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Hirono T, Ikezoe T, Yamagata M, Kato T, Kimura M, Ichihashi N. Relationship between postural sway on an unstable platform and ankle plantar flexor force steadiness in community-dwelling older women. Gait Posture 2021; 84:227-231. [PMID: 33383532 DOI: 10.1016/j.gaitpost.2020.12.023] [Citation(s) in RCA: 7] [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: 09/24/2020] [Revised: 11/24/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Force steadiness is evaluated as force variability during constant force exertion around a target level. Ankle plantar flexor force steadiness is reported to be related to postural sway on an unstable platform in healthy young adults; however, this relationship in older adults is unclear. RESEARCH QUESTION This study aimed to investigate whether ankle plantar flexor force steadiness was related to postural sway on stable and unstable platforms in older adults. METHODS Twenty-six community-dwelling older women participated in this study (72 ± 6 years). Maximal isometric strength and force steadiness at 5%, 20 %, and 50 % of the maximal strength of ankle plantar flexion were assessed. Postural sway in the anteroposterior direction during bipedal standing was measured on stable and unstable platforms. RESULTS The results showed that force steadiness at any intensity level and maximal isometric strength were not related to postural sway on the stable platform. Force steadiness at 20 % of maximal strength alone was significantly correlated with postural sway on the unstable platform (ρ = 0.441, p < 0.05). SIGNIFICANCE These results indicate that the ability to control muscle force could be important for postural stability on an unstable platform in older adults.
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Affiliation(s)
- Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan; Research Fellow of the Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan.
| | - Tome Ikezoe
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan; Research Fellow of the Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan; Graduate School of Human Development and Environment, Kobe University, 3-11 Tsurukabuto, Nada-ku, Kobe, Hyogo, 657-0011, Japan
| | - Takehiro Kato
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Misaka Kimura
- Research Institute, Kyoto University of Advanced Science, 18 Gotanda-cho, Yamanouchi, Ukyo-ku, Kyoto, 615-8577, Japan; Faculty of Nursing, Doshisha Women's College of Liberal Arts, Koudo, 97-1, Minamihokotate, Kodo, Kyotanabe City, Kyoto, 610-0395, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Schroeder A, Wang N, Felson DT, Lewis CE, Nevitt MC, Segal NA. Knee Extensor and Flexor Torque Variability During Maximal Strength Testing and Change in Knee Pain and Physical Function at 60-Mo Follow-Up: The Multicenter Osteoarthritis Study (MOST). Am J Phys Med Rehabil 2021; 100:196-201. [PMID: 32932359 PMCID: PMC8024112 DOI: 10.1097/phm.0000000000001587] [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] [Indexed: 11/27/2022]
Abstract
ABSTRACT As the population ages, there is a growing burden owing to musculoskeletal diseases, such as knee osteoarthritis, and subsequent functional decline. In the absence of a cure, there is a need to identify factors amenable to intervention to prevent or slow this process. The Multicenter Osteoarthritis Study cohort was developed for this purpose. In this study, associations between variability in peak knee flexor and extensor torque at baseline and worsening of pain and physical function over the subsequent 60 mos were assessed in a cohort of 2680 participants. The highest quartile of baseline knee flexor torque variability was found to be associated longitudinally with worsening pain (fourth quartile ß estimate, mean ± SE, 0.49 ± 0.19; P = 0.0115; with R2 = 0.28 and P for trend across quartiles = 0.0370) and physical function scores (fourth quartile ß estimate, mean ± SE, 1.39 ± 0.64; P = 0.0296; with R2 = 0.25 and P for trend across quartiles = 0.0371), after adjusting for baseline knee osteoarthritis and maximum knee flexor torque. There were no associations between baseline knee extensor torque and worsening pain or physical function by 60 mos. The presence of greater variability in maximum knee flexor strength may identify patients who may benefit from therapies aimed at preventing worsening knee pain and physical function.
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Affiliation(s)
- Allison Schroeder
- From the Department of PM&R, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (AS); Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, Massachusetts (NW); Boston University, Boston, Massachusetts (DTF); University of Alabama at Birmingham, Birmingham, Alabama (CEL); University of California, San Francisco, San Francisco, California (MCN); University of Kansas Medical Center, Kansas City, Kansas (NAS); and The University of Iowa, Iowa City, Iowa (NAS)
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Kurihara Y, Ohsugi H, Choda K, Endo Y, Tosaka T, Matsuda T, Tsuneizumi Y, Tsukeoka T. Relationships between early postoperative gait biomechanical factors and patient-reported outcome measures 6 months after total knee arthroplasty. Knee 2021; 28:354-361. [PMID: 33494017 DOI: 10.1016/j.knee.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/30/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated. METHODS Twenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined. RESULTS The maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores. CONCLUSION The early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.
