Preoperative hand-grip strength can be a predictor of stair ascent and descent ability after total knee arthroplasty in female patients

Identifying characteristics and clinical conditions associated with hand grip strength in adults: the Project Baseline Health Study

Low hand grip strength (HGS) is associated with several conditions, but its value outside of the older adult population is unclear. We sought to identify the most salient factors associated with HGS from an extensive list of candidate variables while stratifying by age and sex. We used data from the initial visit from the Project Baseline Health Study (N = 2502) which captured detailed demographic, occupational, social, lifestyle, and clinical data. We applied MI-LASSO using group methods to determine variables most associated with HGS out of 175 candidate variables. We performed analyses separately for sex and age (< 65 vs. ≥ 65 years). Race was associated with HGS to varying degrees across groups. Osteoporosis and osteopenia were negatively associated with HGS in female study participants. Immune cell counts were negatively associated with HGS for male participants ≥ 65 (neutrophils) and female participants (≥ 65, monocytes; < 65, lymphocytes). Most findings were age and/or sex group-specific; few were common across all groups. Several of the variables associated with HGS in each group were novel, while others corroborate previous research. Our results support HGS as a useful indicator of a variety of clinical characteristics; however, its utility varies by age and sex.

Exercise- and education-based prehabilitation before total knee arthroplasty: a pilot study

OBJECTIVE

To determine the feasibility and estimates of effects of a supervised exercise- and education-based prehabilitation programme aiming to improve knee functioning compared with usual care in patients awaiting total knee arthroplasty.

DESIGN

A randomized controlled pilot study.

SUBJECTS

Patients receiving primary, unilateral total knee arthroplasty.

METHODS

Patients randomized to the intervention group participated in a personalized 4-8-week prehabilitation programme before surgery. Feasibility of the intervention and self-reported knee functioning, pain, physical performance and hospital stay were assessed at baseline, immediately preoperatively, 6 and 12 weeks after surgery.

RESULTS

Twenty patients (mean age 72.7±5.95 years) were enrolled in this study. The personalized prehabilitation programme was found to be feasible and safe, with an exercise adherence of 90%. Significant medium interaction effects between groups and over time favouring prehabilitation were reported for the sport subscale of the Knee Osteoarthritis Outcome Score (F(3/54) = 2.895, p = 0.043, η² = 0.139) and Tegner Activity Scale (F(2.2/39.1) = 3.20, p = 0.048, η² = 0.151).

CONCLUSION

The absence of adverse events and high adherence to the programme, coupled with beneficial changes shown in the intervention group, support the conduct of a full-scale trial investigating the effectiveness of prehabilitation.

Does Hand Grip Strength (HGS) Predict Functional Independence Differently in Patients Post Hip Replacement Due to Osteoarthritis versus Patients Status Post Hip Replacement Due to a Fracture?

Purpose

The aim of the study was to determine whether hand grip strength (HGS) predicts functional independence in older patients who have undergone hip replacement due to osteoarthritis versus older patients who have undergone hip replacement surgery due to fracture.

Patients and Methods

The study included 239 patients aged 65 and over in the first weeks after total hip replacement during rehabilitation treatment. Multivariate linear regression was used to determine HGS as a predictor of activities of daily living (ADL) and instrumental activities of daily living (IADL) in both groups: patients post hip replacement due to osteoarthritis and patients post hip replacement due to a fracture.

Results

Analysis showed that pre-rehab HGS in the osteoarthritis group predicts improved activities of daily living after rehabilitation (ADL, OR = 1.098; CI 95% 1.052-1.147 and IADL, OR = 1.182; CI 95% 1.103-1.267) and 6 months after (ADL, OR = 1.191; CI 95% 1.066-1.329 and IADL, OR = 1.096; CI 95% 1.012-1.186). In the fracture group, HGS predicts the ADL (OR = 1.081; CI 95% 1.015-1.152) after rehabilitation, and IADL after rehabilitation (OR = 1.122; CI 95% 1.046-1.205) and 6 months after (OR = 1.090; 95% CI 1.021-1.64).

Conclusion

HGS in patients after hip replacement surgery predicts functional independence in basic and complex activities of daily living. This can allow the identification of osteoarthritis patients with low hand grip - who can be considered as patients with a higher risk of an unsatisfying outcome of surgery. These patients should undergo pre-rehabilitation and should be monitored, and/or supported in terms of rehabilitation after discharge.

