Longitudinal study of knee load avoidant movement behavior after total knee arthroplasty with recommendations for future retraining interventions |
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| Affiliation: | 1. University of Utah, Department of Physical Therapy & Athletic Training, 520 Wakara Way, Salt Lake City, UT 84108, United States;2. University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108, United States;3. University of Montana, School of Physical Therapy & Rehabilitation Science, Missoula, MT, United States;1. Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore;2. Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK;1. Dept. Trauma Surgery, University Hospital Leuven, KU Leuven - University of Leuven, Leuven, Belgium;2. Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands;3. University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, the Netherlands;4. Klinik für Orthopädie und Unfallchirurgie, LUKS Luzern, Switzerland;5. VU Brussel - Free University of Brussels, Department of Orthopedics and Traumatology, Belgium;1. Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 Alcazar St., CPH 155, Los Angeles, CA 90266, United States;2. Department of Physical Therapy, University of Delaware, United States;3. Department of Orthopaedics and Rehabilitation Services, Christiana Health Care System, United States;1. Department of Trauma and Orthopaedic Surgery, Barnet Hospital, Royal Free London NHS Trust, United Kingdom;2. Department of Trauma and Orthopaedic Surgery, Imperial College Healthcare NHS Trust, United Kingdom;3. Department of Trauma and Orthopaedic Surgery, London North West University Healthcare NHS Trust, United Kingdom |
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| Abstract: | BackgroundThis study aimed to evaluate clinical and biomechanical changes in self-report survey, quadriceps strength and gait analysis over 3- and 6-months post-total knee arthroplasty (TKA) and confirm the immediate effects of two forms of kinetic biofeedback on improving inter-limb biomechanics during a physically demanding decline walking task.MethodsThirty patients with unilateral TKA underwent testing at 3- and 6-months following surgery. All underwent self-report survey, quadriceps strength and gait analysis testing. Patients were assigned to one of two types of biofeedback [vertical ground reaction force (vGRF), knee extensor moment (KEM)].ResultsNo decrease in gait asymmetry was observed in non-biofeedback trials over time (p > 0.05), despite significant improvements in self-report physical function (p < 0.01, Cohen d = 0.44), pain interference (p = 0.01, Cohen d = 0.68), numeric knee pain (p = 0.01, Cohen d = 0.74) and quadriceps strength (p = 0.01, Cohen d = 0.49) outcomes. KEM biofeedback induced significant decrease in total support moment (p = 0.05, Cohen f2 = 0.14) and knee extensor moment (p = 0.05, Cohen f2 = 0.21) asymmetry compared to using vGRF biofeedback at 6-months. vGRF biofeedback demonstrated significant decrease in hip flexion kinematic asymmetry compared to KEM biofeedback (p = 0.05, Cohen f2 = 0.18) at 6-months.ConclusionGait compensation remained similar from 3- to 6-months during a task requiring greater knee demand compared to overground walking post-TKA, despite improvements in self-report survey and quadriceps strength. Single session gait symmetry training at 6-month supports findings at 3-month testing that motor learning is possible. KEM biofeedback is more effective at immediately improving joint kinetic loading compared to vGRF biofeedback post-TKA. |
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| Keywords: | Total knee arthroplasty Biofeedback Gait analysis Clinical, biomechanics |
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