Increased knee loading in stair ambulation in patients dissatisfied with their total knee replacement |
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| Institution: | 1. California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA 90840, USA;2. The University of Tennessee, Knoxville, 1914 Andy Holt Ave., Knoxville, TN 37996, USA;3. Tennessee Orthopaedic Clinics, 9430 Park West Blvd., Knoxville, TN 37923, USA;1. Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey Medical Center, 500 University Drive, Mail Code H089, Hershey, PA 17033, USA;2. Department of Public Health Sciences, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA;1. Technology Implementation Research Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts;2. Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts;1. Center for the study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel;2. Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel;3. Sieratzki Chair in Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;4. Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;5. Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel;6. Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel |
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| Abstract: | BackgroundTotal knee replacement patients have shown reductions in knee flexion range of motion, knee extensor moments, and gait speed during stair ascent and stair descent. However, it is unknown how patients dissatisfied with their total knee replacement differ from those who are satisfied during more difficult activities such as stair negotiation. Therefore, the purpose of this study was to compare knee biomechanics of patients who are dissatisfied with their joint replacement to those who are satisfied and healthy participants during stair negotiation.MethodsNine dissatisfied, fifteen satisfied patients and fifteen healthy participants participated, completing stair ascent and descent trials on an instrumented staircase. A 2 × 3 ANOVA was used to analyze biomechanical differences between groups and limbs during both activities.FindingsThe dissatisfied group showed reduced 2nd peak vertical GRF (P ≤ 0.0040) and loading-response knee extension moments (P ≤ 0.0041) in their operated limb compared to their non-operated limb and to satisfied and healthy groups during stair ascent. First peak vertical GRF (P < 0.0088) and both loading-response (P < 0.0117) and push-off abduction moments (P < 0.0028) showed reduced values in operated limbs compared to non-operated limbs for all groups. During stair descent, the dissatisfied group showed reduced loading-response and push-off knee extension moments (P ≤ 0.006) in their operated limb compared to their non-operated limb and the healthy group. The loading-response knee extension (P < 0.0379) and abduction moments (P ≤ 0.0048) were also reduced in the dissatisfied group compared to the satisfied group.InterpretationPatients who were dissatisfied showed asymmetrical loading of the knees in conjunction, which may have contributed to their dissatisfaction. |
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