1
|
Prüfer F, Pavlović M, Matko Š, Löfler S, Fischer MJ, Šarabon N, Grote V. Responsiveness of Isokinetic Dynamometry in Patients with Osteoarthritis after Knee and Hip Arthroplasty: A Prospective Repeated-Measures Cohort Study. Healthcare (Basel) 2024; 12:314. [PMID: 38338199 PMCID: PMC10855832 DOI: 10.3390/healthcare12030314] [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: 12/18/2023] [Revised: 01/18/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Functional assessments are crucial for the evaluation of rehabilitation after total knee (TKA) and hip (THA) arthroplasty. Muscle strength, a key determinant of physical function (PF), is often measured with isokinetic dynamometry (ID), which is considered the gold standard. However, studies lack evaluations of responsiveness-the ability to detect changes over time. This study aims to determine the responsiveness of ID in measuring PF in TKA and THA rehabilitation-is muscle strength a valid indicator for assessing improvement in rehabilitation processes? The pre- and post-surgery PF of 20 osteoarthritis patients (age 55-82) was assessed, using ID, performance-based and self-reported measures. Responsiveness was evaluated by comparing the observed relationship of changes in ID and PF scores with the a priori defined expected relationship of change scores. While the performance-based and self-reported measures showed significant improvements post-surgery (Cohen's d [0.42, 1.05] p < 0.05), ID showed no significant differences. Moderate correlations were found between changes in some ID parameters and selected functional tests (r ≈|0.5|, p < 0.05). Responsiveness was solely found for the peak torque of knee extension at 180°/s on the operated side. Responsiveness is an often-overlooked psychometric property of outcome measurements. The findings suggest that ID may not be fully responsive to the construct of PF after TKA and THA, raising questions about its role and usefulness in this context and the need for more appropriate assessment methods.
Collapse
Affiliation(s)
- Ferdinand Prüfer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Monika Pavlović
- Faculty of Health Sciences, University of Ljubljana, SI-1000 Ljubljana, Slovenia;
| | - Špela Matko
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Stefan Löfler
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| | - Michael J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Vamed Rehabilitation Center Kitzbühel, A-6370 Kitzbühel, Austria
| | - Nejc Šarabon
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
- Faculty of Health Sciences, University of Primorska, SI-6310 Izola, Slovenia
- Innorenew CoE, SI-6310 Izola, Slovenia
| | - Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, A-1100 Vienna, Austria (M.J.F.); (V.G.)
| |
Collapse
|
2
|
Kondo Y, Yoshida Y, Iioka T, Kataoka H, Sakamoto J, Honda Y, Nawata A, Okita M. Effects of Isometric Quadriceps Muscle Exercise with Visual and Auditory Feedback at 1 Year after Total Knee Arthroplasty. Phys Ther Res 2024; 27:6-13. [PMID: 38690528 PMCID: PMC11057392 DOI: 10.1298/ptr.e10260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/17/2023] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To examine the effect of isometric quadriceps exercises with visual and auditory feedback after total knee arthroplasty (TKA). METHODS The sample included 41 patients from our previous study who could be followed up for 1 year after TKA. Patients in the intervention group performed isometric quadriceps exercises with visual and auditory feedback using the quadriceps training machine from the 2nd to the 14th day after TKA, whereas those in the control group underwent standard postoperative rehabilitation (without visual or auditory feedback during isometric quadriceps exercises) in the hospital. Patients were evaluated for pain intensity, timed up and go test (TUG) score, 10-m gait speed, 6-minute walking distance (6MWD), and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score 1 year after TKA. Additionally, exercise habits and responses to the International Physical Activity Questionnaire (IPAQ) were investigated. RESULTS Pain intensity was significantly lower in the intervention group than in the control group. Greater improvements in the TUG test scores, 10-m gait speed, 6MWD, and WOMAC scores were observed in the intervention group. Walking activity, as recorded by the IPAQ, and the proportion of patients with exercise habits were significantly higher in the intervention group than in the control group. CONCLUSIONS These results suggest that performing isometric quadriceps exercise with visual and auditory feedback using the quadriceps training machine has good effects, such as pain reduction, physical function improvement, exercise tolerance, and increased physical activity at 1 year after TKA.