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Affiliation(s)
- Yasushi Kurihara
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture 283-8555, Japan.
| | - Hironori Ohsugi
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture 283-8555, Japan
| | - Kohei Choda
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Yuki Endo
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tomonari Tosaka
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 2-1-1 Hongou Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoshikazu Tsuneizumi
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture 266-0005, Japan
| | - Tadashi Tsukeoka
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture 266-0005, Japan
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Reynaud V, Verdilos A, Pereira B, Boisgard S, Costes F, Coudeyre E. Core Outcome Measurement Instruments for Clinical Trials of Total Knee Arthroplasty: A Systematic Review. J Clin Med 2020; 9:jcm9082439. [PMID: 32751523 PMCID: PMC7463550 DOI: 10.3390/jcm9082439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022] Open
Abstract
(1) Background: We have updated knowledge of the psychometric qualities of patient-reported outcome measures and, for the first time, systematically reviewed and compared the psychometric qualities of physical tests for patients with knee osteoarthritis who are undergoing total knee arthroplasty. This work was conducted to facilitate the choice of the most appropriate instruments to use in studies and clinical practice. (2) Methods: A search of medical databases up to December 2019 identified the studies and thus the instruments used. The quality of the measurement properties was assessed by the Bot et al. criteria. (3) Results: We identified 20 studies involving 25 instruments. Half of the instruments were questionnaires (n = 13). Among the condition-specific instruments, the Oxford knee score, Knee injury and Osteoarthritis Outcomes Score, and the Western Ontario and McMaster Universities Osteoarthritis index had the highest overall scores. Concerning generic tools, the Medical Outcomes Study Short-Form 36 (SF-36) or SF-12 obtained the highest overall score. For patient-specific tools, the Hospital Anxiety and Depression Scale ranked the highest. Some physical tests seemed robust in psychometric properties: 6-min Walk Test, five times Sit-To-Stand test, Timed Up and Go test strength testing of knee flexor/extensor by isometric or isokinetic dynamometer and Pressure Pain Threshold. (4) Conclusion: To make stronger recommendations, key areas such as reproducibility, responsiveness to clinical change, and minimal important change still need more rigorous evaluations. Some promising physical tests (e.g., actimetry) lack validation and require rigorous studies to be used as a core set of outcomes in future studies.
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Affiliation(s)
- Vivien Reynaud
- Plateforme d’Exploration de la Mobilité, INRAE, UNH, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
- Correspondence: ; Tel.: +33-47375-0900
| | - Anargyros Verdilos
- Plateforme d’Exploration de la Mobilité, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
| | - Bruno Pereira
- Unité de Biostatistique, CHU Clermont-Ferrand, Direction Recherche Clinique et Innovation, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
| | - Stéphane Boisgard
- Service d’Orthopédie Traumatologie, CNRS, SIGMA Clermont, CHU Clermont-Ferrand, Université Clermont Auvergne, ICCF, F-63000 Clermont–Ferrand, France;
| | - Frédéric Costes
- Plateforme d’Exploration de la Mobilité, INRAE, UNH, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, INRAE, UNH, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
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Wang XF, Ma ZH, Teng XR. Isokinetic Strength Test of Muscle Strength and Motor Function in Total Knee Arthroplasty. Orthop Surg 2020; 12:878-889. [PMID: 32436619 PMCID: PMC7307260 DOI: 10.1111/os.12699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/20/2020] [Accepted: 04/20/2020] [Indexed: 01/17/2023] Open
Abstract
Objective To use isokinetic strength testing system to test and analyze the relationship between changes in muscle strength before and after knee replacement in patients undergoing total knee arthroplasty (TKA). Methods A total of 200 patients with advanced knee osteoarthritis treated from June 2018 to June 2019 were selected for TKA. The patient's isokinetic muscle strength test was performed in the first, third, and the sixth month before and after the operation. The knee hamstring peak torque (PT value), quadriceps peak torque (PT value), and total work were mainly measured. The knee joint was evaluated at the hospital for special surgery score, range of motion and other knee function standards, and then healthy limbs and normal people were tested with the same method. Statistical data was used to analyze and deal with the data, evaluate the muscle strength and motor function changes with time progressing, then compare the differences to the healthy limb. From P < 0.05, we can see that the differences have some statistical significance. The influences that TKA has on motor function changes of lower limbs were also observed. Results Among the 200 subjects, 162 completed all follow‐up tests, and the remaining 38 were lost to follow‐up for various reasons. The rate of loss of follow‐up was approximately 19%. The isokinetic muscle strength test system and the knee joint function scoring standard were used to record the knee joint muscle strength and function changes before and after knee joint replacement. Statistical analysis was performed to show the knee joint hamstring muscle force and quadriceps muscle strength and joint mobility in the first month after the surgery. The knee joint muscle strength and joint mobility were significantly improved after the third month after the surgery, but there were still some differences compared with normal people. The knee function index was significantly improved in the sixth month after operation (P < 0.05), and there were no significant differences compared with normal people. Conclusions Knee joint strength and knee function after TKA are significantly improved compared with preoperative function, which is of great significance for the treatment of knee osteoarthritis. The constant velocity muscle strength test system has the advantages of safety, accuracy, repeatability and easy operation. It is a good method to evaluate the knee joint's muscle strength and function after the knee joint replacement.
