Movement of the knee in osteoarthritis. The use of electrogoniometry to assess function

Treatment of medial compartment knee osteoarthritis by arthroscopic 'L' medial release procedure

PURPOSE

To evaluate the clinical outcomes of an arthroscopic 'L' medial release (ALMR) procedure for the treatment of medial compartment knee osteoarthritis (MCKOA).

METHODS

Between January 2012 and December 2013, 372 patients with MCKOA of Kellgren's radiographic grade I-III were diagnosed. Among them, 252 patients with MCKOA received ALMR performed by a single surgeon. The other 120 patients received supportive treatment and were regarded as the control group. The Knee Society Score (KSS) at baseline and 2 years, and the subjective visual analogue scale (VAS) at baseline and 1st, 2nd, 6th, 12th, and 24th months were used for outcome studies.

RESULTS

There were 286 patients available for follow-up for more than 2 years and the mean follow-up period was 28 months. There were 202 patients with unilateral MCKOA in the ALMR group and 84 in the control group. The mean subjective VAS showed a statistically significant improvement after 6 months, and then remained relatively stable between the 6th and 24th month. The mean KSS for pain and function improved statistically at 2 years of follow-up.

CONCLUSIONS

This ALMR appears to be an effective and safe treatment for mild and moderate MCKOA.

Postural Sway, Balance Confidence, and Fear of Falling in Women With Knee Osteoarthritis in Comparison to Matched Controls

BACKGROUND

Osteoarthritis (OA) is a chronic degenerative disease that commonly affects the knee joints. Individuals older than 65 years of age with knee OA have a greater risk of falls. However, there has been limited examination of the parameters of postural sway (increased time, speed, and postural sway area [center of pressure{CoP}]), and OA of the knee.

OBJECTIVES

The primary objective of this study was to determine whether the CoP variables discriminate between patients with knee OA and matched healthy volunteers, and to correlate the CoP variables with the Activities-Specific Balance Confidence Scale (ABC) and Falls Self-Efficacy Scale (FES). The secondary objective was to compare the CoP of older women with OA with a control group in bipedal support condition with eyes opened and closed.

DESIGN

Cross-sectional study.

SETTING

University Biomechanics Laboratory.

PARTICIPANTS

A total of 22 participants were divided into the following 2 groups of 11 participants each: an OA group (mean = 68 years, standard deviation = 7.4 years) and a control group (mean = 66 years, standard deviation = 4.4 years).

METHODS

Static postural balance was measured by a portable force platform. Data were collected in both visual conditions (eyes open and closed), in random order. Three attempts of 30 seconds were allowed for each participant on the force platform, with a 1-minute interval between attempts.

MAIN OUTCOME MEASURE

Variables were the CoP total displacement of sway (TDS, in centimeters), anteroposterior amplitude displacement (APAD, in centimeters), medial-lateral amplitude displacement (MLAD, in centimeters), total mean velocity (TMV, in centimeters per second), and dispersion of the center of pressure (AREA, in centimeters squared).

RESULTS

The postural sway analysis found statistically significant differences in the eyes open condition for the TDS (P = .020), APAD (P = .042), TMV (P = .010), and AREA (P = .045). In the discriminant analysis, none of the CoP variables were able to classify the groups (P = .15). The correlation analysis showed that only the AREA with eyes closed was associated with the ABC Scale (rho = -0.42).

CONCLUSIONS

Women with knee OA had greater postural sway when compared with a control group for the eyes open condition. CoP variables could not discriminate between the groups. The AREA was negatively correlated with the ABC Scale, when the eyes were closed.

LEVEL OF EVIDENCE

III.

Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial

OBJECTIVE

To study the efficacy of aquatic resistance training on biochemical composition of tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis (OA).

DESIGN

Eighty seven volunteer postmenopausal women, aged 60-68 years, with mild knee OA (Kellgren-Lawrence grades I/II and knee pain) were recruited and randomly assigned to an intervention (n = 43) and control (n = 44) group. The intervention group participated in 48 supervised aquatic resistance training sessions over 16 weeks while the control group maintained usual level of physical activity. The biochemical composition of the medial and lateral tibiofemoral cartilage was estimated using single-slice transverse relaxation time (T2) mapping and delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC index). Secondary outcomes were cardiorespiratory fitness, isometric knee extension and flexion force and knee injury and OA outcome (KOOS) questionnaire.