Collapse
Affiliation(s)
- Yasutaka Kondo
- Department of Rehabilitation, Japanese Red Cross Nagasaki Genbaku Hospital, Japan
| | - Yoshihiro Yoshida
- Department of Rehabilitation, Japanese Red Cross Nagasaki Genbaku Hospital, Japan
| | - Takashi Iioka
- Department of Orthopedic Surgery, Japanese Red Cross Nagasaki Genbaku Hospital, Japan
| | - Hideki Kataoka
- Department of Rehabilitation, Nagasaki Memorial Hospital, Japan
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Japan
| | - Yuichiro Honda
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Japan
| | | | - Minoru Okita
- Department of Physical Therapy Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Japan
| |
Collapse
|
3
|
Ueyama H, Kanemoto N, Minoda Y, Taniguchi Y, Nakamura H. Perioperative Essential Amino Acid Supplementation Facilitates Quadriceps Muscle Strength and Volume Recovery After TKA: A Double-Blinded Randomized Controlled Trial. J Bone Joint Surg Am 2023; 105:345-353. [PMID: 36856692 DOI: 10.2106/jbjs.22.00675] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Perioperative essential amino acid (EAA) supplementation suppresses lower-limb muscle atrophy and promotes functional improvement in the first 4 weeks after total knee arthroplasty (TKA). However, its effect on the recovery of muscle volume and strength in the intermediate term is unclear. The aim of this study was to evaluate the effect of perioperative EAA supplementation on the recovery of lower-limb muscle volume and strength in the 2 years after TKA. METHODS Sixty patients who underwent unilateral TKA for primary knee osteoarthritis were included in this double-blinded randomized controlled trial. After excluding dropouts, 26 patients assigned to the EAA group (9 g/day) and 26 assigned to the placebo group (powdered lactose, 9 g/day) were available for analysis. Patients received EAA supplementation or a placebo from 1 week prior to surgery to 2 weeks after it. The rectus femoris muscle area was measured using ultrasonography and quadriceps muscle strength was measured isometrically with a handheld dynamometer, preoperatively and periodically up to 2 years postoperatively. Knee pain, knee range of motion, functional mobility, and Knee Society Score 2011 subjective scores were measured at each time point. Perioperative management, except for supplementation, was identical in the 2 groups. RESULTS Taking the baseline as 100%, the mean values in the EAA and placebo groups were 134% ± 31% and 114% ± 27%, respectively, for the rectus femoris muscle area and 159% ± 54% and 125% ± 40% for the quadriceps muscle strength, respectively, at 2 years after surgery. The differences were significant (p < 0.05). Clinical outcomes were not significantly different between the 2 groups. CONCLUSIONS Perioperative EAA supplementation contributes to the recovery of rectus femoris muscle volume and quadriceps muscle strength in the 2 years after TKA. The EAA supplementation did not impact clinical outcomes. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Hideki Ueyama
- Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakai, Osaka, Japan.,Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe City, Wakayama, Japan.,Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Japan
| | - Narihiro Kanemoto
- Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe City, Wakayama, Japan
| | - Yukihide Minoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Japan
| | - Yoshiki Taniguchi
- Department of Orthopedic Surgery, Tanabe Central Hospital, Tanabe City, Wakayama, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Japan
| |
Collapse
|
4
|
Effectiveness of a 3-Week Rehabilitation Program Combining Muscle Strengthening and Endurance Exercises Prior to Total Knee Arthroplasty: A Non-Randomized Controlled Trial. J Clin Med 2023; 12:jcm12041523. [PMID: 36836057 PMCID: PMC9967873 DOI: 10.3390/jcm12041523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/11/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
We evaluated the effectiveness of a high-intensity preoperative resistance and endurance training program in improving physical function among patients scheduled for total knee arthroplasty. This non-randomized controlled trial included 33 knee osteoarthritis patients scheduled to undergo total knee arthroplasty at a tertiary public medical university hospital. Fourteen and nineteen patients were non-randomly assigned to intervention and control groups, respectively. All patients underwent total knee arthroplasty and a postoperative rehabilitation program. The intervention group participated in a preoperative rehabilitation program comprising high-intensity resistance and endurance training exercises to increase lower limb muscle strength and endurance capacity. The control group received only exercise instruction. The primary outcome was the 6-min walking distance, which was significantly higher in the intervention group (399 ± 59.8 m) than in the control group (348 ± 75.1 m) 3 months post-surgery. There were no significant differences between the groups 3 months post-surgery in muscle strength, visual analog scale, WOMAC-Pain, range of motion of knee flexion, and extension. A 3-week preoperative rehabilitation program combining muscle strengthening and endurance training improved endurance 3 months after total knee arthroplasty. Thus, preoperative rehabilitation is important for improving postoperative activity.
Collapse
|
5
|
Kondo Y, Yoshida Y, Iioka T, Kataoka H, Sakamoto J, Hirase T, Honda Y, Nawata A, Okita M. Short-Term Effects of Isometric Quadriceps Muscle Exercise with Auditory and Visual Feedback on Pain, Physical Function, and Performance after Total Knee Arthroplasty: A Randomized Controlled Trial. J Knee Surg 2022; 35:922-931. [PMID: 33241542 DOI: 10.1055/s-0040-1721035] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Severe acute pain after total knee arthroplasty (TKA) may cause delay in muscle strength and functional recovery, and it is a risk factor for chronic postoperative pain. Although pharmacological approaches are the typical firstline to treat acute pain; recently, nonpharmacological approaches such as exercise have been increasingly applied. The purpose of this investigation was to evaluate the effects of a rehabilitation program involving isometric quadriceps exercise with auditory and visual feedback to improve the short-term outcome after TKA. Sixty-two patients, planning a primary unilateral TKA, were randomly assigned to either an intervention group (n = 31) involving isometric quadriceps exercise with auditory and visual feedback in usual rehabilitation after TKA or a control group (n = 31) involving a standardized program for TKA. Patients in the intervention group performed the isometric quadriceps muscle exercise using the Quadriceps Training Machine from 2 to 14 days after TKA instead of the traditional quadriceps sets. Pain intensity, isometric knee extension strength, range of motion, timed up and go test (TUG), 10-m gait speed, 6-minute walking distance, the Western Ontario and McMaster University Osteoarthritis index (WOMAC), the hospital anxiety and depression scale, and the pain catastrophizing scale were assessed before TKA (baseline) and 1 to 3 weeks after TKA. Pain intensity significantly decreased in the intervention group than in the control group at 1 (p = 0.005), 2 (p = 0.002), and 3 (p = 0.010) weeks after TKA. Greater improvements in TUG (p = 0.036), 10-m gait speed (p = 0.047), WOMAC total score (p = 0.017), pain (p = 0.010), and function (p = 0.028) 3 weeks after TKA were observed in the intervention group. These results suggest that isometric quadriceps exercises with auditory and visual feedback provided early knee pain relief, possibly leading to better improvements in physical performance, and patient's perception of physical function in the early stages of postoperative TKA. Further studies should investigate whether this short-term effect is sustainable.