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Affiliation(s)
| | - Zhen-Hua Ma
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Xue-Ren Teng
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China
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Shah JK, Szukics P, Gianakos AL, Liporace FA, Yoon RS. Equivalent union rates between intramedullary nail and locked plate fixation for distal femur periprosthetic fractures - a systematic review. Injury 2020; 51:1062-1068. [PMID: 32115204 DOI: 10.1016/j.injury.2020.02.043] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/14/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The incidence of periprosthetic fracture following total knee arthroplasty continues to rise as the number of knee arthroplasty procedures increases. Management of periprosthetic fractures can be complex, with locked compression plating (LCP) and intramedullary nailing (IMN) being the most commonly used treatment options. We performed a systematic review to report and compare the clinical and radiographic outcomes of patients treated with intramedullary nail fixation versus plate fixation for periprosthetic fractures of the distal femur. METHODS Several databases were screened. Studies evaluating intramedullary nail fixation or locked plate fixation for distal femur periprosthetic fractures were included. Primary and secondary variables as mentioned below, when included, were analyzed and compared. RESULTS One prospective comparative study, 9 retrospective comparative studies, and 28 retrospective case series with 1,188 patients were included in this review. No statistically significant differences were found between IMN and LCP when analyzing union rate or time to union. Plating demonstrated a statistically significant decrease in the overall complication rate and reoperation rate when compared with IMN (p<0.003). IMN demonstrated a slightly higher percentage of patients reaching full weight bearing status and a quicker time to full weight bearing (100% and 7.6 weeks) when compared to plating (94% and 15.8 weeks). A higher percentage of patients treated with IMN returned to preinjury activity when compared to those treated with plating (70.8% vs. 61.6%). CONCLUSIONS Both intramedullary nail and locked plate fixation offer unique benefits in terms of clinical and radiographic outcomes for treatment of periprosthetic distal femur fractures after total knee arthroplasty. While the standard of care remains controversial, an increase in the recent literature has allowed for better clarification of the significant clinicoradiologic advantages and disadvantages of both popular treatment options.
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Affiliation(s)
- Jay K Shah
- Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, Jersey City, NJ 07302, United States
| | - Patrick Szukics
- Division of Orthopedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, NJ 08084, United States
| | - Arianna L Gianakos
- Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, Jersey City, NJ 07302, United States
| | - Frank A Liporace
- Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, Jersey City, NJ 07302, United States
| | - Richard S Yoon
- Division of Orthopedic Surgery, Department of Orthopedic Surgery, Jersey City Medical Center - RWJ Barnabas Health, Jersey City, NJ 07302, United States.
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Total Knee Arthroplasty with a Ti6Al4V/PEEK Prosthesis on an Osteoarthritis Rat Model: Behavioral and Neurophysiological Analysis. Sci Rep 2020; 10:5277. [PMID: 32210280 PMCID: PMC7093407 DOI: 10.1038/s41598-020-62146-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/02/2020] [Indexed: 11/08/2022] Open
Abstract
Arthroplasty is a surgical procedure to restore the function of the joint of patient suffering from knee osteoarthritis. However, postoperative functional deficits are reported even after a rehabilitation program. In order to determine the origin of functional deficits of patient suffering from knee osteoarthritis and total knee arthroplasty, we developed a rodent model including a chemically-induced-osteoarthritis and designed a knee prosthesis (Ti6Al4V/PEEK) biomechanically and anatomically adapted to rat knee joint. Dynamic Weight-Bearing, gait kinematics, H-reflex from vastus medialis muscle and activities from metabosensitive III and IV afferent fibers in femoral nerve were assessed at 1 and 3 months post-surgery. Results indicate that knee osteoarthritis altered considerably the responses of afferent fibers to their known activators (i.e., lactic acid and potassium chloride) and consequently their ability to modulate the spinal sensorimotor loop, although, paradoxically, motor deficits seemed relatively light. On the contrary, results indicate that, after the total knee arthroplasty, the afferent responses and the sensorimotor function were slightly altered but that motor deficits were more severe. We conclude that neural changes attested by the recovery of the metabosensitive afferent activity and the sensorimotor loop were induced when a total knee replacement was performed and that these changes may disrupt or delay the locomotor recovery.
