Physical Therapy Korea (한국전문물리치료학회지)

Korean Research Society of Physical Therapy (한국전문물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

A Comparison of Knee and Ankle Coronal Plane Alignment According to Quadriceps Exercise Method in Early Phase of Total Knee Arthroplasty: Lower Extremity Isometric Co-Contraction and Quadriceps Isolated Isometric Contraction

슬관절 전치환술 초기의 대퇴사두근 운동 방법에 따른 슬관절과 족관절의 관상면 정렬 비교: 하지 등척성 동시수축과 대퇴사두근 단독 등척성 수축

  • 김형수 (부산 부민병원 재활치료실) ;
  • 정영희 (부산 부민병원 재활치료실)
  • Received : 2015.11.19
  • Accepted : 2016.01.28
  • Published : 2016.02.19
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Total knee arthroplasty (TKA) recovers the alignment of the knee joint, but fails to automatically restore the alignment and function of the hip and ankle joints. It may affect the alignment and stability of the knee joint, therefore therapeutic intervention in hip and ankle joint is necessary for the rehabilitation process after TKA. Objects: The aim of this study was to comparison of the effects of the two exercise methods on the coronal plane alignment after TKA. This study conducted an experiment by dividing subjects into a lower extremity isometric co-contraction group (LEIC) and a quadriceps isolated isometric contraction (QIIC) group. Methods: A total of 37 subjects were randomly assigned to the LEIC ($n_1$=19) or the QIIC ($n_2$=18). Exercise was applied to five times per week for three weeks, starting on the eighth day after surgery. Range of motion exercises were performed as a common intervention and then each group performed quadriceps isometric contraction exercises with 10 sets of 5 repetitions. Radiological imaging was performed prior to surgery, one month and six months after surgery. In addition, the hip-knee-ankle angle (HKA) and tibiotalar angle (TTA) were measured. Results: The HKA was close to neutral in the LEIC rather than the QIIC (p<.05). The LEIC showed varus and the QIIC exhibited valgus TTA (p<.05). In a comparison of HKA and TTA over time, there was no significant change in either group (p>.05). According to the comparison of the TTA before surgery, the LEIC showed significant changes in the varus direction (p<.05), while there was no significant change in the QIIC (p>.05). Conclusion: The LEIC method triggered changes in the TTA and brought the HKA close to the neutral. Thus, LEIC is more effective than QIIC in creating stability in the coronal plane alignment of the knee and ankle joints after TKA.

