Journal of the Korean Academy of Clinical Electrophysiology (대한임상전기생리학회지)

The Korean Academy of Clinical Electrophysiology (대한임상전기생리학회)
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Changes in Lower Extremity Joint Angles after Total Knee Replacement

무릎관절 전치환술에 따른 하지의 관절 각도 변화

  • Kim, Sang-Yeong (Department of Physical Therapy, Pohang Medical Center) ;
  • Yoon, Se-Won (Department of Physical Therapy, Kwangju Women's University)
  • 김상영 (포항의료원 물리치료실) ;
  • 윤세원 (광주여자대학교 물리치료학과)
  • Received : 2013.05.27
  • Accepted : 2013.06.17
  • Published : 2013.06.30
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Abstract

Purpose : The purpose of present study is to evaluate the joint angles of legs in the standing posture for six patients with unilateral knee osteoarthritis. Methods : The participants underwent unilateral total knee replacement. A motion analysis was used to measure the joint angles of the hip, knee, and ankle. The measurements were taken before the surgery, one week and two weeks after the surgery. Both sides of the legs were evaluated. Results : This result showed that after a certain healing period, both hip joint angles showed a significant difference while there was no significant difference in the knee and ankle joint angles. After surgery, the angle of ankle dorsiflexion was smaller on the operated side than the opposite side compared to the pre-surgery measurements. Conclusion : After surgery, the asymmetry in a standing position left unchanged due to contracture of the knee joint and tightness in the hamstring muscle. Therefore, when physiotherapists plan an initial exercise programs for TKR patients, it is essential to apply adequate exercises which consider the contracture of the leg joints.