RESULTS

After 4-months aquatic training, there was a significant decrease in both T2 -1.2 ms (95% confidence interval (CI): -2.3 to -0.1, P = 0.021) and dGEMRIC index -23 ms (-43 to -3, P = 0.016) in the training group compared to controls in the full thickness posterior region of interest (ROI) of the medial femoral cartilage. Cardiorespiratory fitness significantly improved in the intervention group by 9.8% (P = 0.010).

CONCLUSIONS

Our results suggest that, in postmenopausal women with mild knee OA, the integrity of the collagen-interstitial water environment (T2) of the tibiofemoral cartilage may be responsive to low shear and compressive forces during aquatic resistance training. More research is required to understand the exact nature of acute responses in dGEMRIC index to this type of loading. Further, aquatic resistance training improves cardiorespiratory fitness.

TRIAL REGISTRATION NUMBER

ISRCTN65346593.

Comparative Clinical Observation of Arthroscopic Microfracture in the Presence and Absence of a Stromal Vascular Fraction Injection for Osteoarthritis

Osteoarthritis (OA) is a degenerative cartilage disease that is characterized by a local inflammatory reaction. Consequently, many studies have been performed to identify suitable prevention and treatment interventions. In recent years, both arthroscopic microfracture (AM) and stem cell therapy have been used clinically to treat OA. This study aimed to evaluate the clinical effects of AM in the presence and absence of a stromal vascular fraction (SVF) injection in the management of patients with OA. Thirty patients with grade 2 or 3 (Lawrence scale) OA of the knee participated in this study. Placebo group patients (n = 15) received AM alone; treatment group patients (n = 15) received AM and an adipose tissue‐derived SVF injection. The SVF was suspended in platelet‐rich plasma (PRP) before injection into the joint. Patient groups were monitored and scored with the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Lysholm, Visual Analog Pain Scale (VAS), and modified Outerbridge classifications before treatment and at 6, 12, and 18 months post‐treatment. Bone marrow edema was also assessed at these time points. Patients were evaluated for knee activity (joint motion amplitude) and adverse effects relating to surgery and stem cell injection. Treatment efficacy was significantly different between placebo and treatment groups. All treatment group patients had significantly reduced pain and WOMAC scores, and increased Lysholm and VAS scores compared with the placebo group. These findings suggest that the SVF/PRP injection efficiently improved OA for 18 months after treatment. This study will be continuously monitored for additional 24 months. Stem Cells Translational Medicine2017;6:187–195

Exercise and osteoarthritis: cause and effects

Osteoarthritis (OA) is a common chronic joint condition predominantly affecting the knee, hip, and hand joints. Exercise plays a role in the development and treatment of OA but most of the literature in this area relates to knee OA. While studies indicate that exercise and physical activity have a generally positive effect on healthy cartilage metrics, depending upon the type of the activity and its intensity, the risk of OA development does appear to be moderately increased with sporting participation. In particular, joint injury associated with sports participation may be largely responsible for this increased risk of OA with sport. Various repetitive occupational tasks are also linked to greater likelihood of OA development. There are a number of physical impairments associated with OA including pain, muscle weakness and altered muscle function, reduced proprioception and postural control, joint instability, restricted range of motion, and lower aerobic fitness. These can result directly from the OA pathological process and/or indirectly as a result of factors such as pain, effusion, and reduced activity levels. These impairments and their underlying physiology are often targeted by exercise interventions and evidence generally shows that many of these can be modified by specific exercise. There is currently little clinical trial evidence to show that exercise can alter mechanical load and structural disease progression in those with established OA, although a number of impairments, that are amenable to change with exercise, appears to be associated with increased mechanical load and/or disease progression in longitudinal studies.

The effect of electromagnetic navigation in total knee arthroplasty on knee kinematics during functional activities using flexible electrogoniometry

BACKGROUND

Navigated total knee arthroplasty has been shown to increase accuracy in post operative implant alignment. By contrast navigated total knee arthroplasty has not shown significant functional improvements to date, when compared with conventional surgery using subjective clinical questionnaire scores. The aim of this study was to compare the knee joint kinematics measured during functional activities using electrogoniometry 12 months after total knee arthroplasty in randomised navigated and conventional total knee arthroplasty groups.