Keywords

References

  1. Abu-Rajab RB, Deakin AH, Kandasami M, et al. Hip-knee-ankle radiographs are more appropriate for assessment of post-operative mechanical alignment of total knee arthroplasties than standard AP knee radiographs. J Arthroplasty. 2015;30(4):695-700. http://dx.doi.org/10.1016/j.arth. 2014.11.024
  2. Ahlback S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh). 1968; Suppl 277:7-72.
  3. Anne Reilly K, Louise Barker K, Shamley D, et al. Influence of foot characteristics on the site of lower limb osteoarthritis. Foot Ankle Int. 2006; 27(3):206-211. https://doi.org/10.1177/107110070602700310
  4. Bae SY, Kim HC, Park YS, et al. Radiologic evaluation of change of ankle joint after total knee arthroplasty. J Korean Foot Ankle Soc. 2007; 11(2):135-140.
  5. Bargren JH, Blaha JD, Freeman MA. Alignment in total knee arthroplasty: Correlated biomechanical and clinical observations. Clin Orthop Relat Res. 1983;(173):178-183.
  6. Brouwer GM, van Tol AW, Bergink AP, et al. Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum. 2007;56(4):1204-1211. https://doi.org/10.1002/art.22515
  7. Chang WD, Huang WS, Lee CL, et al. Effects of open and closed kinetic chains of sling exercise therapy on the muscle activity of the vastus medialis oblique and vastus lateralis. J Phys Ther Sci. 2014;26(9):1363-1366. http://dx.doi.org/ 10.1589/jpts.26.1363
  8. Cooke TD, Sled EA, Scudamore RA. Frontal plane knee alignment: A call for standardized measurement. J Rheumatol. 2007;34(9):1796-1801.
  9. Doets HC, Brand R, Nelissen RG. Total ankle arthroplasty in inflammatory joint disease with use of two mobile-bearing designs. J Bone Joint Surg Am. 2006;88(6):1272-1284. https://doi.org/10.2106/JBJS.E.00414
  10. Durandet A, Ricci PL, Saveh AH, et al. Radiographic analysis of lower limb axial alignments. In: Proceedings of the World Congress on Engineering. Vol. 2, 2013.
  11. Falla D, O'Leary S, Fagan A, et al. Recruitment of the deep cervical flexor muscles during a postural- correction exercise performed in sitting. Man Ther. 2007;12(2):139-143. https://doi.org/10.1016/j.math.2006.06.003
  12. Fang DM, Ritter MA, Davis KE. Coronal alignment in total knee arthroplasty: Just how important is it? J Arthroplasty. 2009;24(6 suppl):39-43. http://dx.doi.org/ 10.1016/j.arth.2009.04.034
  13. Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998;41(8):1343-1355. https://doi.org/10.1002/1529-0131(199808)41:8<1343::AID-ART3>3.0.CO;2-9
  14. Gross KD, Felson DT, Niu J, et al. Association of flat feet with knee pain and cartilage damage in older adults. Arthritis Care Res (Hoboken). 2011; 63(7):937-944. http://dx.doi.org/10.1002/acr.20431
  15. Guccione AA, Felson DT, Anderson JJ, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham study. Am J Public Health. 1994;84(3):351-358. https://doi.org/10.2105/AJPH.84.3.351
  16. Hassan BS, Mockett S, Doherty M. Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis. 2001;60(6):612-618. https://doi.org/10.1136/ard.60.6.612
  17. Hinman RS, Hunt MA, Creaby MW, et al. Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis Care Res (Hoboken). 2010; 62(8):1190-1193. http://dx.doi.org/10.1002/acr.20199
  18. Jeffery RS, Morris RW, Denham RA. Coronal alignment after total knee replacement. J Bone Joint Surg Br. 1991;73(5):709-714.
  19. Johnson F, Leitl S, Waugh W. The distribution of load across the knee. A comparison of static and dynamic measurements. J Bone Joint Surg Br. 1980;62(3):346-349.
  20. Kendall FP, McCreary EK, Provance PG, et al. Muscles: Testing and function with posture and pain. 5th ed. Baltimore, MD, Williams & Wilkins, 2005:436.
  21. Kim BS, Choi WJ, Kim YS, et al. Total ankle replacement in moderate to severe varus deformity of the ankle. J Bone Joint Surg Br. 2009;91(9):1183-1190. http://dx.doi.org/10.1302/0301-620X.91B9.22411
  22. Kim SH, Kim SY, Kim HB. The correlation between foot and knee posture characteristics in knee osteoarthritis people. J Korean Soc Phys Med. 2012;7(4):433-442. https://doi.org/10.13066/kspm.2012.7.4.433
  23. Kohls-Gatzoulis J, Angel JC, Singh D, et al. Tibialis posterior dysfunction: A common and treatable cause of adult acquired flatfoot. BMJ. 2004; 329(7478):1328-1333. https://doi.org/10.1136/bmj.329.7478.1328
  24. Kulig K, Burnfield JM, Requejo SM, et al. Selective activation of tibialis posterior: Evaluation by magnetic resonance imaging. Med Sci Sports Exerc. 2004;36(5):862-867.
