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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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References

Centers for Disease Control National Center for Health Statistics, “FastStats: Inpatient Surgery,” accessed September 28, 2012, http://www.cdc.gov/nchs/fastats/insurg.htm
Healy, W. L., Sanjeev, S., Schwartz, B., and Iorio, R., 2008, “Athletic Activity After Total Joint Arthroplasty,” J. Bone Jt. Surg. Am. Vol., 90, pp. 2245–2252. [CrossRef]
Del Gaizo, D. J., and Della Valle, C. J., 2011, “Instability in Primary Total Knee Arthroplasty,” Orthopedics, 34(9), pp. e519–e521. [PubMed]
Callaghan, J. J., O'Rourke, M. R., and Saleh, K. J., 2004, “Why Knees Fail: Lesson Learned,” J. Arthroplasty, 19(4–1), pp. 31–34. [CrossRef] [PubMed]
Vince, K. G., Abdeen, A., and Sugimori, T., 2006, “The Unstable Total Knee Arthroplasty: Causes and Cures,” J. Arthroplasty, 21(4–1), pp. 44–49. [CrossRef] [PubMed]
Parratte, S., and Pagnano, M. W., 2008, “Instability After Total Knee Arthroplasty,” J. Bone Jt. Surg. Am. Vol., 90(1), pp. 184–194. Available at: http://jbjs.org/article.aspx?articleid=28421
Segal, A. D., Orendurff, M. S., Czerniecki, J. M., Shofer, J. B., and Klute, G. K., 2008, “Local Dynamic Stability in Turning and Straight-Line Gait,” J. Biomech., 41, pp. 1486–1493. [CrossRef] [PubMed]
Hurd, W. J., and Snyder-Mackler, L., 2007, “Knee Instability After Acute ACL Rupture Affects Movement Patterns During the Mid-Stance Phase of Gait,” J. Orthop. Res., 25(10), pp. 1369–1377. [CrossRef] [PubMed]
Benoit, D. L., Ramsey, D. K., Lamontagne, M., Xu, L., Wrentenberg, P., and Renstrom, P., 2007, “In Vivo Knee Kinematics During Gait Reveals New Rotation Profiles and Smaller Translations,” Clin. Orthop. Relat. Res., 454, pp. 81–88. [CrossRef] [PubMed]
Byrne, J. M., and Prentice, S. D., 2003, “Swing Phase Kinetics and Kinematics of Knee Replacement Patients During Obstacle Avoidance,” Gait and Posture, 18, pp. 95–104. [CrossRef] [PubMed]
Smith, A. J., Lloyd, D. G., and Wood, D. J., 2004, “Presurgery Knee Joint Loading Patterns During Walking Predict the Presence and Severity of Anterior Knee Pain After Total Knee Arthroplasty,” J. Orthop. Res., 22, pp. 260–266. [CrossRef] [PubMed]
McClelland, J. A., Webster, K. E., and Feller, J. A., 2007, “Gait Analysis of Patients Following Total Knee Replacement: A Systematic Review,” The Knee, 14, pp. 253–263. [CrossRef] [PubMed]
Christiansen, C. L., Bade, M. J., Judd, D. L., and Stevens-Lapsley, J. E., 2011, “Weight-Bearing Asymmetry During Sit-Stand Transitions Related to Impairment and Functional Mobility After Total Knee Arthroplasty,” Arch. Phys. Med. Rehabil., 92, pp. 1624–1629. [CrossRef] [PubMed]
D'Lima, D. D., Patil, S., Steklov, N., Slamin, J. E., and Colwell, C. W., 2006, “Tibial Forces Measured In Vivo After Total Knee Arthroplasty,” J. Arthroplasty, 21, pp. 255–262. [CrossRef] [PubMed]
Mundermann, A., Dyrby, C. O., D'Lima, D. D., Colwell, C. W., and Andriacchi, T. P., 2008, “In Vivo Knee Loading Characteristics During Activities of Daily Living as Measured by an Instrumented Total Knee Replacement,” J. Orthop. Res., 26, pp. 1167–1172. [CrossRef] [PubMed]
