Changes of body balance before and after total knee arthroplasty in patients who suffered from bilateral knee osteoarthritis

Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan, .
Journal of Orthopaedic Science (Impact Factor: 0.94). 06/2013; 18(5). DOI: 10.1007/s00776-013-0430-1
Source: PubMed


It is still controversial whether simultaneous or staged total knee arthroplasty (TKA) is most desirable for patients with bilateral knee osteoarthritis. We retrospectively evaluated changes in balance among patients with bilateral osteoarthritis who underwent staged TKA using a gravicorder.
Patients were stratified into two groups: the unilateral group (UG) (22 patients) consisted of patients who did not undergo a second TKA within 24 months of the first TKA, and the bilateral group (BG) (20 patients) were those who had a second TKA within 12 months after initial TKA.
The mean gravity center position (GCP), which indicates the translation of GCP in the mediolateral direction between pre- and post-TKA shifted to the operative side in both groups after initial surgery. While the GCP was maintained on the same side in UG over 2 years follow-up, in BG it moved to the opposite side and approached a central position after the second TKA. Locus length of GCP (LG), which indicates postural control function by proprioceptive reflex showed significant improvement after initial TKA in UG, while BG showed significant improvement after the second TKA.
The degree of LG improvement after initial TKA may indicate the necessity of a second TKA for patients with bilateral osteoarthritis. The current study suggests that simultaneous bilateral TKA is not always necessary for patients with bilateral knee arthritis, and that properly performed rehabilitation such as improving postural sway after initial TKA might attenuate the timing for the second TKA.

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    ABSTRACT: We used non-invasive broadband ultrasound attenuation (BUA) to determine (1) whether the pre-surgical bone quality of the calcaneus was improved 5 years postoperatively, and (2) whether the interval between total knee arthroplasty (TKA) surgeries influenced post-surgical calcaneal bone quality. All patients underwent scheduled, staged, bilateral TKA. Twenty-one patients (42 TKAs) with bilateral knee osteoarthritis were evaluated. One day before and 5 years after TKA, BUA through the os calcis on the surgical side was measured. Fourteen out of 21 patients showed post-surgical improvement in BUA bilaterally. When all 42 cases were considered together there was a significant improvement in BUA 5 years after surgery (p = 0.042). There were no significant correlations between the changes in BUA on each side and the interval between TKA surgeries.
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