Article

Muscle Deficits Persist After Unilateral Knee Replacement and Have Implications for Rehabilitation

Rehabilitation and Pain Unit, Kymenlaakso Central Hospital, FIN-48210 Kotka, Finland.
Physical Therapy (Impact Factor: 3.25). 09/2009; 89(10):1072-9. DOI: 10.2522/ptj.20070295
Source: PubMed

ABSTRACT Knee joint arthritis causes pain, decreased range of motion, and mobility limitation. Knee replacement reduces pain effectively. However, people with knee replacement have decreases in muscle strength ("force-generating capacity") of the involved leg and difficulties with walking and other physical activities.
The aim of this cross-sectional study was to determine the extent of deficits in knee extensor and flexor muscle torque and power (ability to perform work over time) and in the extensor muscle cross-sectional area (CSA) after knee joint replacement. In addition, the association of lower-leg muscle deficits with mobility limitations was investigated.
Participants were 29 women and 19 men who were 55 to 75 years old and had undergone unilateral knee replacement surgery an average of 10 months earlier. The maximal torque and power of the knee extensor and flexor muscles were measured with an isokinetic dynamometer. The knee extensor muscle CSA was measured with computed tomography. The symmetry deficit between the knee that underwent replacement surgery ("operated knee") and the knee that did not undergo replacement surgery ("nonoperated knee") was calculated. Maximal walking speed and stair-ascending and stair-descending times were assessed.
The mean deficits in knee extensor and flexor muscle torque and power were between 13% and 27%, and the mean deficit in the extensor muscle CSA was 14%. A larger deficit in knee extension power predicted slower stair-ascending and stair-descending times. This relationship remained unchanged when the power of the nonoperated side and the potential confounding factors were taken into account.
The study sample consisted of people who were relatively healthy and mobile. Some participants had osteoarthritis in the nonoperated knee.
Deficits in muscle torque and power and in the extensor muscle CSA were present 10 months after knee replacement, potentially causing limitations in negotiating stairs. To prevent mobility limitations and disability, deficits in lower-limb power should be considered during rehabilitation after knee replacement.

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    • "Quadriceps weakness is one of the main impairments before and also after TKA affecting normal functional activities like walking and stair climbing (Mizner et al., 2005; Vissers et al., 2013). Differences in quadriceps strength between the operated leg (OP) and the nonoperated leg (NOP) become more pronounced immediately after surgery and fail to completely resolve even after several years post surgery (Mizner et al., 2005; Meier et al., 2008; Valtonen et al., 2009; Stevens- Lapsley et al., 2010). These long-lasting differences in strength are also described between TKA patients and age-matched healthy adults (Meier et al., 2008; Stevens-Lapsley et al., 2010). "
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    • "Although quadriceps muscle strength of TKA patients has been increasingly assessed in the last two decades (Walsh et al., 1998; Mizner et al., 2003; Silva et al., 2003; Valtonen et al., 2009; Swank et al., 2011), there is no consensus among researchers and clinicians regarding the most valid test modality (that is, the modality considered most reliable and best related to physical function). Quadriceps muscle strength of TKA patients has been prevalently assessed during short (3–5 s) static contractions, of which the main outcome is isometric maximal voluntary contraction (MVC) torque (Mizner et al., 2003; Silva et al., 2003), or during slow isokinetic concentric contractions, of which the main outcome is isokinetic peak torque (Walsh et al., 1998; Valtonen et al., 2009; Swank et al., 2011). Isometric and isokinetic testing modalities are generally selected due to their reliability (Kean et al., 2010; Staehli et al., 2010), objectivity and safety, even though their validity has not been amply explored in patients with TKA. "
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    • "Although quadriceps muscle strength of TKA patients has been increasingly assessed in the last two decades (Walsh et al., 1998; Mizner et al., 2003; Silva et al., 2003; Valtonen et al., 2009; Swank et al., 2011), there is no consensus among researchers and clinicians regarding the most valid test modality (that is, the modality considered most reliable and best related to physical function). Quadriceps muscle strength of TKA patients has been prevalently assessed during short (3–5 s) static contractions, of which the main outcome is isometric maximal voluntary contraction (MVC) torque (Mizner et al., 2003; Silva et al., 2003), or during slow isokinetic concentric contractions, of which the main outcome is isokinetic peak torque (Walsh et al., 1998; Valtonen et al., 2009; Swank et al., 2011). Isometric and isokinetic testing modalities are generally selected due to their reliability (Kean et al., 2010; Staehli et al., 2010), objectivity and safety, even though their validity has not been amply explored in patients with TKA. "
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