Development and validation of a portable articulated dynamometry system to assess knee extensor muscle strength

Muscle strength assessment is important in predicting clinical and functional outcomes in many disorders. Manual muscle testing, although commonly used, offers suboptimal accuracy and reliability. Isokinetic dynamometers (IKDs) have excellent accuracy and reliability; but are bulky and expensive, offering limited accessibility. This study aimed to design a portable dynamometer that is accessible, accurate and reliable, and to validate the device in a general population. The portable articulated dynamometry system (PADS) is a portable device with an embedded high-precision load cell, designed to measure muscle strength with optimal accuracy. Seventy-two participants underwent maximal isometric and isokinetic knee extensor torque measurement with the PADS and IKD, respectively. The PADS results were cross-validated against IKD results using change in mean (CIM). Interrater and intra-rater reliabilities were assessed using intraclass correlation coefficients, standard error of measurement, and minimal detectable change. The PADS maximal knee extensor strength results were not significantly different from those by IKD (CIM: - 2.13 Nm; 95% CI - 4.74, 0.49 Nm). The PADS showed interrater reliability (Pearson's r: 0.958; ICC: 0.979; SEM: 5.51%) and excellent intra-rater reliability (Pearson's r: 0.912; ICC: 0.954; SEM: 8.38%). The proposed PADS may be an effective alternative to IKD, offering good accuracy, reliability, and potentially better accessibility.

More Predictable and Less Automatized Movements during Walking -not during Repetitive Punching- in Knee Osteoarthritis

Using the non-affected leg as stable frame of reference for the affected leg in gait assessment in knee osteoarthritis (KO) fails due to compensatory mechanisms. Assessing the cyclical movements of the upper extremities in a frequency-controlled repetitive punching task may provide an alternative frame of reference in gait assessment in patients with KO. Eleven participants with unilateral KO and eleven healthy controls were asked to perform treadmill walking and repetitive punching. The KO group showed more predictable (p = 0.020) and less automatized (p = 0.007) movement behavior than controls during treadmill walking. During repetitive punching, the KO group showed a similar degree of predictability (p = 0.784) but relative more automatized movement behavior (p = 0.013). Thus, the predictability of the movement behavior of the upper extremities during repetitive punching seems unaffected by KO and could provide an alternative frame of reference in gait assessment in patients with KO.

The course of knee extensor strength after total knee arthroplasty: a systematic review with meta-analysis and -regression

PURPOSE

Muscular strength loss and atrophy are postoperative complications. This systematic review with meta-analysis investigated the course of on knee extensor mass and strength from pre-surgery over total knee arthroplasty to rehabilitation and recovery.

METHODS

A systematic literature search was conducted in PubMed (Medline), Cochrane Library (CINAHL, Embase) and Web of Science (until 29th of June 2022). Main inclusion criteria were  ≥ 1 preoperative and  ≥ 1 measurement  ≥ 3-months post-operation and ≥ 1 objective assessment of quadriceps strength, muscle mass or neuromuscular activity, measured at both legs. Studies were excluded if they met the following criteria: further impairment of treated extremity or of the contralateral extremity; further muscle affecting disease, or muscle- or rehabilitation-specific intervention. The Robins-I tool for non-randomized studies, and the Cochrane Rob 2 tool for randomized controlled studies were used for risk of bias rating. Pre-surgery, 3 months, 6 months and 1 year after surgery data were pooled using random effects meta-analyses (standardized mean differences, SMD, Hedge's g) in contrast to the pre-injury values.

RESULTS

1417 studies were screened, 21 studies on 647 participants were included. Thereof, 13 were non-randomized controlled trails (moderate overall risk of bias in most studies) and 7 were randomized controlled trials (high risk of bias in at least one domain in most studies). Three (k = 12 studies; SMD = - 0.21 [95% confidence interval = - 0.36 to - 0.05], I² = 4.75%) and six (k = 9; SMD = - 0.10 [- 0.28 to - 0.08]; I² = 0%) months after total knee arthroplasty, a deterioration in the strength of the operated leg compared with the strength of the non-operated leg was observed. One year after surgery, the operated leg was stronger in all studies compared to the preoperative values. However, this increase in strength was not significant compared to the non-operated leg (k = 6, SMD = 0.18 [- 0.18 to 0.54], I² = 77.56%).