Collapse
Affiliation(s)
- Yasutaka Kondo
- Department of Rehabilitation, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan.,Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiro Yoshida
- Department of Rehabilitation, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Takashi Iioka
- Department of Orthopedic Surgery, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Hideki Kataoka
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rehabilitation, Nagasaki Memorial Hospital, Nagasaki, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
| | - Tatsuya Hirase
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
| | - Yuichiro Honda
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
| | - Atsushi Nawata
- Medical Engineering Laboratory, ALCARE Co, Ltd, Tokyo, Japan
| | - Minoru Okita
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
| |
Collapse
|
6
|
Kurowicki J, Khlopas A, Sultan AA, Sodhi N, Samuel LT, Chughtai M, Roche M, Bonutti PM, Mont MA. Improvement in hamstring and quadriceps muscle strength following cruciate-retaining single radius total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2018; 5:S27. [PMID: 29299474 DOI: 10.21037/atm.2017.11.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The ability to reach full functional capacity following total knee arthroplasty (TKA) is reliant on the strength of the quadriceps and hamstring muscles. Weakness of these muscles can persist anywhere from 1 to 3 years post-operatively. There remains considerable controversy as to what factors influence restoration of muscle strength after TKA. Implant designs have been implicated in the ability of patients to recover. Currently there is a paucity of literature available describing the influence of patient characteristics, surgical factors, and clinical outcomes on quadriceps and hamstring muscle strength following TKA with a cruciate-retaining, single radius (SR) implant. For this reason, we sought to investigate TKA patients for: (I) quadriceps muscle strength; (II) hamstring muscle strength; (III) flexion/extension (F/E) ratio; (IV) clinical outcome scores; (V) influence of patient characteristics on muscle strength at one-year post-operatively. Methods A review of TKA patients who were assessed for hamstring and quadriceps muscle strength was conducted. A total of 39 patients (26 men and 13 women), who had a mean age of 68 years (range, 51 to 88 years) were included. Isokinetic dynamometer testing at 180 degree/second for 3 sets of 10 repetitions in extension and flexion were performed by an independent physical therapist to assess dynamic concentric torque of the hamstrings and quadriceps muscle. F/E ratios were calculated. TKA was performed via subvastus (n=20) or midvastus (n=19) approach. Subgroup analysis for surgical approach, concomitant spinal pathology (n=11), gender, age and body mass index (BMI) were performed. Knee Society Scores (KSS) and range of motion (ROM) were assessed at each visit. Comparisons of groups were performed using paired t-tests. Results Mean postoperative relative extension torque was 23 Nm/kg (range, 9 to 43 Nm/kg), representing a mean increase of 38% (range, -16% to 100%; P=0.0267) from pre-operative status. A mean increase of 27% (range, -15% to 100%; P=0.0433) in flexion strength and mean relative flexion torque of 19 Nm/kg (range, 8-37 Nm/kg) was observed. Pre-operative mean F/E ratio was 0.8 and 0.9 post-operatively (P=0.3028). Men demonstrated significantly greater improvements in flexion compared to women (22% vs. 12%; P<0.0001), but gender had no influence on improvement in extension (27% vs. 15%; P=0.0537). Postoperative F/E was similar for males (0.8) and females (0.9; P=0.4454). Surgical approach did not influence quadriceps muscle strength (P=0.1786) or hamstrings muscle strength (P=0.9592). History of spine pathology had no impact on muscles strength (hamstring, P=0.5684; quadriceps, P=0.7221). For the overall group, a mean KSS pain score was 96 points (range, 84 to 100 points), KSS function was 96 points (range, 80 to 100 points), and mean ROM of 0 to 114 degrees. Conclusions Restoration of quadriceps and hamstring muscle strength can be expected at 1 year post-operatively regardless of gender, surgical approach or concomitant spinal pathology. Further comparative investigation on the impact of implant design on hamstring and quadriceps muscle strength is warranted. However, the use of a SR, CR TKA system demonstrated significant improvements post-operatively in quadriceps and hamstring strength.
Collapse
Affiliation(s)
- Jennifer Kurowicki
- Department of Orthopaedics, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Martin Roche
- Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida, USA
| | - Peter M Bonutti
- Department of Orthopaedic Surgery, Bonutti Clinic, Effingham, Illinois, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Jang SW, Koh IJ, Kim MS, Kim JY, In Y. Semimembranosus Release for Medial Soft Tissue Balancing Does Not Weaken Knee Flexion Strength in Patients Undergoing Varus Total Knee Arthroplasty. J Arthroplasty 2016; 31:2481-2486. [PMID: 27235326 DOI: 10.1016/j.arth.2016.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/16/2016] [Accepted: 04/21/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The sequential medial release technique including semimembranosus (semiM) release is effective and safe during varus total knee arthroplasty (TKA). However, there are concerns about weakening of knee flexion strength after semiM release. We determined whether semiM release to balance the medial soft tissue decreased knee flexion strength after TKA. METHODS Fifty-nine consecutive varus knees undergoing TKA were prospectively enrolled. A 3-step sequential release protocol which consisted of release of (1) the deep medial collateral ligament (dMCL), (2) the semiM, and (3) the superficial medial collateral ligament based on medial tightness. Gap balancing was obtained after dMCL release in 31 knees. However, 28 knees required semiM release or more after dMCL release. Isometric muscle strength of the knee was compared 6 months postoperatively between the semiM release and semiM nonrelease groups. Knee stability and clinical outcomes were also compared. RESULTS No differences in knee flexor or extensor peak torque were observed between the groups 6 months postoperatively (P = .322 and P = .383, respectively). No group difference was observed in medial joint opening angle on valgus stress radiographs (P = .327). No differences in the Knee Society or Western Ontario and McMaster Universities Osteoarthritis Index scores were detected between the groups (P = .840 and P = .682, respectively). CONCLUSION These results demonstrate that semiM release as a sequential step to balance medial soft tissue in varus knees did not affect knee flexion strength after TKA.