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Hirono T, Ikezoe T, Taniguchi M, Yamagata M, Miyakoshi K, Umehara J, Ichihashi N. Relationship between ankle plantar flexor force steadiness and postural stability on stable and unstable platforms. Eur J Appl Physiol 2020; 120:1075-1082. [DOI: 10.1007/s00421-020-04346-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/10/2020] [Indexed: 01/06/2023]
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Loyd BJ, Stackhouse S, Dayton M, Hogan C, Bade M, Stevens-Lapsley J. The relationship between lower extremity swelling, quadriceps strength, and functional performance following total knee arthroplasty. Knee 2019; 26:382-391. [PMID: 30772186 PMCID: PMC6486428 DOI: 10.1016/j.knee.2019.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 12/15/2018] [Accepted: 01/20/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The relationships between swelling after total knee arthroplasty (TKA) and quadriceps strength and functional performance are poorly understood. Therefore, the aim of this study was to examine the relationships between lower extremity swelling, measured using bioelectrical impedance assessment (SF-BIA), and quadriceps strength and timed up and go (TUG) times following TKA. METHODS 53 participants (64 ± 9.5 y/o, 43% male) undergoing primary unilateral TKA were recruited for the longitudinal observational study with repeated measures. Quantities of swelling were examined for contribution to two and six-week outcomes of strength and TUG time using hierarchical regression controlling for age, sex, and the baseline value of the dependent variable. Swelling was assessed using bioelectrical impedance assessment and quantified as the peak level of swelling and cumulative swelling (integral) over the post-TKA time window. Maximum isometric quadriceps strength (MVIC) was measured using a electromechanical dynamometer and participant functional performance measured using the TUG. RESULTS Neither peak swelling nor cumulative swelling significantly contributed to the variance of two-week quadriceps strength. At six weeks, peak swelling significantly improved the variance in maximal quadriceps strength by an additional four percent (p = 0.05), while cumulative swelling did not significantly contribute. Peak swelling significantly contributed to the variance in two-week (16%) and six-week (five percent) TUG times (p < 0.05), but the cumulative swelling did not. CONCLUSIONS Peak swelling represents a value of post-TKA swelling that is associated with strength and function. Reducing the peak level of swelling, occurring early after surgery, may improve patient functional recovery. LEVEL OF EVIDENCE Level II - Prospective observational study.
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Affiliation(s)
- Brian J Loyd
- The University of Colorado Denver AMC, Department of Physical Medicine and Rehabilitation, United States of America.