Zhao, D., Banks, S. A., D'Lima, D. D., Colwell, C. W., and Fregly, B. J., 2007, “In Vivo Medial and Lateral Tibial Loads During Dynamic and High Flexion Activities,” J. Orthop. Res., 25, pp. 593–602. [CrossRef] [PubMed]
D'Lima, D. D., Steklov, B. S., Patil, S., and Colwell, C. W., 2008, “In Vivo Knee Forces During Recreation and Exercise After Knee Arthroplasty,” Clin. Orthop. Relat. Res., 466, pp. 2605–2611. [CrossRef] [PubMed]
Moisio, K. C., Sumner, D. R., Shott, S., and Hurwitz, D. E., 2003, “Normalization of Joint Moments During Gait: A Comparison of Two Techniques,” J. Biomech., 36(4), pp. 599–603. [CrossRef] [PubMed]
Rossi, M. D., Eberle, T., Roche, M., Wong, M. L., Waggoner, M. R., Blake, R., Burwell, B., and Baxter, A., 2011, “Squatting After Primary Unilateral Total Knee Arthroplasty: A Pilot Study Examining Differences Between Genders,” PM+R, Jnl Injury, Function, and Rehabilitation, 3, pp. 613–618. [CrossRef]
Yoshida, Y., Mizner, R., Ramsey, D. K., and Snyder-Mackler, L., 2008, “Examining Outcomes From Total Knee Arthroplasty and the Relationship Between Quadriceps Strength and Knee Function Over Time,” Clin. Biomech., 23, pp. 320–328. [CrossRef]
Mandeville, D., Osternig, L. R., and Chou, L. S., 2008, “The Effect of Total Knee Replacement Surgery on Gait Stability,” Gait and Posture, 27(1), pp. 103–109. [CrossRef] [PubMed]
Chatterji, U., Ashworth, M. J., Lewis, P., and Dobson, P., 2005, “Effect of Total Knee Arthroplasty on Recreational and Sporting Activity,” Aust. N. Z. J. Surg., 75, pp. 405–408. [CrossRef]
Wylde, V., Blom, A., Dieppe, P., Hewlett, S., and Learmonth, I., 2008, “Return to Sport After Joint Replacement,” J. Bone Jt. Surg., 90-B, pp. 920–923. [CrossRef]
Motion Lab System, Inc., “Knee Alignment Device: User Manual,” Motion-labs.com, 1998, accessed 09/24/2012, http://www.motion-labs.com/pdf/kneealignment_ug.pdf
Henmi, S., Yonenobu, K., Masatomi, T., and Oda, K., 2006, “A Biomechanical Study of Activities of Daily Living Using Neck and Upper Limb With an Optical Three-Dimensional Motion Analysis System,” Mod. Trends Rheumatol., 16, pp. 289–293. [CrossRef]
Rossi, M. D., Hasson, S., Kohia, M., Pineda, E., and Bryan, W., 2006, “Mobility and Perceived Function After Total Knee Arthroplasty,” J. Arthroplasty, 21, pp. 6–12. [CrossRef] [PubMed]
Oakeshott, R., Stiehl, J. B., Komistek, R. A., Anderson, D. T., and Haas, B. D., 2003, “Kinematic Analysis of a Posterior Cruciate Retaining Mobile-Bearing Total Knee Arthroplasty,” J. Arthroplasty, 18(8), pp. 1029–1037. [CrossRef] [PubMed]
Yercan, H. S., Ait Si Selmi, T., Sugun, T. S., and Neyret, P., 2001, “Tibiofemoral Instability in Primary Total Knee Replacement: A Review, Part 1: Basic Principles and Classification,” The Knee, 12, pp. 257–266. [CrossRef]
Wu, C., Wong, M., Lin, K., and Chen, H., 2001, “Effects of Task Goal and Personal Preference on Seated Reaching Kinematics After Stroke,” Stroke, 32, pp. 70–79. [CrossRef] [PubMed]