Collapse
Affiliation(s)
- Sung Won Jang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Yeong Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
8
|
Graff C, Hohmann E, Bryant AL, Tetsworth K. Subjective and objective outcome measures after total knee replacement: is there a correlation? ANZ J Surg 2016; 86:921-925. [PMID: 27561210 DOI: 10.1111/ans.13708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 04/27/2016] [Accepted: 07/03/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although various methods for quantifying outcomes following total knee replacement (TKR) are used, there are few studies of the relationships between patient reported scores and functional tests. This paper aims to assess the relationships between commonly used outcome scores after TKR through a prospective cohort study. METHODS Twenty-four patients who had undergone unilateral TKR were assessed using four patient-reported outcome scores as well as objective measurements of knee laxity, quadriceps muscle strength and the Timed Up and Go Test. All scores and measures were correlated using the Pearson product moment correlation coefficient using the lower one-sided 95% confidence interval. A level of significance of P < 0.05 was selected. RESULTS The Timed Up and Go Test was the only objective measure to demonstrate a statistically significant correlation (r = -0.557 to -0.770, P = 0.0001-0.005) with patient-reported scores. CONCLUSION A comprehensive assessment of outcomes after TKR requires both subjective and objective assessments. Walking ability and speed are important to the TKR patient and are representative of their pain and function.
Collapse
Affiliation(s)
- Christy Graff
- Musculoskeletal Research Unit, Central Queensland University, Rockhampton, Queensland, Australia.
| | - Erik Hohmann
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adam L Bryant
- Musculoskeletal Research Unit, Central Queensland University, Rockhampton, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kevin Tetsworth
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Moon YW, Kim HJ, Ahn HS, Lee DH. Serial Changes of Quadriceps and Hamstring Muscle Strength Following Total Knee Arthroplasty: A Meta-Analysis. PLoS One 2016; 11:e0148193. [PMID: 26849808 PMCID: PMC4744064 DOI: 10.1371/journal.pone.0148193] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/14/2016] [Indexed: 01/16/2023] Open
Abstract
This meta-analysis was performed to analyze serial changes in thigh muscles, including quadriceps and hamstring muscles, from before to one year after total knee arthroplasty (TKA). All studies sequentially comparing isokinetic quadriceps and hamstring muscle strengths between the TKA side and the contralateral uninjured limb were included in this meta-analysis. Five studies with 7 cohorts were included in this meta-analysis. The mean differences in the strengths of quadriceps and hamstring muscles between the TKA and uninjured sides were greatest three months after surgery (26.8 N∙m, 12.8 N∙m, P<0.001), but were similar to preoperative level at six months (18.4 N∙m, 7.4 N∙m P<0.001) and were maintained for up to one year (15.9 N∙m, 4.1 N∙m P<0.001). The pooled mean differences in changes in quadriceps and hamstring strengths relative to preoperative levels were 9.2 N∙m and 4.9 N∙m, respectively, three months postoperatively (P = 0.041), but were no longer significant after six months and one year. During the year after TKA, quadriceps and hamstring muscle strengths were lowest after 3 months, recovering to preoperative level after six months, but not reaching the muscle strength on the contralateral side. Relative to preoperative levels, the difference in muscle strength between the TKA and contralateral knees was only significant at three months. Because decrease of strength of the quadriceps was significantly greater than decrease in hamstring muscle strength at postoperative three months, early rehabilitation after TKA should focus on recovery of quadriceps muscle strength.
Collapse
Affiliation(s)
- Young-Wan Moon
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Jung Kim
- Department of Preventive medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyeong-Sik Ahn
- Department of Preventive medicine, Korea University College of Medicine, Seoul, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
10
|
Feczko P, Engelmann L, Arts JJ, Campbell D. Computer-assisted total knee arthroplasty using mini midvastus or medial parapatellar approach technique: A prospective, randomized, international multicentre trial. BMC Musculoskelet Disord 2016; 17:19. [PMID: 26762175 PMCID: PMC4711101 DOI: 10.1186/s12891-016-0872-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 01/05/2016] [Indexed: 12/18/2022] Open
Abstract