| | | | - Michael Dayton
- The University of Colorado Denver AMC, Department of Orthopedics, United States of America
| | - Craig Hogan
- The University of Colorado Denver AMC, Department of Orthopedics, United States of America
| | - Michael Bade
- The University of Colorado Denver AMC, Department of Physical Medicine and Rehabilitation, United States of America
| | - Jennifer Stevens-Lapsley
- The University of Colorado Denver AMC, Department of Physical Medicine and Rehabilitation, United States of America; Veterans Affairs Geriatric Research, Education and Clinical Center, Denver, CO, United States of America
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Fakler JKM, Pönick C, Edel M, Möbius R, Brand AG, Roth A, Josten C, Zajonz D. A new classification of TKA periprosthetic femur fractures considering the implant type. BMC Musculoskelet Disord 2017; 18:490. [PMID: 29178860 PMCID: PMC5702181 DOI: 10.1186/s12891-017-1855-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/16/2017] [Indexed: 12/16/2022] Open
Abstract
Background The treatment aims of periprosthetic fractures (PPF) of the distal femur are a gentle stabilization, an early load-bearing capacity and a rapid postoperative mobilization of the affected patients. For the therapy planning of PPF a standardized classification is necessary which leads to a clear and safe therapy recommendation. Despite different established classifications, there is none that includes the types of prosthesis used in the assessment. For this purpose, the objective of this work is to create a new more extensive fracture and implant-related classification of periprosthetic fractures of the distal femur based on available classifications which allows distinct therapeutic recommendations. Methods In a retrospective analysis all patients who were treated in the University Hospital Leipzig from 2010 to 2016 due to a distal femur fracture with total knee arthroplasty (TKA) were established. To create an implant-associated classification the cases were discussed in a panel of experienced orthopaedists and well-practiced traumatologists with a great knowledge in the field of endoprosthetics and fracture care. In this context, two experienced surgeons classified 55 consecutive fractures according to Su et al., Lewis and Rorabeck and by the new created classification. In this regard, the interobserver reliability was determined for two independent raters in terms of Cohen Kappa. Results On the basis of the most widely recognized classifications of Su et al. as well as Lewis and Rorabeck, we established an implant-dependent classification for PPF of the distal femur. In accordance with the two stated classifications four fracture types were created and defined. Moreover, the four most frequent prosthesis types were integrated. Finally, a new classification with 16 subtypes was generated based on four types of fracture and four types of prosthesis. Considering all cases the presented implant-associated classification (κ = 0.74) showed a considerably higher interobserver reliability compared to the other classifications of Su et al. (κ = 0.39) as well as Lewis and Rorabeck (κ = 0.31). Excluding the cases which were only assessable by the new classification, it still shows a higher interobserver reliability (κ = 0.70) than the other ones (κ = 0.63 or κ = 0.45). Conclusions The new classification system for PPF of the distal femur following TKA considers fracture location and implant type. It is easy to use, shows agood interobserver reliability and allows conclusions to be drawn on treatment recommendations. Moreover, further studies on the evaluation of the classification are necessary and planned.
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Affiliation(s)
- Johannes K M Fakler
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany.
| | - Cathleen Pönick
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany
| | - Melanie Edel
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany.,ZESBO - Center for Research on Musculoskeletal Systems, University of Leipzig, Semmelweisstrasse 14, D-04103, Leipzig, Germany
| | - Robert Möbius
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany.,ZESBO - Center for Research on Musculoskeletal Systems, University of Leipzig, Semmelweisstrasse 14, D-04103, Leipzig, Germany
| | - Alexander Giselher Brand
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany.,ZESBO - Center for Research on Musculoskeletal Systems, University of Leipzig, Semmelweisstrasse 14, D-04103, Leipzig, Germany
| | - Dirk Zajonz
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany.,ZESBO - Center for Research on Musculoskeletal Systems, University of Leipzig, Semmelweisstrasse 14, D-04103, Leipzig, Germany
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Ishii Y, Noguchi H, Sato J, Sakurai T, Toyabe SI. Quadriceps strength impairment in the mid- to long-term follow-up period after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:3372-3377. [PMID: 27650527 DOI: 10.1007/s00167-016-4333-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Quadriceps strength impairment after total knee arthroplasty (TKA) continues to be a concern. However, most studies of quadriceps strength have short-term follow-up periods. Whether quadriceps strength impairment occurs in the long-term follow-up period after TKA remains unclear. The purpose of this study was to compare the quadriceps strength between posterior cruciate ligament-retaining (CR) and substituting (PS) design mobile-bearing TKA (1) in the same patients after an average of 10 years and (2) between TKA patients and age-matched controls. METHODS A prospective, quasi-randomized design was used. Thirty-four patients (68 knees) who underwent bilateral TKA (CR on one side and PS on the other) were followed for a minimum of 5 years, and 35 age-matched controls (70 knees) were evaluated. A handheld dynamometer was used to measure quadriceps isometric strength. For each patient, the maximum value of three trials was used. The ratio of muscle strength to body weight (MS/BW ratio; N/kg) was used to evaluate outcomes. RESULTS The median MS/BW ratio was 3.3 (range 1.4-10.5) for CR 3.4 (range 0.9-9.3) for PS, and 4.6 (range 0.4-8.8) for controls. The MS/BW ratio did not differ between prosthesis designs, but was significantly smaller in both CR (p = 0.020) and PS (p = 0.024) than in controls. CONCLUSIONS Posterior cruciate ligament-retaining TKA does not confer a substantial advantage an average of 10 years postoperatively. In addition, quadriceps strength, as measured using a hand-held dynamometer, was significantly lower in both TKA patient groups than in age-matched controls. Clinically, the results of this study indicate that quadriceps-strengthening exercises should be continued in the long term after TKA. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan.