CONCLUSION

We found moderate certainty evidence that deficits in muscle strength of the knee extensors persist and progress until 3 months post-total knee arthroplasty in patients with end-stage knee osteoarthritis. Very low certainty evidence exists that preoperatively existing imbalance of muscle strength and mass in favor of the leg not undergoing surgery is not recovered within 1 year after surgery.

Body composition and grip strength constraints in elite male rink-hockey players of contrasting ethnicity

Rink hockey is a highly specialized and physiological demanding sport with sparse research regarding the game and athletes’ characteristics. A cross-sectional study was developed to characterize the body composition and grip strength of elite male rink hockey players and to establish the relationship between ethnicity on body composition and grip strength. A sample of 100 elite rink-hockey athletes aged 26.59 ± 6.02 participated in the study, comprised of 69 Caucasian male adults aged 27.58 ± 6.44 years and 31 Black African male adults aged 24.39 ± 4.27. Body composition was assessed by anthropometric measurements. Static grip strength was assessed with an adjustable dynamometer. Multiple regression analysis was applied to understand which variables constraints body fat percentage (BF) and grip strength. Body mass showed an average of 76.36 ± 9.18 kg for 175.80 ± 5.87 cm of height and BF% of 10.82 ± 5.07%. Maximal right grip strength was 50.91 ± 6.26 kg and 50.27 ± 6.23 kg for left grip strength. Four predictors accounted for 70.01% of the variance of BF%: abdominal circumference (p < 0.001), right thigh circumference (p < 0.001), right calf circumference (p = 0.001) and ethnicity (p = 0.016). Three predictors accounted for 13.1% of the variance of right grip strength: ethnicity (p = 0.013), chronological age (p = 0.024) and right distal thigh circumference (p = 0.014). Results suggest that elite rink hockey athletes have a specific anthropometric identity, which at the elite level may lead to reduced body fat and greater handgrip strength. Ethnicity seems to predict body fat and grip strength in elite rink hockey athletes.

A Longitudinal Study on the Association of Interrelated Factors Among Frailty Dimensions, Cognitive Domains, Cognitive Frailty, and All-Cause Mortality

BACKGROUND

Cognitive frailty integrating impaired cognitive domains and frailty dimensions has not been explored.

OBJECTIVE

This study aimed to explore 1) associations among frailty dimensions and cognitive domains over time and 2) the extended definitions of cognitive frailty for predicting all-cause mortality.

METHODS

This four-year cohort study recruited 521 older adults at baseline (2011-2013). We utilized 1) generalized linear mixed models exploring associations of frailty dimensions (physical dimension: modified from Fried et al.; psychosocial dimension: integrating self-rated health, mood, and social relationship and support; global frailty: combining physical and psychosocial frailty) with cognition (global and domain-specific) over time and 2) time-dependent Cox proportional hazard models assessing associations between extended definitions of cognitive frailty (cognitive domains-frailty dimensions) and all-cause mortality.

RESULTS

At baseline, the prevalence was 3.0%for physical frailty and 37.6%for psychosocial frailty. Greater physical frailty was associated with poor global cognition (adjusted odds ratio = 1.43-3.29, β: -1.07), logical memory (β: -0.14 to -0.10), and executive function (β: -0.51 to -0.12). Greater psychosocial frailty was associated with poor global cognition (β: -0.44) and attention (β: -0.15 to -0.13). Three newly proposed definitions of cognitive frailty, "mild cognitive impairment (MCI)-psychosocial frailty," "MCI-global frailty," and "impaired verbal fluency-global frailty," outperformed traditional cognitive frailty for predicting all-cause mortality (adjusted hazard ratio = 3.49, 6.83, 3.29 versus 4.87; AIC = 224.3, 221.8, 226.1 versus 228.1).

CONCLUSION

Notably, extended definitions of cognitive frailty proposed by this study better predict all-cause mortality in older adults than the traditional definition of cognitive frailty, highlighting the importance of psychosocial frailty to reduce mortality in older adults.