Background Despite the growing evidence in the literature there is still a lack of consensus regarding the use of minimally invasive surgical technique (MIS) in total knee arthroplasty (TKA). Methods A prospective, randomized, international multicentre trial including 69 patients was performed to compare computer-assisted TKA (CAS-TKA) using either mini-midvastus (MIS group) or standard medial parapatellar approach (conventional group). Patients from 3 centers (Maastricht, Zwickau, Adelaide) with end-stage osteoarthritis of the knee were randomized to either an MIS group with dedicated instrumentation or a conventional group to receive cruciate retaining CAS-TKA without patella resurfacing. The primary outcome was to compare post operative pain and range of motion (ROM). The secondary outcome was to measure the duration of surgery, blood loss, chair rise test, quadriceps strength, anterior knee pain, Knee Society Score (KSS),WOMAC scores, mechanical leg axis and component alignment. Results Patients in the MIS group (3.97 ± 2.16) had significant more pain at 2 weeks than patients in the conventional group (2.77 ± 1.43) p = 0.003. There was no significant difference in any of the other primary outcome parameters. Surgery time was significantly longer (p < 0.001) and there were significantly higher blood loss (p = 0.002) in the MIS group as compared to the conventional group. The difference of the mean mechanical leg alignment between the groups was not statistically significant (–0.43° (95 % CI –1.50 – 0.64); p = 0.43). There was no significant difference of component alignment between the two surgical groups with respect to flexion/extension (p = 0.269), varus/valgus (p = 0.653) or rotational alignment (p = 0.485) of the femur component and varus valgus alignment (p = 0.778) or posterior slope (p = 0.164) of the tibial component. Conclusion There was no advantage of the MIS approach compared to a conventional approach CAS-TKA in any of the primary outcome measurements assessed, however the MIS approach was associated with longer surgical time and greater blood loss. MIS-TKA in combination with computer navigation is safe in terms of implant positioning. Trial registration number ClinicalTrials.gov NCT02625311 8 December 2015
Collapse
Affiliation(s)
- Peter Feczko
- Department Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
| | - Lutz Engelmann
- Heinrich-Braun-Krankenhaus Zwickau, Städtisches Klinikum, Zwickau, Germany
| | - Jacobus J Arts
- Department Orthopaedic Surgery, Research School Capri, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | | |
Collapse
|
11
|
Callaghan JJ, Pugely A, Liu S, Noiseux N, Willenborg M, Peck D. Measuring rapid recovery program outcomes: are all patients candidates for rapid recovery. J Arthroplasty 2015; 30:531-2. [PMID: 25702594 DOI: 10.1016/j.arth.2015.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/14/2015] [Indexed: 02/01/2023] Open
Abstract
Total joint arthroplasty procedures have been demonstrated to be effective in the treatment of end stage hip and knee arthritis. The purpose of this paper is to outline various processes utilized to assess the outcomes of rapid recovery programs and to outline areas where future research and metrics will be beneficial in demonstrating the effectiveness of these programs. We have highlighted the use of large databases [NIS (National Inpatient Sample) and NSQIP (National Surgical Quality Improvement Program)] to help identify patients who are candidates for the rapid recovery approach. Continued thorough investigation should not only justify rapid recovery, but also move traditional joint arthroplasty programs to more efficient cost effective care once appropriate metrics are identified that support the need for resources for rapid recovery programs.
Collapse
Affiliation(s)
| | - Andrew Pugely
- University of Southern California, Los Angeles, California
| | - Steve Liu
- University of Southern California, Los Angeles, California
| | | | | | - Denise Peck
- University of Southern California, Los Angeles, California
| |
Collapse
|
12
|
Valtonen AM, Pöyhönen T, Manninen M, Heinonen A, Sipilä S. Knee extensor and flexor muscle power explains stair ascension time in patients with unilateral late-stage knee osteoarthritis: a cross-sectional study. Arch Phys Med Rehabil 2014; 96:253-9. [PMID: 25283351 DOI: 10.1016/j.apmr.2014.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/21/2014] [Accepted: 09/05/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the extent of asymmetrical deficits in knee extensor and flexor muscles, and to examine whether asymmetrical muscle deficits are associated with mobility limitations in persons with late-stage knee osteoarthritis (OA). DESIGN Cross-sectional. SETTING Research laboratory. PARTICIPANTS A clinical sample (N=56; age range, 50-75y) of eligible persons with late-stage knee OA awaiting knee replacement. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Knee extensor and flexor power and torque assessed isokinetically; thigh muscle cross-sectional area (CSA) assessed by computed tomography; mobility limitation assessed by walking speed and stair ascension time; and pain assessed with the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. RESULTS The asymmetrical deficits in knee extensor and flexor power and torque were between 18% and 29% (P<.001). Regarding the thigh muscle CSA, the asymmetrical deficit was 4% (P<.001). Larger asymmetrical knee extensor power deficits and weaker knee extensor and flexor power on the contralateral side were associated with slower stair ascension times. Moreover, weaker knee extensor and flexor power on the ipsilateral side were associated with slower stair ascension times. Greater knee pain in the OA joint was independently associated with slower stair ascending time in both models. CONCLUSIONS The knee extensor and flexor muscle power of both the ipsilateral and contralateral sides and the pain in the OA knee were independently associated with stair ascension times. These results highlight the importance of assessing muscle power on both sides and knee pain in the prevention of mobility limitations in patients with knee OA.
Collapse
Affiliation(s)
- Anu M Valtonen
- Department of Human Movement and Functioning, Helsinki Metropolia University of Applied Sciences, Helsinki, Finland; Rehabilitation and Pain Unit, Kymenlaakso Central Hospital, Carea, Kotka, Finland.