| | - Hideo Noguchi
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Tetsuya Sakurai
- Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Shin-Ichi Toyabe
- Division of Information Science and Biostatistics, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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12
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Neuromuscular function of the quadriceps muscle during isometric maximal, submaximal and submaximal fatiguing voluntary contractions in knee osteoarthrosis patients. PLoS One 2017; 12:e0176976. [PMID: 28505208 PMCID: PMC5432168 DOI: 10.1371/journal.pone.0176976] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/20/2017] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Knee osteoarthrosis (KOA) is commonly associated with a dysfunction of the quadriceps muscle which contributes to alterations in motor performance. The underlying neuromuscular mechanisms of muscle dysfunction are not fully understood. The main objective of this study was to analyze how KOA affects neuromuscular function of the quadriceps muscle during different contraction intensities. MATERIALS AND METHODS The following parameters were assessed in 20 patients and 20 healthy controls: (i) joint position sense, i.e. position control (mean absolute error, MAE) at 30° and 50° of knee flexion, (ii) simple reaction time task performance, (iii) isometric maximal voluntary torque (IMVT) and root mean square of the EMG signal (RMS-EMG), (iv) torque control, i.e. accuracy (MAE), absolute fluctuation (standard deviation, SD), relative fluctuation (coefficient of variation, CV) and periodicity (mean frequency, MNF) of the torque signal at 20%, 40% and 60% IMVT, (v) EMG-torque relationship at 20%, 40% and 60% IMVT and (vi) performance fatigability, i.e. time to task failure (TTF) at 40% IMVT. RESULTS Compared to the control group, the KOA group displayed: (i) significantly higher MAE of the angle signal at 30° (99.3%; P = 0.027) and 50° (147.9%; P < 0.001), (ii) no significant differences in reaction time, (iii) significantly lower IMVT (-41.6%; P = 0.001) and tendentially lower RMS-EMG of the rectus femoris (-33.7%; P = 0.054), (iv) tendentially higher MAE of the torque signal at 20% IMVT (65.9%; P = 0.068), significantly lower SD of the torque signal at all three torque levels and greater MNF at 60% IMVT (44.8%; P = 0.018), (v) significantly increased RMS-EMG of the vastus lateralis at 20% (70.8%; P = 0.003) and 40% IMVT (33.3%; P = 0.034), significantly lower RMS-EMG of the biceps femoris at 20% (-63.6%; P = 0.044) and 40% IMVT (-41.3%; P = 0.028) and tendentially lower at 60% IMVT (-24.3%; P = 0.075) and (vi) significantly shorter TTF (-51.1%; P = 0.049). CONCLUSION KOA is not only associated with a deterioration of IMVT and neuromuscular activation, but also with an impaired position and torque control at submaximal torque levels, an altered EMG-torque relationship and a higher performance fatigability of the quadriceps muscle. It is recommended that the rehabilitation includes strengthening and fatiguing exercises at maximal and submaximal force levels.
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13
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Ward SH, Pearce A, Bennell KL, Pietrosimone B, Bryant AL. Quadriceps cortical adaptations in individuals with an anterior cruciate ligament injury. Knee 2016; 23:582-7. [PMID: 27162116 DOI: 10.1016/j.knee.2016.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/30/2016] [Accepted: 04/03/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Altered quadriceps corticomotor excitability has been demonstrated following anterior cruciate ligament (ACL) injury and reconstruction, however only the single joint vasti muscles have been assessed. There is no current data on rectus femoris corticomotor excitability following ACL injury, the biarticular quadriceps muscle also critical for force attenuation and locomotion. The purpose of this study was to examine rectus femoris corticomotor excitability, intracortical inhibition and cortical motor representation in individuals with and without an ACL injury. METHODS A cross-sectional design was used to evaluate corticomotor excitability bilaterally in individuals with a physician confirmed ACL injury (12 males, six females; mean±SD age: 29.6±8.4years; BMI: 24.8±2.3kg·m(2); 69.5±42.5days post-injury) compared to a healthy control group (12 males, six females; age: 29.2±6.8years; BMI: 24.6±2.3kg·m(2)). Single-pulse transcranial magnetic stimulation (TMS) was used to assess corticomotor excitability and cortical motor representation, and paired-pulse TMS used to assess intracortical inhibition for rectus femoris while participants maintained a knee extension force at 10% of body weight. RESULTS The cortical silent period (cSP) duration was longer in the injured limb of the ACL group compared to the uninjured limb (P=0.004). No significant differences were found for corticomotor excitability, intracortical inhibition or cortical motor representation center position and size (P>0.05). CONCLUSIONS There is preliminary evidence that the cSP is longer, but changes in rectus femoris corticomotor excitability and cortical motor representation are not present following ACL injury.