  25. Lee JH, Jeong BO. Radiologic changes of ankle joint after total knee arthroplasty. Foot Ankle Int. 2012;33(12):1087-1092. http://dx.doi.org/10.3113/FAI. 2012.1087
  26. Levinger P, Menz HB, Fotoohabadi MR, et al. Foot posture in people with medial compartment knee osteoarthritis. J Foot Ankle Res. 2010;3:29. https://doi.org/10.1186/1757-1146-3-29
  27. Lotke PA, Ecker ML. Influence of positioning of prosthesis in total knee replacement. J Bone Joint Surg Am. 1977;59(1):77-79. https://doi.org/10.2106/00004623-197759010-00013
  28. Loughead JM, Malhan K, Mitchell SY, et al. Outcome following knee arthroplasty beyond 15 years. Knee. 2008;15(2):85-90. http://dx.doi.org/10.1016/ j.knee.2007.11.003
  29. Marx RG, Grimm P, Lillemoe KA, et al. Reliability of lower extremity alignment measurement using radiographs and PACS. Knee Surg Sports Traumatol Arthrosc. 2011;19(10):1693-1698. http://dx.doi.org/ 10.1007/s00167-011-1467-3
  30. McKellop HA, Llinas A, Sarmiento A. Effects of tibial malalignment on the knee and ankle. Orthop Clin North Am. 1994;25(3):415-423.
  31. McNair PJ, Depledge J, Brettkelly M, et al. Verbal encouragement: Effects on maximum effort voluntary muscle action. Br J Sports Med. 1996; 30(3):243-245. https://doi.org/10.1136/bjsm.30.3.243
  32. Meier W, Mizner RL, Marcus RL, et al. Total knee arthroplasty: Muscle impairments, functional limitations, and recommended rehabilitation approaches. J Orthop Sports Phys Ther. 2008;38(5):246-256. https://doi.org/10.2519/jospt.2008.2715
  33. Mosier SM, Pomeroy G, Manoli A 2nd. Pathoanatomy and etiology of posterior tibial tendon dysfunction. Clin Orthop Relat Res. 1999;(365):12-22.
  34. Mullaji A, Shetty GM. Persistent hindfoot valgus causes lateral deviation of weightbearing axis after total knee arthroplasty. Clin Orthop Relat Res. 2011;469(4):1154-1160. http://dx.doi.org/10.1007/ s11999-010-1703-z
  35. Mullaji AB, Shetty GM, Lingaraju AP, et al. Which factors increase risk of malalignment of the hip-knee-ankle axis in TKA? Clin Orthop Relat Res. 2013;471(1):134-141. http://dx.doi.org/10.1007/ s11999-012-2520-3
  36. Norton AA, Callaghan JJ, Amendola A, et al. Correlation of knee and hindfoot deformities in advanced knee OA: Compensatory hindfoot alignment and where it occurs. Clin Orthop Relat Res. 2015;473(1):166-174. http://dx.doi.org/ 10.1007/s11999-014-3801-9
  37. Page P, Frank C, Lardner R. Assessment and Treatment of Muscle Imbalance: The Janda approach. 1st ed. Champaign, IL, Human kinetics, 2010:32.
  38. Perry J, Davids JR. Gait analysis: Normal and pathological function. J Pediatr Orthop. 1992;12(6):815.
  39. Queen RM, Adams SB Jr, Viens NA, et al. Differences in outcomes following total ankle replacement in patients with neutral alignment compared with tibiotalar joint malalignment. J Bone Joint Surg Am. 2013;95(21):1927-1934. http://dx.doi.org/10.2106/ JBJS.L.00404
  40. Rudolph KS, Schmitt LC, Lewek MD. Age-related changes in strength, joint laxity, and walking patterns: Are they related to knee osteoarthritis? Phys Ther. 2007;87(11):1422-1432. https://doi.org/10.2522/ptj.20060137
  41. Shih HN, Shih LY, Wong YC, et al. Long-term changes of the nonresurfaced patella after total knee arthroplasty. J Bone Joint Surg Am. 2004; 86-A(5):935-939.
  42. Shyam AK, Joshi R, Patil S, et al. Hindfoot alignment variation before and after total knee arthroplasty- results of a pilot study. Journal of Orthopaedic and Rehabilitation. 2011;1(1):40-43.
  43. Tallroth K, Harilainen A, Kerttula L, et al. Ankle osteoarthritis is associated with knee osteoarthritis. Conclusions based on mechanical axis radiographs. Arch Orthop Trauma Surg. 2008;128(6):555-560. https://doi.org/10.1007/s00402-007-0502-9
  44. Tanamas S, Hanna FS, Cicuttini FM, et al. Does knee malalignment increase the risk of development and progression of knee osteoarthritis? A systematic review. Arthritis Rheum. 2009;61(4): 459-467. http://dx.doi.org/10.1002/art.24336
  45. Tetsworth K, Paley D. Malalignment and degenerative arthropathy. Orthop Clin North Am. 1994; 25(3):367-377.
  46. Thomas AC, Judd DL, Davidson BS, et al. Quadriceps/ hamstrings co-activation increases early after total knee arthroplasty. Knee. 2014;21(6):1115-1119. http://dx.doi.org/10.1016/j.knee.2014.08.001