METHODS

The study design was a double blinded, randomised, prospective, controlled trial. The patients were randomised into 2 surgical groups (n=102 navigated group, n=98 conventional group; mean age navigated=67, conventional=67). Flexible electrogoniometry was used to measure patient's knee kinematics with respect to time during 12 functional activities.

FINDINGS

No significant difference was found in terms of the maximum, minimum and excursion knee joint angle during any of the functional activities. However there was a statistically significant improvement in the level and slope gait cycle at the pre swing phase in the navigated group.

INTERPRETATION

There were minimal functional improvements in the navigated total knee arthroplasty group 12 months after surgery. However, these are unlikely to have a significant effect on daily activity for the navigated group.

Hypermobility of the first ray in patients with planovalgus feet and tarsometatarsal osteoarthritis

BACKGROUND

Hypermobility in the foot is a common observation but difficult to quantify. Primary tarsometatarsal arthritis is less common and its aetiology uncertain. This study introduces a novel means of clinical measurement for range of motion of the medial column and investigates the association between hypermobility, planovalgus foot shape and tarsometatarsal arthritis.

METHOD

32 planovalgus feet with symptomatic tarsometatarsal arthritis were compared with 36 controls. Radiographic angular measurements and arthritic grade were recorded from standing radiographs. Medial column flexion and extension was measured clinically using a validated electronic goniometer.

RESULTS

There was a significant difference in medial column range of motion between the patient and control groups (17±5° compared to 9±3° [P<0.001]).

CONCLUSION

Patients with planovalgus feet and tarsometatarsal osteoarthritis have greater range of motion of the medial column than controls with normal feet when measured using this technique. Recognition of this association may lead to progress in prevention and treatment.

Reliability and validity of a new ankle electrogoniometer

OBJECTIVES

To establish reliability, accuracy and concurrent validity of a new electrogoniometer (SG110A, Biometrics) for measuring ankle movement.

METHODS

The new electrogoniometer, placed at the lateral malleolus (A-perp), was compared to a customary electrogoniometer (SG110, Biometrics), placed along the Achilles tendon (A-para). Concurrent recordings were made with motion analysis. Common dance movements were performed by 17 dancers on two days. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) were calculated for sagittal angular displacements.

RESULTS

Instrument and intra-tester reliability of A-perp was high (r >or= 0.985, r >or= 0.979, respectively). Criterion and concurrent validity were also high (r >or= 0.954, r >or= 0.937). SEM ranged from 1.43 degrees to 6.99 degrees.

CONCLUSIONS

The high ICC values establish acceptable reliability and validity. Subjects found A-perp more comfortable. Although both electrogoniometers are acceptable (comparable SEM) to measure extreme ankle motions, the greater comfort and durability of the new A-perp sensor is advantageous.

Range of motion and repeatability of knee kinematics for 11 clinically relevant motor tasks

Standard gait analysis reports knee joint rotations in the three anatomical planes without addressing their different levels of reliability. Most clinical studies also restrict analysis to knee flexion-extension, because knee abduction-adduction and axial rotation are small with respect to the corresponding amount of measurement artefact. This study analyses a set of 11 motor tasks, in order to identify those that are adequately repeatable and that can induce greater motion at the knee than walking. Ten volunteers (mean ± SD age: 29 ± 9 years) each underwent three motion analysis sessions on different days with a standard gait analysis system and protocol. In each session they performed normal walking, walking with sidestep and crossover turns, ascent onto and descent off a step, descent with sidestep and crossover turns, chair rise, mild and deep squats, and lunge. Range and repeatability of motions in the three anatomical planes were compared by ANOVA. The sidestep turns showed a range of axial rotation significantly larger than that in walking (about 8°), while maintaining similar levels of repeatability. Ascent, chair rise, squat, and lunge showed greater flexion ranges than walking; among these, ascent was the most repeatable. The results show that turning increases knee axial rotation in young subjects significantly. Further, squats and lunges, currently of large interest in orthopaedics and sports research, have smaller repeatability, likely accounted for to the smaller constraints than in the traditional motor tasks.

