Copenhagen University, Copenhagen, Denmark
| | - Kirill Gromov
- Orthopedics Department, Copenhagen University Hospital Hvidovre, Copenhagen;,The Lundbeck Foundation Center for Fast-track Hip and Knee Replacement
| | - Henrik Kehlet
- The Lundbeck Foundation Center for Fast-track Hip and Knee Replacement;,Section for Surgical Pathophysiology, Righospitalet, Copenhagen University, Copenhagen, Denmark
| | - on behalf of the Lundbeck Foundation Center for Fast-track Hip and Knee Replacement Collaborative Group
- The Lundbeck Foundation Center for Fast-track Hip and Knee Replacement Collaborative Group consists of: Kjeld Soeballe, Orthopedics Department, Århus University Hospital; Torben B Hansen, Orthopedics Department, Holstebro Hospital; Mogens B Laursen, Farsoe Clinic, Orthopedics Department, Aalborg University Hospital; Søren Solgaard, Orthopedics Department, Gentofte Hospital; Lars T Hansen, Orthopedics Department, Sydvestjysk Hospital, Grindsted; Per Kjaersgaard-Andersen, Orthopedics Department, Vejle Hospital; Lars Peter Jorn, Orthopedics Department, Viborg Regional Hospital, Viborg, Denmark
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Gustavson AM, Wolfe P, Falvey JR, Eckhoff DG, Toth MJ, Stevens-Lapsley JE. Men and Women Demonstrate Differences in Early Functional Recovery After Total Knee Arthroplasty. Arch Phys Med Rehabil 2016; 97:1154-62. [PMID: 27063363 DOI: 10.1016/j.apmr.2016.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/23/2016] [Accepted: 03/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether sex affects the trajectory of functional recovery after total knee arthroplasty (TKA). DESIGN Retrospective analysis from a historical database containing data from 3 prospective clinical trials and a pilot study. SETTING Clinical laboratory setting. PARTICIPANTS Recruitment across studies was restricted to patients who underwent an elective unilateral TKA for the treatment of osteoarthritis and were between 50 and 85 years of age (N=301). INTERVENTIONS Across all 4 studies, patients received a TKA and physical therapy intervention. Measures of physical function and strength were assessed before TKA and 1, 3, and 6 months after TKA. MAIN OUTCOME MEASURES Using a repeated-measures maximum likelihood model, statistical inference was made to estimate the changes in outcomes from before surgery to 1, 3, and 6 months after TKA that were stratified by sex. Muscle strength was assessed during maximal isometric quadriceps and hamstrings contractions. Muscle activation was assessed in the quadriceps muscle. Physical function outcomes included timed Up and Go (TUG) test, stair climbing test, and 6-minute walk test (6MWT). RESULTS Women demonstrated less decline in quadriceps strength than did men at 1, 3, and 6 months after TKA (P<.04), whereas women demonstrated less decline in hamstrings strength 1 month after TKA (P<.0001). Women demonstrated a greater decline than did men on the TUG test (P=.001), stair climbing test (P=.004), and 6MWT (P=.001) 1 month after TKA. Sex differences in physical function did not persist at 3 and 6 months after TKA. CONCLUSIONS Sex affected early recovery of muscle and physical function in the first month after TKA. Women demonstrated better preservation of quadriceps strength but a greater decline on measures of physical function than did men.
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Affiliation(s)
- Allison M Gustavson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Pamela Wolfe
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO
| | - Jason R Falvey
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | | | - Michael J Toth
- Department of Medicine, College of Medicine, University of Vermont, Burlington, VT
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Denver, CO.
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