Houck, J. R., Duncan, A., and De Haven, K., 2006, “Comparison of Frontal Plane Trunk Kinematics and Hip and Knee Moments During Anticipated and Unanticipated Walking and Side Cutting Tasks,” Gait and Posture, 24, pp. 314–322. [CrossRef] [PubMed]
Zurcher, A. W., Wolterbeek, N., Harlaar, J., and Poll, R. G., 2008, “Knee Rotation During a Weight Bearing Activity: Influence of Turning,” Gait and Posture, 28, pp. 472–477. [CrossRef] [PubMed]
Harato, K., Nagura, T., Matsumoto, H., Otani, T., Toyama, Y., and Suda, Y., 2010, “Extension Limitation in Standing Affects Weight-Bearing Asymmetry After Unilateral Total Knee Arthroplasty,” J. Arthroplasty, 25, pp. 225–229. [CrossRef] [PubMed]
Milner, C. E., 2008, “Interlimb Asymmetry During Walking Following Unilateral Total Knee Arthroplasty,” Gait and Posture, 28, pp. 69–73. [CrossRef] [PubMed]
Walsh, M., Woodhouse, L. J., Thomas, S. G., and Finch, E., 1998, “Physical Impairments and Functional Limitations: A Comparison of Individuals 1 Year After Total Knee Arthroplasty With Control Subjects,” Phys. Ther, 78, pp. 248–258. Available at: http://ptjournal.apta.org/content/78/3/248.long [PubMed]
Mizner, R. L., and Snyder-Mackler, L., 2005, “Altered Loading During Walking and Sit-to-Stand is Affected by Quadriceps Weakness After Total Knee Arthroplasty,” J. Orthop. Res., 23, pp. 1083–1090. [CrossRef] [PubMed]
Shakoor, N., Block, J. A., Shott, S., and Case, J. P., 2002, “Nonrandom Evolution of Endstage Osteoarthritis of the Lower Limbs,” Arthritis Rheum., 46, pp. 3185–3189. [CrossRef] [PubMed]
McClelland, J., Zeni, J., Haley, R. M., and Snyder-Mackler, L., 2012, “Functional and Biomechanical Outcomes After Using Biofeedback for Retraining Symmetrical Movement Patterns After Total Knee Arthroplasty: A Case Report,” J. Orthop. Sports Phys. Ther., 42(2), pp. 135–144. [CrossRef] [PubMed]
Wilson, S. A., McCann, P. D., Gotlin, R. S., Ramakrishnan, H. K., Wootten, M. E., and Insall, J. N., 1996, “Comprehensive Gait Analysis in Posterior-Stabilized Knee Arthroplasty,” J. Arthroplasty, 11(4), pp. 359–367. [CrossRef] [PubMed]
Shakoor, N., Hurwitz, D. E., Block, J. A., Shott, S., and Case, J. P., 2003, “Asymmetric Knee Loading in Advanced Unilateral Hip Osteoarthritis,” Arthritis Rheum., 48, pp. 1556–1561. [CrossRef] [PubMed]
Lo, J., Müller, O., Dilger, T., Wülker, N., and Wünschel, M., 2010, “Translational and Rotational Knee Joint Stability in Anterior and Posterior Cruciate-Retaining Knee Arthroplasty,” The Knee, 18, pp. 491–495. [CrossRef] [PubMed]
Stoddard, J. E., Deehan, D. J., Bull, A. M. J., ScCaskie, A. W., and Amis, A. A., 2012, “The Kinematics and Stability of Single-Radius versus Multi-Radius Femoral Components Related to Mid-Range Instability After TKA,” J. Orthop. Res., 31(1), pp. 1–6.
Firestone, T. P., and Eberle, R. W., 2006, “Surgical Management of Symptomatic Instability Following Failed Primary Total Knee Replacement,” J. Bone Jt. Surg. Am. Vol., 88(4), pp. 80–84. [CrossRef]
McPherson, E. J., Cuckler, J., and Lombardi, A. V., 2008, “Midflexion Instability in Revision Total Knee Arthroplasty,” Surg. Technol. Int., 17, pp. 249–252. [PubMed]

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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