Dairy farm worker exposure to awkward knee posture during milking and feeding tasks

Musculoskeletal disorders are common among agricultural workers, particularly among dairy farm workers. Specifically, dairy farm workers have been identified as being at risk for knee osteoarthritis. Physical risk factors that may contribute to knee osteoarthritis include awkward postures of the knee, such as kneeling or squatting. The purpose of this study was to quantify exposure to awkward knee posture among dairy farm workers during milking and feeding tasks in two common types of milking facilities (stanchion and parlor). Twenty-three dairy farm workers performed milking and feeding tasks; 11 worked in a stanchion milking facility, and 12 worked in a parlor milking facility. An electrogoniometer was used to measure knee flexion during 30 min of the milking and feeding tasks. Milking in a stanchion facility results in a greater duration of exposure to awkward posture of the knee compared with milking in a parlor facility. Specifically, the percentage of time in >or=110 degrees knee flexion was significantly greater in the stanchion facility (X = 17.7; SE 4.2) than in the parlor facility (X = 0.05; SE 0.04; p <or= 0.05). Similar results were observed with other categories of awkward knee posture in both milking and feeding tasks. This study supports previous findings that working in stanchion milking facility results in greater exposure to awkward knee posture compared with working in a parlor milking facility.

The Pain Behaviors for Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE)

Older adults with severe cognitive impairment have trouble responding to questions about their osteoarthritis knee or hip pain, which makes pain management difficult. Therefore, the Pain Behaviors for Osteoarthritis Instrument for Cognitively Impaired Elders (PBOICIE) was developed as an alternative. This article reports the development and psychometric testing of the PBOICIE in three studies. The 6-item PBOICIE was not associated with the Verbal Descriptor Scale but was significantly associated with Keefe's method for observing pain behaviors in patients with knee osteoarthritis, with r=0.36 to 0.55, indicating good concurrent validity. The 6-item PBOICIE was able to discriminate older adults' pain behaviors before and after administration of an analgesic agent (2.9+/-1.89 versus 1.97+/-1.98; p<0.001). This study has shown that multifaceted pain assessments are needed in older adults with osteoarthritis knee or hip pain, as the observed behaviors did not parallel but added information to verbal report.

Actual knee motion during continuous passive motion protocols is less than expected

Investigations of the usefulness of continuous passive motion (CPM) after TKA have yielded mixed results, with evidence suggesting its efficacy is contingent on the presence of larger motion arcs. Surprisingly, the range of motion (ROM) the knee actually experiences while in a CPM machine has not been elucidated. In this study, the ability of a CPM apparatus to bring about a desired knee ROM was assessed with an electrogoniometer. The knee experienced only 68% to 76% of the programmed CPM arc, with the higher percentages generated by elevating the head of the patient's bed. This disparity between true knee motion and CPM should be accounted for when designing CPM protocols for patients or investigations evaluating efficacy of CPM.

Knee osteoarthritis: primary care using noninvasive devices and biomechanical principles

Osteoarthritis (OA) is an epidemic for which there is no known cure. There is enormous popular demand for noninvasive and nonpharmacologic therapies for OA, and there is a pressing need for primary care physicians to respond by updating their pattern of practice. Despite increasing concern about the capacity of our health care system to meet rising demands, routine primary care for knee OA has changed little over several decades. This article introduces physicians to many of the most important noninvasive devices used in the conservative management of symptomatic knee OA.

Development and validation of an electrogoniometric wrist alignment device

This paper reports the development of an instrumented flexible electrogoniometric hand posture corrective device designed specifically for monitoring and controlling the range of motion (ROM) at the hand and wrist. The device, known as the wrist alignment device (WAD), consists of flexible electrogoniometers attached to a Lycra® glove and a control box housing the WAD circuitry. The WAD controls the wrist ROM within set limits by means of presetting the joint angle ranges prior to commencing measurements, thereby preventing or reducing extreme wrist ulnar deviation, wrist hyperflexion, and wrist hyperextension. Additionally, the device consists of a window comparator, which allows the joint movement always to remain within the set limits. Where the subject's wrist ROM is outside the presettings, a piezo-buzzer is triggered which alerts the subject to reduce the ROM, thereby ensuring that the joint angles are always kept within the preset angle range. All instrumentation associated with the development of the device underwent calibration. As a device, it has widespread applications within the office and clinical environment. Preliminary results indicate that reliable measurements based on ROM settings can be obtained when using the WAD.

The reliability of knee joint position testing using electrogoniometry

BACKGROUND

The current investigation examined the inter- and intra-tester reliability of knee joint angle measurements using a flexible Penny and Giles Biometric electrogoniometer. The clinical utility of electrogoniometry was also addressed.