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Affiliation(s)
- Sarah H Ward
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, VIC, Australia.
| | - Alan Pearce
- Melbourne School of Health Science, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, VIC, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, VIC, Australia
| | | | - Adam L Bryant
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, VIC, Australia
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Chung-Hoon K, Tracy BL, Dibble LE, Marcus RL, Burgess P, LaStayo PC. The Association Between Knee Extensor Force Steadiness, Force Accuracy, and Mobility in Older Adults Who Have Fallen. J Geriatr Phys Ther 2016; 39:1-7. [PMID: 25695470 PMCID: PMC4540703 DOI: 10.1519/jpt.0000000000000044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Older adults often experience limited mobility, lower extremity muscle weakness, and increased fall risk. Furthermore, when older adults perform tasks that require control of submaximal force, impairments in their ability to maintain steady and accurate force output have been reported. Such problems may be related to deteriorating levels of mobility, particularly in older adults who have fallen. PURPOSE The purpose of this study was to determine whether an association exists between muscle force steadiness (MFS) or muscle force accuracy (MFA) of the knee extensors and mobility in older adults who have fallen. METHODS Twenty older adults ((Equation is included in full-text article.)= 77.5 ± 7 years, 5 males and 15 females) with 2 or more comorbid conditions and who experienced a fall in the past year underwent assessment of maximal voluntary isometric contraction of the knee extensors. A submaximal target force of 50% of their maximal voluntary isometric contraction was used to determine concentric and eccentric (ECC) steadiness (the fluctuations in force production) and accuracy (the average distance of the mean force from the target force) measures. Mobility was indicated by the 6-minute walk test, the Timed Up and Go, stair ascent, and stair descent tests. Correlation analysis was used to assess the relationship between measures of muscle force control and mobility. RESULTS The correlations between muscle force steadiness and mobility were not significant (P > .05) for either contraction type. However, MFA during ECC contractions only was correlated significantly with all measures of mobility-6 minute walk test (r = -0.48; P = .03), Timed Up and Go (r = 0.68; P = .01), stair ascent (r = 0.60; P = .01), and stair descent (r = 0.75; P < .01). CONCLUSION The identification of the relationship between ECC MFA and mobility in older adults who have fallen is novel. Although the correlations are not causal, these relationships suggest that inaccurate force output during ECC contractions of the knee extensors is linked to impaired mobility.
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Affiliation(s)
- Kaiwi Chung-Hoon
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
| | - Brian L. Tracy
- Colorado State University, Department of Health and Exercise Science, 220 Moby-B Complex, Fort Collins, CO 80523
| | - Leland E. Dibble
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
| | - Robin L. Marcus
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
| | - Paul Burgess
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
| | - Paul C. LaStayo
- University of Utah, Department of Physical Therapy, 520 Wakara Way, SLC, UT 84108
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15
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Goetschius J, Hart JM. Knee-Extension Torque Variability and Subjective Knee Function in Patients with a History of Anterior Cruciate Ligament Reconstruction. J Athl Train 2015; 51:22-7. [PMID: 26720104 DOI: 10.4085/1062-6050-51.1.12] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT When returning to physical activity, patients with a history of anterior cruciate ligament reconstruction (ACL-R) often experience limitations in knee-joint function that may be due to chronic impairments in quadriceps motor control. Assessment of knee-extension torque variability may demonstrate underlying impairments in quadriceps motor control in patients with a history of ACL-R. OBJECTIVE To identify differences in maximal isometric knee-extension torque variability between knees that have undergone ACL-R and healthy knees and to determine the relationship between knee-extension torque variability and self-reported knee function in patients with a history of ACL-R. DESIGN Descriptive laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 53 individuals with primary, unilateral ACL-R (age = 23.4 ± 4.9 years, height = 1.7 ± 0.1 m, mass = 74.6 ± 14.8 kg) and 50 individuals with no history of substantial lower extremity injury or surgery who served as controls (age = 23.3 ± 4.4 years, height = 1.7 ± 0.1 m, mass = 67.4 ± 13.2 kg). MAIN OUTCOME MEASURE(S) Torque variability, strength, and central activation ratio (CAR) were calculated from 3-second maximal knee-extension contraction trials (90° of flexion) with a superimposed electrical stimulus. All participants completed the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and we determined the number of months after surgery. Group differences were assessed using independent-samples t tests. Correlation coefficients were calculated among torque variability, strength, CAR, months after surgery, and IKDC scores. Torque variability, strength, CAR, and months after surgery were regressed on IKDC scores using stepwise, multiple linear regression. RESULTS Torque variability was greater and strength, CAR, and IKDC scores were lower in the ACL-R group than in the control group (P < .05). Torque variability and strength were correlated with IKDC scores (P < .05). Torque variability, strength, and CAR were correlated with each other (P < .05). Torque variability alone accounted for 14.3% of the variance in IKDC scores. The combination of torque variability and number of months after surgery accounted for 21% of the variance in IKDC scores. Strength and CAR were excluded from the regression model. CONCLUSIONS Knee-extension torque variability was moderately associated with IKDC scores in patients with a history of ACL-R. Torque variability combined with months after surgery predicted 21% of the variance in IKDC scores in these patients.
