Brian J Loyd1, Jason M Jennings2, Jason R Falvey1, Raymond H Kim3, Douglas A Dennis4, Jennifer E Stevens-Lapsley5. 1. Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado. 2. Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado; Department of Mechanical and Materials Engineering, Denver University, Denver, Colorado. 3. The Steadman Clinic, Vail, Colorado; Department of Biomedical Engineering, University of Denver, Denver, Colorado; Department of Orthopedic Surgery, Marshall University, Huntington, West Virginia. 4. Colorado Joint Replacement, Porter Adventist Hospital, Denver, Colorado; Department of Mechanical and Materials Engineering, Denver University, Denver, Colorado; Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee; Department of Orthopaedics, University of Colorado School of Medicine, Denver, Colorado. 5. Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado.
Abstract
BACKGROUND: Malalignment of the lower extremity is commonly seen in patients with severe osteoarthritis undergoing total knee arthroplasty (TKA) and is believed to play a role in quadriceps strength loss. Deformity correction is typically achieved through surgical techniques to provide appropriate ligamentous balancing. Therefore, this study examined the influence of change in lower extremity alignment on quadriceps strength outcomes after TKA. METHODS: Seventy-three participants (36 male; mean age, 62 years; and mean body mass index, 29.7 kg/m2) undergoing primary unilateral TKA were used in this investigation. Before surgery and at 1 and 6 months after surgery, measures of isometric knee extensor strength, quadriceps activation, and long-standing plain films were collected. Using the films, measures of mechanical axis, distal femoral angle (DFA), proximal tibial angle, and patellofemoral angle were performed. Hierarchical linear regression was used to evaluate how change in alignment from baseline to 1 and 6 months influenced the change in quadriceps strength. RESULTS: DFA was found to significantly contribute to changes in quadriceps strength at 1 and 6 months after TKA above those contributed by associated covariates. None of the other measures of lower extremity alignment were found to contribute to quadriceps strength in this sample. CONCLUSION: Reductions in quadriceps strength experienced after TKA are likely to be influenced by changes in lower extremity alignment. Specifically, measures of DFA were found to significantly contribute to these changes. Future work is needed to prospectively examine measures of lower extremity alignment change and recovery after TKA.
BACKGROUND: Malalignment of the lower extremity is commonly seen in patients with severe osteoarthritis undergoing total knee arthroplasty (TKA) and is believed to play a role in quadriceps strength loss. Deformity correction is typically achieved through surgical techniques to provide appropriate ligamentous balancing. Therefore, this study examined the influence of change in lower extremity alignment on quadriceps strength outcomes after TKA. METHODS: Seventy-three participants (36 male; mean age, 62 years; and mean body mass index, 29.7 kg/m2) undergoing primary unilateral TKA were used in this investigation. Before surgery and at 1 and 6 months after surgery, measures of isometric knee extensor strength, quadriceps activation, and long-standing plain films were collected. Using the films, measures of mechanical axis, distal femoral angle (DFA), proximal tibial angle, and patellofemoral angle were performed. Hierarchical linear regression was used to evaluate how change in alignment from baseline to 1 and 6 months influenced the change in quadriceps strength. RESULTS:DFA was found to significantly contribute to changes in quadriceps strength at 1 and 6 months after TKA above those contributed by associated covariates. None of the other measures of lower extremity alignment were found to contribute to quadriceps strength in this sample. CONCLUSION: Reductions in quadriceps strength experienced after TKA are likely to be influenced by changes in lower extremity alignment. Specifically, measures of DFA were found to significantly contribute to these changes. Future work is needed to prospectively examine measures of lower extremity alignment change and recovery after TKA.
Authors: Douglas A Dennis; Andrew J Kittelson; Charlie C Yang; Todd M Miner; Raymond H Kim; Jennifer E Stevens-Lapsley Journal: Clin Orthop Relat Res Date: 2016-01 Impact factor: 4.176
Authors: Jennifer E Stevens-Lapsley; Michael J Bade; Benjamin C Shulman; Wendy M Kohrt; Michael R Dayton Journal: J Arthroplasty Date: 2012-03-28 Impact factor: 4.757
Authors: Whitney Meier; Ryan L Mizner; Robin L Marcus; Leland E Dibble; Christopher Peters; Paul C Lastayo Journal: J Orthop Sports Phys Ther Date: 2007-12-14 Impact factor: 4.751
Authors: Brian J Loyd; Scott Stackhouse; Michael Dayton; Craig Hogan; Michael Bade; Jennifer Stevens-Lapsley Journal: Knee Date: 2019-02-14 Impact factor: 2.199