METHODS

The first study examined the inter- and intra-tester reliability of measurements of knee joint angles in supine, sitting and standing in 35 healthy adults. The second study evaluated inter-tester and intra-tester reliability of knee joint angle measurements in standing and after walking 10 metres in 20 healthy adults, using an enhanced measurement protocol with a more detailed electrogoniometer attachment procedure. Both inter-tester reliability studies involved two testers.

RESULTS

In the first study, inter-tester reliability (ICC[2,10]) ranged from 0.58-0.71 in supine, 0.68-0.79 in sitting and 0.57-0.80 in standing. The standard error of measurement between testers was less than 3.55 degrees and the limits of agreement ranged from -12.51 degrees to 12.21 degrees . Reliability coefficients for intra-tester reliability (ICC[3,10]) ranged from 0.75-0.76 in supine, 0.86-0.87 in sitting and 0.87-0.88 in standing. The standard error of measurement for repeated measures by the same tester was less than 1.7 degrees and the limits of agreement ranged from -8.13 degrees to 7.90 degrees . The second study showed that using a more detailed electrogoniometer attachment protocol reduced the error of measurement between testers to 0.5 degrees .

CONCLUSION

Using a standardised protocol, reliable measures of knee joint angles can be gained in standing, supine and sitting by using a flexible goniometer.

Magnetic resonance imaging analysis of kinematics in osteoarthritic knees

Kinematics in osteoarthritic knees may be impeding efforts to reproduce "normal" knee kinematics in the prosthetic knee. Fourteen subjects with unilateral symptomatic knee osteoarthritis performed a supine leg press from 0 degrees to 90 degrees flexion against a 150-N load. The tibiofemoral contact pattern was recorded for both knees using sagittal T1-weighted magnetic resonance imaging. Severity of osteoarthritis ranged from Kellgren Lawrence grade 2 to 4 in the symptomatic knees and from 0 to 3 in the contralateral knees. Contact in the lateral and medial compartments of osteoarthritic knees was more anterior on the tibial plateau than healthy knees, both in knee extension and to 90 degrees flexion (P < .01). This anterior contact pattern was associated with severity of osteoarthritis (P < .01).

Correction of severe crouch gait in patients with spastic diplegia with use of multilevel orthopaedic surgery

BACKGROUND

Severe crouch gait in patients with spastic diplegia causes excessive loading of the patellofemoral joint and may result in anterior knee pain, gait deterioration, and progressive loss of function. Multilevel orthopaedic surgery has been used to correct severe crouch gait, but no cohort studies or long-term results have been reported, to our knowledge.

METHODS

In order to be eligible for the present retrospective cohort study, a patient had to have a severe crouch gait, as defined by sagittal plane kinematic data, that had been treated with multilevel orthopaedic surgery as well as a complete clinical, radiographic, and instrumented gait analysis assessment. The surgical intervention consisted of lengthening of contracted muscle-tendon units and correction of osseous deformities, followed by the use of ground-reaction ankle-foot orthoses until stable biomechanical realignment of the lower limbs during gait was achieved. Outcome at one and five years after surgery was determined with use of selected sagittal plane kinematic and kinetic parameters and valid and reliable scales of functional mobility. Knee pain was recorded with use of a Likert scale, and all patients had radiographic examination of the knees.

RESULTS

Ten subjects with severe crouch gait and a mean age of 12.0 years at the time of surgery were studied. After surgery, the patients walked in a more extended posture, with increased extension at the hip and knee and reduced dorsiflexion at the ankle. Pelvic tilt increased, and normalized walking speed was unaltered. Knee pain was diminished, and patellar fractures and avulsion injuries healed. Improvements in functional mobility were found, and, at the time of the five-year follow-up, fewer patients required the use of wheelchairs or crutches in the community than had been the case prior to intervention.

CONCLUSIONS

Multilevel orthopaedic surgery for older children and adolescents with severe crouch gait is effective for relieving stress on the knee extensor mechanism, reducing knee pain, and improving function and independence.