| | - Tapani Pöyhönen
- Rehabilitation and Pain Unit, Kymenlaakso Central Hospital, Carea, Kotka, Finland
| | - Mikko Manninen
- Orthopaedic Department, Orton Hospital, Helsinki, Finland
| | - Ari Heinonen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
13
|
Better quadriceps recovery after minimally invasive total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22:1759-64. [PMID: 23760038 DOI: 10.1007/s00167-013-2556-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The proponents of minimally invasive total knee arthroplasty (TKA) have reported better functional recovery than conventional TKA. In most of the previous studies, the results were shown with the relatively subjective methods. We investigated the objective results with a dynamometry in this prospective randomized study. It was hypothesized that minimally invasive TKA would have a better and earlier recovery of quadriceps force in terms of the objective numeric data. METHODS Sixty-six TKAs were prospectively randomized into two groups. Thirty-three knees underwent minimally invasive TKA using mini-midvastus approach and 33 knees underwent conventional TKA using medial parapatellar approach. The quadriceps force was assessed using a dynamometer. The data were collected preoperatively and at postoperative 6 weeks, 3 months, 6 months and 1 year consecutively. RESULTS The mean of quadriceps force in minimally invasive TKA group at postoperative 6 weeks was greater than conventional TKA after removing the covariate (preoperative quadriceps force) with analysis of covariance (P = 0.002), but thereafter, the difference was not significant till 1 year. Meanwhile, with repeated measures analysis of variance, conventional TKA group had greater quadriceps recovery than minimally invasive TKA group during postoperative 6 weeks to 3 months (P = 0.035). The proportion of patients unable to recover the quadriceps force to their preoperative levels by 1 year postoperatively was similar in two groups. CONCLUSION Minimally invasive TKA has benefit in quadriceps recovery at earlier rehabilitation period although catch-up recovery in conventional TKA was accelerated from the postoperative 6 weeks to 3 months. It may support the concept of early return to full activity after minimally invasive TKA, and patients might get back early to normal life.
Collapse
|
14
|
Lin TC, Wang HK, Chen JW, Chiu CM, Chou HL, Chang CH. Minimally invasive knee arthroplasty with the subvastus approach allows rapid rehabilitation: a prospective, biomechanical and observational study. J Phys Ther Sci 2013; 25:557-62. [PMID: 24259801 PMCID: PMC3804974 DOI: 10.1589/jpts.25.557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 12/25/2012] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To study the recovery of patients treated with minimally invasive total knee
arthroplasty (TKA) performed via the subvastus approach, and to develop an optimal
rehabilitation program for these patients. [Methods] Twenty-two patients (17 females and 5
males; mean age 69.2 years), who received unilateral minimally invasive TKA for
osteoarthritis, underwent isometric and isokinetic muscle testing and completed a quality
of life questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index
(WOMAC), before and after surgery. Muscle strength and ultrasound tests were repeated 1,
2, 6, and 12 months after surgery. [Results] Strength and range of motion were initially
lower in the operated knees but demonstrated no significant difference from the healthy
knees after 12 months. Sonographically, joint effusion was greater in the osteoarthritic
knees than in the healthy knees at baseline, but no significant difference was observed
after 12 months. The mean WOMAC pain, stiffness and function scores all decreased from
baseline to 6 months, and then slightly increased at 12 months, but only the function
score showed a significant difference compared to baseline. [Conclusions] One year after
minimally invasive TKA using a subvastus approach, patients had a good overall prognosis,
with prompt functional recovery.
Collapse
Affiliation(s)
- Tsung-Ching Lin
- Department of Physical Medicine and Rehabilitation, Far Eastern Memorial Hospital
| | | | | | | | | | | |
Collapse
|
15
|
Umrani SP, Cho KY, Kim KI. Patellar eversion does not adversely affect quadriceps recovery following total knee arthroplasty. J Arthroplasty 2013; 28:591-4. [PMID: 23153598 DOI: 10.1016/j.arth.2012.06.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/04/2012] [Accepted: 06/20/2012] [Indexed: 02/08/2023] Open
Abstract
Although avoiding patellar eversion during a total knee arthroplasty (TKA) has theoretical benefit in quadriceps recovery, there has been paucity of supportive objective clinical results. We prospectively designed the study whether TKA without patellar eversion has better quadriceps recovery in an objective, dynamometer study. Seventy-two knees undergoing TKA with midvastus approach were randomized into two groups according to patellar eversion or not. Clinical data and objective quadriceps recovery using a dynamometer were investigated preoperatively and postoperative at 6weeks, 3months, 6months and 1year. There were no statistical differences between two groups throughout the follow-up periods in recovery of quadriceps force or power and clinical data. Choosing to evert patella during TKA using midvastus approach would not adversely affect postoperative quadriceps recovery.
Collapse
Affiliation(s)
- Salil P Umrani
- Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Seoul, Korea
| | | | | |
Collapse
|
16
|
Wegrzyn J, Parratte S, Coleman-Wood K, Kaufman KR, Pagnano MW. The John Insall award: no benefit of minimally invasive TKA on gait and strength outcomes: a randomized controlled trial. Clin Orthop Relat Res 2013; 471:46-55. [PMID: 22806264 PMCID: PMC3528913 DOI: 10.1007/s11999-012-2486-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While some clinical reports suggest minimally invasive surgical (MIS) techniques improve recovery and reduce pain in the first months after TKA, it is unclear whether it improves gait and thigh muscle strength. QUESTIONS/PURPOSES We hypothesized TKA performed through a mini-subvastus approach would improve subjective and objective and subjective function compared to a standard medial parapatellar approach 2 months after surgery. METHODS We randomized 40 patients into two groups using either the mini-subvastus approach or standard medial parapatellar approach. Patients were evaluated preoperatively and 2 months after surgery. We assessed subjective functional outcome and quality of life (QOL) using routine questionnaires (SF-12, Knee Society Score [KSS], Knee Injury and Osteoarthritis Outcome Score [KOOS], UCLA activity, patient milestone diary of activities). We determined isometric strength of the thigh muscles and assessed gait with a three-dimensional (3-D) analysis during level walking and stair climbing. RESULTS We observed improvements from preoperatively to 2 months postoperatively in functional scores, QOL, and knee kinematic and kinetic gait parameters during level and stair walking. Isometric quadriceps strength increased in both groups, although remaining lower when compared to sound limbs. We found no differences between the groups in KSS, SF-12, KOOS, UCLA activity, patient milestone diary of activities, isometric quadriceps strength, or 3-D gait parameters, except a marginally higher speed of stair ascent in the MIS group. CONCLUSIONS Our observations suggest an MIS approach does not confer a substantial advantage in early function after TKA. LEVEL OF EVIDENCE Level I, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA ,Biomechanics and Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Sebastien Parratte