Factors Affecting the Length of Convalescent Hospital Stay Following Total Hip and Knee Arthroplasty

Objectives

: An important role of convalescent rehabilitation wards is the short-term improvement of mobility and activities of daily living (ADL). We aimed to identify predictors associated with the length of stay (LOS) in a convalescent hospital after total hip and knee arthroplasty.

Methods

: This study included 308 patients hospitalized in a convalescent ward following total hip or total knee arthroplasty. The following factors were examined: age, sex, orthopedic comorbidities, motor component of the functional independence measure (M-FIM), M-FIM gain, pain, 10-m walk test, timed up and go (TUG) test, functional ambulation category (FAC), cognitive function, and nutritional status. LOS was categorized as shorter (≤40 days) or longer (>40 days), based on the national average LOS in a convalescent ward, and was statistically analyzed with predictor variables.

Results

: In our hospital, the average LOS was 36.9 ± 21.4 days, and the average M-FIM at admission to the convalescent ward and the M-FIM gain were 71.1 ± 7.0 and 16.3 ± 6.9, respectively. In univariate analysis, there was a significant correlation between LOS and M-FIM at admission and M-FIM gain, pain, TUG time, and FAC. Logistic multivariate analysis identified M-FIM at admission (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88–0.98) and TUG time (OR 1.10, 95% CI 1.03–1.18) as independent predictors of LOS.

Conclusions

: The M-FIM and TUG test can be used to accurately estimate LOS and to plan rehabilitation treatment in a convalescent rehabilitation ward after lower-limb arthroplasty. Furthermore, preoperative or early postoperative intervention may lead to better quality motor activity and shorter LOS during the convalescent period.

Low Grip Strength Associated with Clinical Outcomes after Total Hip Arthroplasty - A Prospective Case-Control Study

OBJECTIVE

To assess whether low grip strength (GS) is associated with clinical outcomes after total hip arthroplasty (THA).

METHODS

A prospective case-control study was designed to assess 231 cases of primary THA between January 1, 2015 to May 1, 2018, at an urban tertiary care hospital. Patients were placed into two cohorts based on preoperative GS levels. Low GS in the present study was defined as GS lower than 26 kg for men and 16 kg for women in the dominant hand. Baseline data were prospectively collected and included patient demographics (age, sex, body mass index [BMI]), the surgeon's diagnoses, medical history, length of stay, and American Society of Anaesthesiologists' (ASA) score. Clinical outcomes included surgery- and prosthesis-related variables. The Harris hip score (HHS) and the Short Form Health Survey (SF-12) were completed at the baseline visit and at 1 and 2 years postoperatively in the outpatient department to assess the hip's function and quality of life. Differences in baseline data, length of study (LOS), 90-day postoperative complications, and hospital readmissions were compared. Besides, the correlations between GS and Harris hip score (HHS) and Short Form score (SF-12) were tested.

RESULTS

A total of 202 participants have completed records for analysis finally. The patients were followed up for an average of 24.8 months postoperatively (24-26 months). Eighty-two patients (40.6%) had low GS before THA. Patients with low GS were more likely to be female, older, fracture of femoral head or neck as the primary cause, albumin <3.5 g/dL, and have a lower BMI, higher ASA score, increased rates of the pressure sore, blood transfusion, and LOS compared to normal GS (all P < 0.05). Also, patients in the low GS cohort showed a statistically significant increased unplanned hospital readmissions and decreased discharge home compared to normal GS (both P < 0.05). There was an increasing rate of complications between the two cohorts, for cardiac complications, pressure sore after THA, respiratory complications, urinary tract infection, stroke, and DVT (all P < 0.05). A partial correlation test by controlling medical comorbidities and demographic factors was used to determine the correlation between GS and HHS. There was a significant correlation between them (r = -0.673; P = 0.002). A similar condition was detected in the correlation between GS and SF-12 (r = 0.645; P = 0.001).

CONCLUSIONS

Clinicians should be encouraged to include GS assessment in their evaluation of patients who planned to undergo THA in order to optimize the treatment of high-risk individuals.