The effect of patella resurfacing in total knee arthroplasty on functional range of movement measured by flexible electrogoniometry

BACKGROUND

The need for patella resurfacing remains an area of considerable controversy in total knee replacement surgery. There would appear to be no reported evidence on the effect of patella resurfacing on knee function, as measured by functional range of movement used in a series of tasks, in patients undergoing knee replacement. The object of this study was to measure knee joint motion during functional activities both prior to and following total knee replacement in a randomised group of patients with and without patella resurfacing and to compare these patient groups with a group of normal age-matched subjects.

METHODS

The study design was a double blinded, randomised, prospective, controlled trial. The knee joint functional ranges of movement of a group of patients (n=50, mean age=70 years) with knee osteoarthritis were investigated prior to and following total knee arthroplasty (4 months and 18-24 months) along with a group of normal subjects (n=20, mean age=67). Patients were randomly allocated into two groups, those who received patella resurfacing (n=25) and those who did not (n=25). Flexible electrogoniometry was used to measure the flexion-extension angle of the knees with respect to time in eleven functional activities.

FINDINGS

No statistically significant differences (alpha level 0.05) in joint excursion of the affected knee were found between patients who received patella resurfacing and those who did not.

INTERPRETATION

Routine patella resurfacing in a typical knee arthroplasty population does not result in an increase in the functional range of movement used after knee replacement.

Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis

OBJECTIVE

To investigate the effects of ultrasound (US) in isokinetic muscle strengthening exercises on functional status of patients with knee osteoarthritis (OA).

DESIGN

Effectiveness of isokinetic muscle strengthening exercises for treatment of periarticular soft tissue disorders was compared with and without pulsed and continuous US.

SETTING

Outpatient exercise program in a Taiwan medical university hospital.

PARTICIPANTS

One hundred twenty subjects with bilateral knee OA (Altman grade II).

INTERVENTION

Subjects were randomized sequentially into 1 of 4 groups. Group I received isokinetic muscular strengthening exercises, group II received isokinetic exercise and continuous US, group III received isokinetic exercise and pulsed US treatment, and group IV was the control group.

MAIN OUTCOME MEASURES

Therapeutic effects of isokinetic exercise were evaluated by changes in ambulation speed and the Lequesne index. In addition, changes in knee range of motion (ROM), visual analog scale for pain, and muscle peak torques during knee flexion and extension were compared. Compliance in each group was recorded.

RESULTS

Each treated group had increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-up. However, only patients in groups II and III had significant improvement in ROM and ambulation speed after treatment. Fewer participants in group III discontinued treatment due to knee pain during exercise. Patients in group III also showed the greatest increase in walking speed and decrease in disability after treatment and at follow-up. Gains in muscular strength in 60 degrees /s angular velocity peak torques were also noted in groups II and III. However, group III showed the greatest muscular strength gains with 180 degrees /s angular velocity peak torques after treatment and follow-up.

CONCLUSIONS

US treatment could increase the effectiveness of isokinetic exercise for functional improvement of knee OA, and pulsed ultrasound has a greater effect than continuous US.

The effect of total knee arthroplasty on joint movement during functional activities and joint range of motion with particular regard to higher flexion users

PURPOSE

To evaluate active and functional knee excursion of patients before and after total knee arthroplasty (TKA) and to determine whether TKA restores quality of life related to functional activities of daily living.

METHODS

Electrogoniometry was used to measure the functional movement of the knee during 11 activities of daily living in 50 patients who underwent TKA. These data were compared with the patient's active range of motion and quality-of-life scores.

RESULTS

A cut-off point existed between loss and gain in flexion at between 90 and 95 degrees of preoperative active flexion. Two thirds of patients had preoperative flexion of more than 90 degrees, 83% of them had reduced flexion postoperatively. The remaining one third had preoperative flexion of 90 degrees or less, 85% of them had improved flexion postoperatively. A similar pattern of loss and gain occurred for functional movement of the knee. Reduced functional range was associated with significantly reduced physical quality of life compared with age-matched healthy subjects.

CONCLUSION

Although TKA offers excellent pain relief and contributes to the overall well-being of the patient, these results suggest that it also leads to a reduced range of active and functional motion in the majority of patients. This is associated with a lower-than-normal physical quality of life. The design of implants and rehabilitation programmes should be reconsidered so that better range of motion and quality of life can be achieved for patients.

