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Wang YC, Wu SH, Chen CA, Liang JM, Yang CC, Chen CH, Chung WR, Chou PPH, Huang HT. Compare the Quadriceps Activity between Mini-Midvastus and Mini-Medial Parapatellar Approach in Total Knee Arthroplasty with Electromyography. J Clin Med 2024; 13:2736. [PMID: 38792280 PMCID: PMC11122619 DOI: 10.3390/jcm13102736] [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: 02/23/2024] [Revised: 03/18/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The comparison between the mini-midvastus (mini-MV) and mini-parapatellar (mini-MPP) approach in total knee arthroplasty (TKA) remains a subject of debate. The present study compared quadriceps activation, pain levels, and clinical outcomes between the two approaches; quadricep activation was assessed using surface electromyography (sEMG). Methods: This retrospective cross-sectional study comprised a total of 78 patients aged between 50 and 85 years with primary osteoarthritis. Patients were divided into a mini-MV (n = 38) group and a mini-MPP (n = 40) group according to the surgical approach. Results: The two groups exhibited no significant differences in sEMG for the vastus medialis (VM) or rectus femoris (RF) at the follow-up time points, with the exception that the mini-MV group exhibited superior strength of RF during extensions at the 2-week follow-up. However, the mini-MPP group had superior Western Ontario and McMaster Universities Index (WOMAC) total and function scores at the 2- and 6-week follow-ups. The mini-MPP group also had superior WOMAC stiffness scores at the 2-week follow-up. The two groups did not differ significantly in terms of pain levels or morphine consumption. Conclusions: The sEMG data of quadriceps muscle would not differ significantly between the mini-MV and mini-MPP approaches for TKA. Moreover, the mini-MPP approach may yield superior WOMAC scores when compared with the mini-MV approach.
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Affiliation(s)
- Ying-Chun Wang
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Sheng-Hua Wu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.W.); (C.-A.C.)
- Department of Anesthesiology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chi-An Chen
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (S.-H.W.); (C.-A.C.)
| | - Jing-Min Liang
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Chia-Chi Yang
- The Master Program of Long-Term Care in Aging, College of Nursing, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wan-Rong Chung
- Department of Anesthesiology, E-Da Hospital, Kaohsiung 807, Taiwan;
- College of Medicine, I-Shou University, Kaohsiung 807, Taiwan
| | - Paul Pei-Hsi Chou
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Hsuan-Ti Huang
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Hyodo K, Kanamori A, Kadone H, Takahashi T, Kajiwara M, Yamazaki M. Gait Analysis Comparing Kinematic, Kinetic, and Muscle Activation Data of Modern and Conventional Total Knee Arthroplasty. Arthroplast Today 2020; 6:338-342. [PMID: 32529016 PMCID: PMC7280752 DOI: 10.1016/j.artd.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 11/28/2022] Open
Abstract
Background To provide normal knee function, a total knee arthroplasty (TKA) implant with an anatomic surface shape and an adequate sagittal position has been developed. However, it is unclear how this modern implant influences knee joint kinetics and muscle activation during a gait. Therefore, we evaluated this modern TKA prosthesis and compared it with a conventional TKA prosthesis for gait analysis in terms of kinetics and muscle activation. Methods Subjects were patients (>60 years of age) with knee osteoarthritis who had undergone unilateral TKA. Twelve patients received the modern TKA prosthesis (group modern), and the other 12 patients received a conventional TKA prosthesis (group conventional). The subjects underwent motion capture analyses with a force plate, and kinematic and kinetic data were acquired from a 10-m gait test. Electromyography data of 6 lower limb muscles were simultaneously collected during the gait test. The 2 groups were compared using unpaired t-tests. Results In group modern, gait speed was faster, step length was longer, and the knee flexion angle during the initial stance phase was larger. Furthermore, in group modern, the maximum knee extension moment was higher; however, the quadriceps muscle activity tended to be lower than that in group conventional. Conclusions Gait characteristics of group modern were more like a normal gait, and knee joint extension moments were greater. This finding indicates that the quadriceps muscles can be more effectively activated, and the anterior stability function of the anterior cruciate ligament may be reproduced with the shape of the modern implant.