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Affiliation(s)
| | - Joseph M Hart
- Departments of * Kinesiology and.,Orthopaedics, University of Virginia, Charlottesville
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16
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Rice DA, McNair PJ, Lewis GN, Mannion J. Experimental knee pain impairs submaximal force steadiness in isometric, eccentric, and concentric muscle actions. Arthritis Res Ther 2015; 17:259. [PMID: 26377678 PMCID: PMC4574021 DOI: 10.1186/s13075-015-0768-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/26/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Populations with knee joint damage, including arthritis, have noted impairments in the regulation of submaximal muscle force. It is difficult to determine the exact cause of such impairments given the joint pathology and associated neuromuscular adaptations. Experimental pain models that have been used to isolate the effects of pain on muscle force regulation have shown impaired force steadiness during acute pain. However, few studies have examined force regulation during dynamic contractions, and these findings have been inconsistent. The goal of the current study was to examine the effect of experimental knee joint pain on submaximal quadriceps force regulation during isometric and dynamic contractions. METHODS The study involved fifteen healthy participants. Participants were seated in an isokinetic dynamometer. Knee extensor force matching tasks were completed in isometric, eccentric, and concentric muscle contraction conditions. The target force was set to 10 % of maximum for each contraction type. Hypertonic saline was then injected into the infrapatella fat pad to generate acute joint pain. The force matching tasks were repeated during pain and once more 5 min after pain had subsided. RESULTS Hypertonic saline resulted in knee pain with an average peak pain rating of 5.5 ± 2.1 (0-10 scale) that lasted for 18 ± 4 mins. Force steadiness significantly reduced during pain across all three muscle contraction conditions. There was a trend to increased force matching error during pain but this was not significant. CONCLUSION Experimental knee pain leads to impaired quadriceps force steadiness during isometric, eccentric, and concentric contractions, providing further evidence that joint pain directly affects motor performance. Given the established relationship between submaximal muscle force steadiness and function, such an effect may be detrimental to the performance of tasks in daily life. In order to restore motor performance in people with painful arthritic conditions of the knee, it may be important to first manage their pain more effectively.
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Affiliation(s)
- David A Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand. .,Waitemata Pain Service, Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, New Zealand.
| | - Peter J McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Gwyn N Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Jamie Mannion
- Unitec Institute of Technology, Private Bag 92025, Victoria St West, Auckland, New Zealand.
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Smith JW, Christensen JC, Marcus RL, LaStayo PC. Muscle force and movement variability before and after total knee arthroplasty: A review. World J Orthop 2014; 5:69-79. [PMID: 24829868 PMCID: PMC4017309 DOI: 10.5312/wjo.v5.i2.69] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 02/26/2014] [Accepted: 03/11/2014] [Indexed: 02/06/2023] Open
Abstract
Variability in muscle force output and movement variability are important aspects of identifying individuals with mobility deficits, central nervous system impairments, and future risk of falling. This has been investigated in elderly healthy and impaired adults, as well as in adults with osteoarthritis (OA), but the question of whether the same correlations also apply to those who have undergone a surgical intervention such as total knee arthroplasty (TKA) is still being investigated. While there is a growing body of literature identifying potential rehabilitation targets for individuals who have undergone TKA, it is important to first understand the underlying post-operative impairments to more efficiently target functional deficits that may lead to improved long-term outcomes. The purpose of this article is to review the potential role of muscle force output and movement variability in TKA recipients. The narrative review relies on existing literature in elderly healthy and impaired individuals, as well as in those with OA before and following TKA. The variables that may predict long-term functional abilities and deficits are discussed in the context of existing literature in healthy older adults and older adults with OA and following TKA, as well as the role future research in this field may play in providing evidence-based data for improved rehabilitation targets.
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