Knee kinematics in medial arthrosis. Dynamic radiostereometry during active extension and weight-bearing

We studied the kinematics of the knee during weight-bearing active extension in 14 patients with medial osteoarthrosis (OA) and in 10 controls using dynamic radiostereometry. Between 50 degrees and 20 degrees of extension the OA knees showed decreased internal tibial rotation corresponding to less posterior displacement of the lateral femoral flexion facet center. The midpoint between the two tips of the tibial intercondylar eminence occupied a more posterior position within the range of motion analyzed. The observed changes were similar to those previously recorded in chronic tear of the anterior cruciate ligament. Patients with medial arthrosis of the knee joint show a specific and abnormal pattern of joint motion.

Recovery of mobility after knee arthroplasty: expected rates and influencing factors

Mobility was measured in 79 people 6 months after knee arthroplasty using timed tests of stair climbing and walking speed. Recovery rates were calculated in comparison with a preoperative assessment. Changes in leg extensor power, knee flexion range, and pain were tracked simultaneously. Stair climbing speed improved on average by 53% during the first 6 months, and walking speed by 45%. In multivariate models, 2 preoperative factors emerged as being influential on recovery of mobility: leg extensor power and body mass index. A marked loss of flexion in the postoperative period was not a significant determinant of mobility speed. At 6 months, body mass index was the most significant determinant of stair speed, and leg extensor power was the most significant determinant of walking speed.

Kinematic analysis of the hind limb during swimming and walking in healthy dogs and dogs with surgically corrected cranial cruciate ligament rupture

OBJECTIVE

To determine hip, stifle, and tarsal joint ranges of motion (ROM) and angular velocities during swimming and walking in healthy dogs and dogs with surgically corrected cranial cruciate ligament (CCL) rupture.

DESIGN

Prospective clinical study.

ANIMALS

13 healthy dogs and 7 dogs with CCL rupture.

PROCEDURE

Dogs with CCL rupture were enrolled in a postoperative aquatic rehabilitation program and evaluated 21 to 35 days after surgery. Dogs were filmed while swimming in a pool and while walking at a fast (1.3 m/s) or slow (0.9 m/s) pace on a treadmill. Maximal angles of extension and flexion, ROM, and angular velocities were calculated.

RESULTS

In healthy dogs, swimming resulted in a significantly greater ROM in the hip joint than did walking, but in dogs with CCL rupture, ROM of the hip joint did not vary with swimming versus walking. For dogs in both groups, swimming resulted in significantly greater ROM of the stifle and tarsal joints than did walking, primarily because of greater joint flexion. Stifle joint ROM was significantly lower in dogs with CCL rupture than in healthy dogs, regardless of whether dogs were swimming or walking.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested that following surgical management of a ruptured CCL in dogs, swimming resulted in greater ROM of the stifle and tarsal joints than did walking. This suggests that if ROM is a factor in the rate or extent of return to function in these dogs, then aquatic rehabilitation would likely result in a better overall outcome than walking alone.

Relationship between knee range of motion and Kellgren-Lawrence radiographic scores in knee osteoarthritis

OBJECTIVE

To investigate the relationships between the joint range of motion and Kellgren-Lawrence radiographic scores of knee joint compartments in patients with knee osteoarthritis.

DESIGN

Forty knees of 20 consecutive bilateral, primary knee osteoarthritis patients were examined in the study. Maximal flexion, extension, and internal and external rotation were assessed using a goniometer. Kellgren-Lawrence radiographic scores were determined for medial tibiofemoral, lateral tibiofemoral, and patellofemoral compartments of the knee joint on lateral, tangential, and standing anteroposterior radiographs.

RESULTS

Statistically significant negative correlations were found between the range of motion and radiographic scores. Specifically, internal rotation was correlated with lateral compartment scores (r = -0.439, P < 0.01), and external rotation and flexion were correlated with medial compartment scores (r = -0.361, P < 0.05; r = -0.338, P < 0.05; respectively) [corrected]. Extension values were correlated with patellofemoral ( = -0.533, < 0.01), medial (r = -0.456, P < 0.01), and lateral (r = -0.327, P < 0.05) compartment scores.

CONCLUSIONS

A clear relationship is present between joint range of motion and Kellgren-Lawrence radiographic scores in knee osteoarthritis patients. Examination of the joint range of motion can give information about the compartmental distribution of the disease and help the physician focus on the compartment or compartments involved when performing diagnostic and therapeutic procedures. Evaluation of the compartments of the knee joint in radiographs can be informative about the joint range of motion in knee osteoarthritis.