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References

  1. Dieppe P, Basler HD, Chard J et al. Knee replacement surgery for osteoarthritis: Effectiveness, practice variations, indications and possible determinants of utilization. Rheumatology (Oxford). 1999;38(1):73-83. https://doi.org/10.1093/rheumatology/38.1.73
  2. Hochberg MC, Silman AJ, Smolen JS et al. Rheumatology, 2-volume set: Expert consultenhanced online features and print, 5th ed. Philadelphia, Mosby, 2011:1724.
  3. Altman R, Asch E, Bloch D et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and therapeutic criteria committee of the american rheumatism association. Arthritis Rheum. 1986;29(8):1039-49. https://doi.org/10.1002/art.1780290816
  4. Messier SP, Loeser RF, Hoover JL et al. Osteoarthritis of the knee: Effects on gait, strength, and flexibility. Arch Phys Med Rehabil. 1992;73(1):29-36.
  5. Huang SC, Wei IP, Chien HL et al. Effects of severity of degeneration on gait patterns in patients with medial knee osteoarthritis. Med Eng Phys. 2008;30(8):997-1003. https://doi.org/10.1016/j.medengphy.2008.02.006
  6. McGibbon CA, Krebs DE. Compensatory gait mechanics in patients with unilateral knee arthritis. J Rheumatol. 2002;29(11):2410-9.
  7. Potter PJ, Kirby RL, MacLeod DA. The effects of simulated knee-flexion contractures on standing balance. Am J Phys Med Rehabil. 1990;69(3):144-7. https://doi.org/10.1097/00002060-199006000-00009
  8. Harato K, Nagura T, Matsumoto H et al. A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome. Gait Posture. 2008;28(4):687-92. https://doi.org/10.1016/j.gaitpost.2008.05.008
  9. Campbell, Cohoon W, Canale ST. Campbell's operative orthopaedics. 10th ed. St.Louis, Mosby, 2003:223.
  10. Hatfield GL, Hubley-Kozey CL, Astephen Wilson JL et al. The effect of total knee arthroplasty on knee joint kinematics and kinetics during gait. J Arthroplasty. 2011;26(2):309-18. https://doi.org/10.1016/j.arth.2010.03.021
  11. Saari T, Tranberg R, Zugner R et al. Changed gait pattern in patients with total knee arthroplasty but minimal influence of tibial insert design: Gait analysis during level walking in 39 tkr patients and 18 healthy controls. Acta Orthop. 2005;76(2):253-60. https://doi.org/10.1080/00016470510030661
  12. Harato K, Nagura T, Matsumoto H et al. Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. J Arthroplasty. 2010;25(2):225-9. https://doi.org/10.1016/j.arth.2009.02.003
  13. Christiansen CL, Bade MJ, Weitzenkamp DA et al. Factors predicting weight-bearing asymmetry 1month after unilateral total knee arthroplasty: A crosssectional study. Gait Posture. 2012(in press).
  14. McClelland JA, Webster KE, Feller JA et al. Knee kinematics during walking at different speeds in people who have undergone total knee replacement. Knee. 2011;18(3):151-5. https://doi.org/10.1016/j.knee.2010.04.005
  15. Fitzgerald JD, Orav EJ, Lee TH et al. Patient quality of life during the 12 months following joint replacement surgery. Arthritis Rheum. 2004;51(1):100-9. https://doi.org/10.1002/art.20090
  16. Yoshida Y, Mizner RL, Ramsey DK et al. Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech (Bristol, Avon). 2008;23(3):320-8. https://doi.org/10.1016/j.clinbiomech.2007.10.008
  17. Smith AJ, Lloyd DG, Wood DJ. Pre-surgery knee joint loading patterns during walking predict the presence and severity of anterior knee pain after total knee arthroplasty. J Orthop Res. 2004;22(2):260-6. https://doi.org/10.1016/S0736-0266(03)00184-0
  18. Liebensteiner MC, Herten A, Gstoettner M et al. Correlation between objective gait parameters and subjective score measurements before and after total knee arthroplasty. Knee. 2008;15(6):461-6. https://doi.org/10.1016/j.knee.2008.07.001
  19. Moffet H, Collet JP, Shapiro SH et al. Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A single-blind randomized controlled trial. Arch Phys Med Rehabil. 2004;85(4):546-56. https://doi.org/10.1016/j.apmr.2003.08.080
  20. Harato K, Otani T, Nakayama N et al. When does postoperative standing function after total knee arthroplasty improve beyond preoperative level of function? Knee. 2009;16(2):112-5. https://doi.org/10.1016/j.knee.2008.10.008
  21. Kendall FP, McCreary EK, Provance PG. Muscles testing and function with posture and pain. 5th ed. Lippincott Willianms & Wilkins, 2005:80-3.
  22. Oatis CA. Kinesiology: The mechanics & pathomechanics of human movement. Lippincott Williams & Wilkins, 2004:106-7.
  23. Creaby MW, Bennell KL, Hunt MA. Gait differs between unilateral and bilateral knee osteoarthritis. Arch Phys Med Rehabil. 2012;93(5):822-7. https://doi.org/10.1016/j.apmr.2011.11.029
  24. Hwang SJ, Woo YK, Jeon HS. Effects of immobilization of the ankle and knee joints on postural stability in standing. Journal of the Korean Academy of University Trained Physical Therapists. 2008;15(1):30-7.
  25. Gage WH, Frank JS, Prentice SD et al. Postural responses following a rotational support surface perturbation, following knee joint replacement: Frontal plane rotations. Gait Posture. 2008;27(2):286-93. https://doi.org/10.1016/j.gaitpost.2007.04.006
  26. Valtonen A, Poyhonen T, Heinonen A et al. Muscle deficits persist after unilateral knee replacement and have implications for rehabilitation. Phys Ther. 2009;89(10):1072-9. https://doi.org/10.2522/ptj.20070295
  27. Zeni Jr J, Logerstedt D, Flowers P et al. Rehabilitation to reduce secondary osteoarthritis after total knee arthroplasty. Osteoarthritis and Cartilage. 2012;20, Supplement 1(0):S264-S265. https://doi.org/10.1016/j.joca.2012.02.444