Association of Sarcopenic Dysphagia with Underlying Sarcopenia Following Hip Fracture Surgery in Older Women

This study aimed to investigate the association between the development of dysphagia in patients with underlying sarcopenia and the prevalence of sarcopenic dysphagia in older patients following surgical treatment for hip fracture. Older female patients with hip fractures (n = 89) were studied. The data of skeletal muscle mass, hand-grip strength, and nutritional status were examined. The development of dysphagia postoperatively was graded using the Food Oral Intake Scale by a certified nurse in dysphagia nursing. The patients’ mean age was 85.9 ± 6.5 years. The prevalence of sarcopenia was 76.4% at baseline. Of the 89 patients, 11 (12.3%) and 12 (13.5%) had dysphagia by day 7 of hospitalization and at discharge, respectively. All patients who developed dysphagia had underlying sarcopenia. Lower skeletal muscle mass index (SMI) (<4.7 kg/m²) and grip strength (<8 kg) at baseline indicated a higher incidence of dysphagia on day 7 (p = 0.003 and Phi = 0.391) and at discharge (p = 0.001 and Phi = 0.448). Dysphagia developed after hip fracture surgery could be sarcopenic dysphagia, and worsening sarcopenia was a risk factor for dysphagia following hip fracture surgery. Clinicians and medical coworkers should become more aware of the risks of sarcopenic dysphagia. Early detection and preventive interventions for dysphagia should be emphasized.

Association of handgrip strength with patient-reported outcome measures after total hip and knee arthroplasty

About 33% patients with osteoarthritis undergoing total hip/knee arthroplasty are not satisfied with the outcome, warranting the need to improve patient selection. Handgrip strength (HGS) has been suggested as a proxy for overall muscle strength and may be associated with post-arthroplasty function. This study aims to assess the association of pre-operative HGS with change in hip/knee function and quality of life in patients with arthroplasty. 226 hip (THA) and 246 knee (TKA) arthroplasty patients were included in this prospective cohort study. Pre-operative HGS was assessed by means of a dynamometer and the HOOS/KOOS and SF-36 questionnaires were collected before arthroplasty and 1 year thereafter. The association of HGS with score change on each sub-domain of the included questionnaires was assessed by linear regression models, adjusting for sex, body mass index and baseline score. Mean pre-operative HGS was 26 kg for patients undergoing THA and 24 kg for those undergoing TKA. HGS was positively associated with an increased improvement score on “function in sport and recreation”-domain in hip (β = 0.68, P = 0.005) and knee (β = 0.52, P = 0.049) and “symptoms”-domain in hip (β = 0.56, P = 0.001). For patients with THA, HGS was associated with the “quality of life” domain (β = 0.33, P = 0.033). In patients with TKA, HGS was associated with the physical component score (β = 0.31, P = 0.001). All statistically significant effects were positive, indicating that with greater pre-operative HGS, an increased gain in 1-year post-surgery score was observed. HGS can be used as a tool to inform patients with OA who are future candidates for a prosthesis about the possible improvements of certain aspects of life after arthroplasty.

Establishing a patient centered, outpatient total joint home recovery program within an integrated healthcare system

Outpatient total joint home recovery (HR) is a rapidly growing initiative being developed and employed at high volume orthopedic centers. Minimally invasive surgery, improved pain control and home health services have made HR possible. Multidisciplinary teams with members ranging from surgeons and anesthesiologists to hospital administrators, physical therapists, nurses and research analysts are necessary for success. Eligibility criteria for outpatient total joint arthroplasty will vary between medical centers. Surgeon preference in addition to medical comorbidities, social support, preoperative patient mobility and safety of the HR location are all factors to consider when selecting patients for outpatient total joint HR. As additional knowledge is gained, the next steps will be to establish 'best practices' and speciality society-endorsed guidelines for patients undergoing outpatient total joint arthroplasty.

Grip Strength: An Indispensable Biomarker For Older Adults

Grip strength has been proposed as a biomarker. Supporting this proposition, evidence is provided herein that shows grip strength is largely consistent as an explanator of concurrent overall strength, upper limb function, bone mineral density, fractures, falls, malnutrition, cognitive impairment, depression, sleep problems, diabetes, multimorbidity, and quality of life. Evidence is also provided for a predictive link between grip strength and all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. Consequently, the routine use of grip strength can be recommended as a stand-alone measurement or as a component of a small battery of measurements for identifying older adults at risk of poor health status.