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA ,Biomechanics and Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Krista Coleman-Wood
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA ,Biomechanics and Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Kenton R. Kaufman
- Biomechanics and Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Mark W. Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
| |
Collapse
|
17
|
Chiang H, Lee CC, Lin WP, Jiang CC. Comparison of quadriceps-sparing minimally invasive and medial parapatellar total knee arthroplasty: a 2-year follow-up study. J Formos Med Assoc 2012; 111:698-704. [PMID: 23265749 DOI: 10.1016/j.jfma.2011.11.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 08/08/2011] [Accepted: 11/18/2011] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/PURPOSE Quadriceps-sparing minimally invasive total knee arthroplasty (TKA) has been proposed to limit surgical dissection without compromising surgical outcome. We conducted a prospective and randomized study to compare the outcomes of patients who underwent quadriceps-sparing TKA with the outcomes of those who underwent standard medial parapatellar TKA, after a 2-year follow-up period. METHODS Eighty primary TKA procedures that were to be performed in 60 osteoarthritis patients were randomly assigned to either a quadriceps-sparing (40 knees) or a standard medial parapatellar (40 knees) group. All surgeries were designed to set the prosthesis with a femoral component alignment of 7° valgus and a tibial component alignment that was perpendicular to the tibial shaft. Surgical time and tourniquet time were recorded. Outcome variables included knee function, as defined by a hospital for special surgery knee score; quadriceps muscle strength, which was measured by an isokinetic dynamometer; pain, as indicated on a visual analog scale; prosthetic position, which was measured on plain radiograph; and range of motion. RESULTS Patients who underwent the 38 quadriceps-sparing and 37 standard TKA procedures completed the 2-year follow-up period without any infection or revision. The mean surgical time and tourniquet time were significantly longer in the quadriceps-sparing group. The mean peak quadriceps muscle strength, hamstring muscle strength, normalized muscle balance (hamstring/quadriceps ratio), pain score, function score, and range of motion were comparable in both groups at 2 months and 2 years. In the quadriceps-sparing group, both the femoral and the tibial components were significantly more varus-deviated from the expected position. CONCLUSIONS Patients undergoing quadriceps-sparing and standard medial parapatellar TKA had comparable outcomes for quadriceps muscle strength, hamstring-quadriceps balance, and knee function; however, the quadriceps-sparing TKA was more time consuming surgically and resulted in a less accurate prosthesis position.
Collapse
Affiliation(s)
- Hongsen Chiang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | |
Collapse
|
18
|
Metcalfe D, Watts E, Masters JP, Smith N. Anabolic steroids in patients undergoing total knee arthroplasty. BMJ Open 2012; 2:bmjopen-2012-001435. [PMID: 23002159 PMCID: PMC3468811 DOI: 10.1136/bmjopen-2012-001435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To systematically review the evidence for using anabolic-androgenic steroids (AAS) to aid rehabilitation following total knee replacement (TKR). DESIGN Systematic review of all clinical study designs. DATA SOURCES MEDLINE, EMBASE, AMED, CINAHL and the Cochrane Library were searched from inception to August 2012. ELIGIBILITY CRITERIA All clinical study designs without language or patient demographic limits. OUTCOME MEASURES All functional, physiological and administrative outcomes as well as reporting of adverse events. RESULTS Only two small randomised controlled trials satisfied the inclusion criteria. Statistically significant improvements were reported in the AAS group for quadriceps strength at 3 (p=0.02), 6 (p=0.01) and 12 (p=0.02) months, Functional Independence Measure score at 35 days (p=<0.05) and Knee Society Score at 6 weeks (p=0.02), 6 months (p=0.04) and 12 months (p=0.03). However, differences in hamstring strength, bone mineral density, sit-to-stand testing, walking speed, length of hospital stay and need for further inpatient rehabilitation did not reach statistical significance. There were no reported adverse events. CONCLUSIONS There is insufficient evidence to recommend routine administration of AAS to patients undergoing TKR. However, pilot data suggest that AAS can be administered safely and may improve important postoperative outcome measures. This justifies a randomised trial sufficiently powered to identify between-group differences likely to be of clinical significance.
Collapse
Affiliation(s)
- David Metcalfe
- Department of Orthopaedic Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Evan Watts
- Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada
| | - James P Masters
- Department of Orthopaedic Surgery, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Neil Smith
- St George's University of London, London, UK
| |
Collapse
|
19
|
Schroer WC, Diesfeld PJ, LeMarr AR, Reedy ME. Benefits of prolonged postoperative cyclooxygenase-2 inhibitor administration on total knee arthroplasty recovery: a double-blind, placebo-controlled study. J Arthroplasty 2011; 26:2-7. [PMID: 21723695 DOI: 10.1016/j.arth.2011.04.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 04/02/2011] [Indexed: 02/01/2023] Open
Abstract
A double-blind, placebo-controlled study of a selective cyclooxygenase (COX)-2 inhibitor administered in 107 patients for 6 weeks after total knee arthroplasty was done to determine any benefits. All patients received celecoxib preoperatively and during hospitalization. At hospital discharge, patients were randomized to receive celecoxib or placebo for 6 weeks. Narcotic use, knee flexion, Knee Society Score, Oxford Knee Score, and Short-Form 12 scores were determined preoperatively and at postoperative intervals to 1 year. Visual analog scale scores documented pain at rest, at night, and with activities. The celecoxib group used fewer narcotics and had significantly better visual analog scale scores, knee flexion, Knee Society Score scores, Oxford Knee Score scores, and Short-Form 12 physical composite scores than the placebo group. Knee flexion remained significantly improved through 1 year. These results demonstrate that patients who took celecoxib for 6 weeks after total knee arthroplasty had a less painful and more rapid recovery.
