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Research Papers

Strategies Utilized to Transfer Weight During Knee Flexion and Extension With Rotation for Individuals With a Total Knee Replacement

[+] Author and Article Information
Lauren A. Ferris

Department of Mechanical Engineering,
University of Kansas,
Lawrence, Kansas 66045
e-mail: lferris@ku.edu

Linda M. Denney

Department of Physical Therapy and Rehabilitation Science,
University of Kansas Medical Center,
Kansas City, Kansas 66105
e-mail: ldenney@kumc.edu

Lorin P. Maletsky

Department of Mechanical Engineering,
University of Kansas,
Lawrence, Kansas 66045
e-mail: maletsky@ku.edu

Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received October 1, 2012; final manuscript received January 7, 2013; accepted manuscript posted January 18, 2013; published online February 7, 2013. Editor: Beth Winkelstein.

J Biomech Eng 135(2), 021020 (Feb 07, 2013) (7 pages) Paper No: BIO-12-1450; doi: 10.1115/1.4023385 History: Received October 01, 2012; Revised January 07, 2013; Accepted January 18, 2013

Functional activities in daily life can require squatting and shifting body weight during transverse plane rotations. Stability of the knee can be challenging for people with a total knee replacement (TKR) due to reduced proprioception, nonconforming articular geometry, muscle strength, and soft tissue weakness. The objective of this study was to identify strategies utilized by individuals with TKR in double-stance transferring load during rotation and flexion. Twenty-three subjects were recruited for this study: 11 TKR subjects (age: 65 ± 6 years; BMI 27.4 ± 4.1) and 12 healthy subjects (age: 63 ± 7; BMI 24.6 ± 3.8). Each subject completed a novel crossover button push task where rotation, flexion, and extension of the knee were utilized. Each subject performed two crossover reaching tasks where the subject used the opposite hand to cross over their body and press a button next to either their shoulder (high) or knee (low), then switched hands and rotated to press the opposite button, either low or high. The two tasks related to the order they pressed the buttons while crossing over, either low-to-high (L2H) or high-to-low (H2L). Force platforms measured ground reaction forces under each foot, which were then converted to lead force ratios (LFRs) based on the total force. Knee flexion angles were also measured. No statistical differences were found in the LFRs during the H2L and L2H tasks for the different groups, although differences in the variation of the loading within subjects were noted. A significant difference was found between healthy and unaffected knee angles and a strong trend between healthy and affected subject's knee angles in both H2L and L2H tasks. Large variations in the LFR at mid-task in the TKR subjects suggested possible difficulties in maintaining positional stability during these tasks. The TKR subjects maintained more of an extended knee, which is a consistent quadriceps avoidance strategy seen by other researchers in different tasks. These outcomes suggest that individuals with a TKR utilize strategies, such as keeping an extended knee, to achieve rotary tasks during knee flexion and extension. Repeated compensatory movements could result in forces that may cause difficulty over time in the hip joints or low back. Early identification of these strategies could improve TKR success and the return to activities of daily living that involve flexion and rotation.

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Figures

Grahic Jump Location
Fig. 1

Equipment set up. Subject performing a low to high (L2H) sequence. The subject performs this sequence three times. Button positions are indicated with circles.

Grahic Jump Location
Fig. 2

Sequence of both high to low (H2L) and low to high (L2H) that the subjects performed

Grahic Jump Location
Fig. 3

(a) Mean lead force ratio and (b) knee flexion angle throughout a H2L activity, and (c) mean lead force ratio and (d) knee flexion angle throughout a L2H activity. Shaded areas indicate a ±1 standard deviation. Black vertical lines indicate where the subject is at 10%, right after the first button push, and 90%, right before the second button push. The horizontal black line indicates when the subject has 0.5 LFR, or an equal distribution of weight. A single factor ANOVA was performed at each black line. (The * denotes unaffected statistically significant (p < 0.05) from healthy. The † denotes unaffected statistically significant (p < 0.05) from affected.)

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