Changes in Functional Status Among Persons Over Age Sixty-Five Undergoing Total Knee Arthroplasty

ArticleinMedical care 47(7):742-8 · August 2009with8 Reads
Impact Factor: 3.23 · DOI: 10.1097/MLR.0b013e31819a5ae3 · Source: PubMed
Abstract

This study assessed changes in physical functional status following receipt of total knee arthroplasty (TKA) for patients diagnosed with osteoarthritis (OA) of the knee in a national sample of persons aged 65+ in the United States relative to a sample of similar OA patients who did not receive TKA. Data from the Health Retirement Survey (HRS) and linked Medicare claims from 1994 to 2006 were used to identify persons with diagnoses of OA of the lower leg who received a TKA (n = 516) and those who did not receive TKA (n = 1756). Predicted probabilities of receiving total knee arthroplasty from logit analysis were used for matching TKA and comparison groups on demographic, socioeconomic, and baseline functional status factors. Functional status measures were: mobility, gross motor function, large muscle, and limitations in activities of daily living (ADL). Average treatment effects of the treated (ATT), which compares changes in functional status between those who received TKA with similar individuals who did not receive TKA, were computed using propensity score matching. Mobility (average treatment effect of the treated (ATT = 0.315; 95% CI: 0.118-0.512), gross motor function (ATT = 0.314; 95% CI: 0.156-0.472), and ADL limitations (ATT = 0.174; 95% CI: 0.055-0.293), improved among persons receiving TKA relative to the comparison group. Relative to the mean values of the physical function at baseline, mobility, gross motor function, and ADL limitations persons receiving TKA had better functional outcomes than the comparison group by 17.5, 39.3, and 46.9 percent, respectively. TKA is effective in improving functional status in elderly persons.

    • "In the US, over 500,000 total knee arthroplasty (TKA) surgeries are performed each year for severe knee osteoarthritis and that number is expected to increase sevenfold over the next two decades [1]. Most TKA recipients experience a successful reduction of their knee pain and an improvement in knee function [2, 3]. Unfortunately, not all TKA recipients experience substantial improvements in their levels of pain, functional status, nor overall health-related quality of life. "
    Full-text · Dataset · Mar 2014
    0Comments 0Citations
    • "Total knee arthroplasty has revolutionized the results of patients suffering from debilitating gonarthrosis [15]. However reduced pain and increased functions are inconsistently attained and levels of satisfaction are less predictable. "
    [Show abstract] [Hide abstract] ABSTRACT: Quadriceps functional impairment accounts for a considerable amount of morbidity after knee replacement. Cruciate-retaining total knee arthroplasty (CR-TKA) may predispose to increased quadriceps demand. We compared bilateral relative quadriceps effort in seven patients with successful unilateral CR-TKA at least 2years after surgery. Dynamic electromyography (EMG) recorded quadriceps activity during walking recorded simultaneously with gait analysis using IDEEA. There was greater EMG activity for the operated knees, both in amplitude (43.08±26.47 vs. 16.02±5.38, P=.0355), and the area under the curve (7231.1±3869.8 vs. 2547.3±1007.9, P=.0267). The onset and duration of muscle activity were similar for both knees (P=.74). CR-TKA demonstrated threefold EMG activity and muscle effort during normal walking. The study suggested that quadriceps functional deficiency is associated with CR-TKA.
    Full-text · Article · Dec 2012 · The Journal of arthroplasty
    0Comments 2Citations
    • "In the US, over 500,000 total knee arthroplasty (TKA) surgeries are performed each year for severe knee osteoarthritis and that number is expected to increase sevenfold over the next two decades [1]. Most TKA recipients experience a successful reduction of their knee pain and an improvement in knee function [2, 3]. Unfortunately, not all TKA recipients experience substantial improvements in their levels of pain, functional status, nor overall health-related quality of life. "
    [Show abstract] [Hide abstract] ABSTRACT: Rehabilitation services are less-studied aspects of the management following total knee arthroplasty (TKA) despite long-term suboptimal physical functioning and chronic deficits in muscle function. This paper describes the preliminary findings of a six-week (12 session) eccentrically-biased rehabilitation program targeted at deficits in physical function and muscle function, initiated one month following surgery. A quasiexperimental, one group, pretest-posttest study with thirteen individuals (6 female, 7 male; mean age 57 ± 7 years) examined the effectiveness of an eccentrically-biased rehabilitation program. The program resulted in improvements in the primary physical function endpoints (SF-36 physical component summary and the six-minute walk test) with increases of 59% and 47%, respectively. Muscle function endpoints (knee extension strength and power) also increased 107% and 93%, respectively. Eccentrically-biased exercise used as an addition to rehabilitation may help amplify and accelerate physical function following TKA surgery.
    Full-text · Article · Apr 2011
    0Comments 12Citations
Show more