Collapse
Affiliation(s)
- William C Schroer
- St Louis Joint Replacement Institute, SSM DePaul Health Center, St Louis, Missouri, USA
| | | | | | | |
Collapse
|
20
|
Soft tissue balance measurement in minimal incision surgery compared to conventional total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19:880-6. [PMID: 20680244 DOI: 10.1007/s00167-010-1224-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
PURPOSES Minimal incision surgery (MIS) total knee arthroplasty (TKA) is widely promoted as a possible improvement over conventional TKA, and accurate implantations have recently been reported using navigation systems. However, soft tissue balance during MIS-TKA remains challenging. Therefore, in this report, joint gap (component gap) and ligament balance (varus angle) were assessed during MIS-TKA using a tensor, which enables soft tissue balance assessment with a reduced patellofemoral joint and femoral component in place. METHODS Results were compared to those of conventional TKA. Posterior stabilized TKA were performed in 50 knees (25 knees: MIS-TKA using quadriceps-sparing approach; 25 knees: conventional TKA using medial parapatellar approach) with varus osteoarthritis. Component gap and varus angle were measured using the tensor with a reduced patellofemoral joint at 0, 10, 45, 90, and 135°. RESULTS Whereas the component gap in MIS-TKA was significantly larger through the entire arc of flexion compared with conventional TKA, the pattern of joint looseness showed no difference between the two procedures. The varus angle in MIS-TKA was significantly larger than that in conventional TKA at 0, 90, and 135° of knee flexion. CONCLUSIONS MIS-TKA may lead to ligament imbalance due to the difficulties induced by a limited working space. Understanding this pattern allows surgeons to be able to adjust the soft tissue balance more accurately and thereby expect a better post-operative outcome even in MIS-TKA.
Collapse
|
21
|
Nestor BJ, Toulson CE, Backus SI, Lyman SL, Foote KL, Windsor RE. Mini-midvastus vs standard medial parapatellar approach: a prospective, randomized, double-blinded study in patients undergoing bilateral total knee arthroplasty. J Arthroplasty 2010; 25:5-11, 11.e1. [PMID: 20541889 DOI: 10.1016/j.arth.2010.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 04/01/2010] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to determine whether the mini-midvastus approach to total knee arthroplasty (TKA) results in differences in quadriceps muscle strength as well as previously cited advantages in a double blind prospective randomized trial. Twenty-seven patients (54 TKAs) scheduled for bilateral TKA were randomized to undergo mini-midvastus approach on one knee and standard approach on the other. Incision lengths were the same. Postoperative strength was determined by isokinetic and isometric peak torque testing. Range of motion, pain Visual analog scale, side-preference, and gait analysis were assessed preoperatively and postoperatively. The only significant difference in strength testing was increased isokinetic and isometric extension torque at 3 weeks postoperatively for the mini-midvastus approach. No differences between the mini-midvastus and standard approach were observed for stride length, stance time, pain Visual analog scale, or knee range of motion. The mini-midvastus approach has limited benefit compared to the standard approach for TKA.
Collapse
Affiliation(s)
- Bryan J Nestor
- Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | | | | | | | |
Collapse
|
22
|
Cheng T, Liu T, Zhang G, Peng X, Zhang X. Does minimally invasive surgery improve short-term recovery in total knee arthroplasty? Clin Orthop Relat Res 2010; 468:1635-48. [PMID: 20229136 PMCID: PMC2865591 DOI: 10.1007/s11999-010-1285-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 02/18/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concerns have been raised regarding minimally invasive surgery (MIS) and its possible effect on postoperative functional recovery, complications, and survival rate after TKA. QUESTIONS/PURPOSES We specifically asked whether MIS TKA would be associated with (1) increased operative time, (2) reduced blood loss, (3) shortened hospital stay, (4) faster recovery of ROM, (5) higher knee scores, (6) inferior component positioning, and (7) increased complications. METHODS We performed a systematic literature search of randomized controlled trials between minimally invasive and standard approaches in TKA that compared operative time, blood loss, ROM, knee scores, component positioning, and complications. We conducted a systematic review and meta-analysis of 13 trials published from 2007 to 2009 of MIS versus standard TKA. RESULTS Patients in the MIS group had longer operating times (10-19 minutes). Mean Knee Society scores were better after MIS than after the standard procedure at 6 and 12 weeks postoperatively, but not after 6 months. Improvement in ROM occurred more rapidly in the MIS group 6 days after TKA but later improvements are not clearly documented. We identified no differences between minimally invasive and standard approaches regarding the short-term overall complications and alignment of femoral and tibial components. However, wound healing problems and infections occurred more frequently in the MIS group. CONCLUSIONS MIS leads to faster recovery than conventional surgery with similar rates of component malalignment but is associated with more frequent delayed wound healing and infections. Potential benefits in long-term survival rate and functional improvement require additional investigation. Level of Evidence Level II, therapeutic study (systematic review). See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Tao Liu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
| | - Guoyou Zhang
- Department of Hand and Plastic Surgery, Second Affiliated Hospital, Wenzhou Medical College, Wenzhou, Zhejiang Province People’s Republic of China
| | - Xiaochun Peng
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Xianlong Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| |
Collapse
|