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Affiliation(s)
- Kojiro Hyodo
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiro Kanamori
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Tatsuya Takahashi
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaya Kajiwara
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Faculty of Medicine, Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Beach A, Regazzola G, Neri T, Verheul R, Parker D. The effect of knee prosthesis design on tibiofemoral biomechanics during extension tasks following total knee arthroplasty. Knee 2019; 26:1010-1019. [PMID: 31402095 DOI: 10.1016/j.knee.2019.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 07/05/2019] [Accepted: 07/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Determine whether the tibiofemoral motion and electromyographic activity of the knee differs in patients with a medial pivot implant, compared to those with cruciate-retaining and posterior-stabilised designs, during knee extension after Total Knee Arthroplasty (TKA). METHODS An observational study was conducted on a cohort of patients that had undergone TKA for a minimum of 12 months prior. Three matched groups (n = 18) were categorised based on implant type: medial-pivot (MP), posterior-stabilised (PS) and cruciate-retaining (CR). Kinematics, with motion analysis (Vicon, USA) and surface electromyography (Delsys, USA) were assessed during step-ascent and walking tasks. RESULTS All groups displayed a similar amount of knee extension in both tasks. They also paradoxically produced an average mean internal rotation movement during knee extension in both the step-ascent and walking tasks. The only significant difference was found in the step-ascent task, in which the MP group produced a larger absolute amount of rotation than the CR implant group (P = 0.007), but neither group differed from the PS implant group. The groups did not differ in rotation during the walking task (P > 0.05). The MP group displayed significantly (P < 0.01) greater knee extensor activation during the step-ascent than the PS group. CONCLUSION The MP design was only significantly different to another implant design for the step-ascent task. Patients with either knee implant types were not strictly limited to producing the traditional "screw-home" mechanism, defined by external rotation during extension. Furthermore, comparison with the non-implant contralateral limb suggested that rotation is not necessarily dictated by implant design.
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Affiliation(s)
- Aaron Beach
- Sydney Orthopaedic Research Institute, Sydney, Australia.
| | | | - Thomas Neri
- Sydney Orthopaedic Research Institute, Sydney, Australia
| | | | - David Parker
- Sydney Orthopaedic Research Institute, Sydney, Australia
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Zhou M, An S, Feng M, Li Z, Shen H, Zhang K, Sun J, Cao G. Gait analysis of patients with continuous proximal sciatic nerve blockade in flexion contractures after primary total knee arthroplasty. Gait Posture 2018; 66:166-171. [PMID: 30195220 DOI: 10.1016/j.gaitpost.2018.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 06/30/2018] [Accepted: 08/20/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The main objective of total knee arthroplasty is to relieve pain, restore normal knee function, and improve gait stability. Significant flexion contractures can severely impair function after surgery. The purpose of this study is to evaluate the efficacy of implementing a continuous proximal sciatic nerve block in conjunction with aggressive physical therapy to treat patients with persistent flexion contractures that were recalcitrant to rehabilitation efforts following primary total knee arthroplasty (TKA). METHODS From December 2012 to January 2016, the following subjects were enrolled in this study: 20 patients (15 females and 5 males aged between 62 and 78 years old; median age = 65.7 y) with flexion contractures ranging from 15° to 25° (19.2°±5.6°) that persisted for at least 1.5 months following total knee arthroplasty and showed no significant improvement in response to conventional therapeutic methods. Demographic data, the passive range of motion, flexion contracture, pain score during stretching, and the Hospital for Special Surgery knee score were recorded. A portable motion analyzer was used to obtain the corresponding gait parameters from the flexion contractures group and control group. Repeated measurement ANOVA was used to compare the clinical results. RESULTS In combination with 2 to 4 (2.5 ± 1.3) months of aggressive knee stretching exercises, 16 out of 18 knees achieved full extension, and 2 out of 18 improved to within 5° of the full extension. An average of the 12 to 48 (26.6 ± 10.7) month follow-up showed that this improved range of motion was maintained for all the corresponding patients, and that there were no reoccurrences of deformity. The mean Hospital for Special Surgery knee scores improved from 61.2 to 93.2 points (p < 0.001). After six months of continuous proximal sciatic nerve blockage, all gait parameters for the flexion contractures group exhibited significant improvement. CONCLUSION A continuous proximal sciatic nerve block could be a useful adjunct to a physical therapy regimen for patients with knee flexion contractures, especially for patients with difficult-to-treat cases of knee flexion contracture that are recalcitrant to conservative therapy.
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Affiliation(s)
- Meng Zhou
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China; Department of Orthopedics, Beijing Jishuitan Hospital, No.31 East Street, Beijing, China.
| | - Shuai An
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
| | - Mingli Feng
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
| | - Zheng Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
| | - Huiliang Shen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
| | - Kuan Zhang
- School of Biomedical Engineering, Capital Medical University, No.10 Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, China.
| | - Jun Sun
- Department of Radiology, Beijing Youan Hospital, Capital Medical University, No.8 Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, China.
| | - Guanglei Cao
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.
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Compensatory strategies for muscle weakness during stair ascent in subjects with total knee arthroplasty. J Arthroplasty 2014; 29:1499-502. [PMID: 24612738 DOI: 10.1016/j.arth.2014.01.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/13/2014] [Accepted: 01/27/2014] [Indexed: 02/01/2023] Open
Abstract
Subjects with total knee arthroplasty (TKA) exhibit decreased quadriceps and hamstring strength. This may bring about greater relative effort or compensatory strategies to reduce knee joint moments in daily activities. To study gait and map out the resource capacity, knee muscle strength was assessed by maximal voluntary concentric contractions, and whole body kinematics and root mean square (RMS) electromyography (EMG) of vastus lateralis and semitendinosus were recorded during stair ascent in 23 unilateral TKA-subjects ~19 months post-operation, and in 23 healthy controls. Muscle strength and gait velocity were lower in the TKA group, but no significant group differences were found in RMS EMG or forward trunk lean. The results suggest that reduced walking velocity sufficiently compensated for reduced knee muscle strength.
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