Abstract
Total knee replacement (TKR) is commonly used to correct end-stage knee osteoarthritis. Unfortunately, difficulty with stair climbing often persists and prolongs the challenges of TKR patents. Complete understanding of loading at the knee is of great interest in order to aid patient populations, implant manufacturers, rehabilitation, and future healthcare research. Musculoskeletal modeling and simulation approximates joint loading and corresponding muscle forces during a movement. The purpose of this study was to determine if knee joint loadings following TKR are recovered to the level of healthy individuals, and determine the differences in muscle forces causing those loadings. Data from five healthy and five TKR patients were selected for musculoskeletal simulation. Variables of interest included knee joint reaction forces (JRF) and the corresponding muscle forces. A paired samples t-test was used to detect differences between groups for each variable of interest (p<0.05). No differences were observed for peak joint compressive forces between groups. Some muscle force compensatory strategies appear to be present in both the loading and push-off phases. Evidence from knee extension moment and muscle forces during the loading response phase indicates the presence of deficits in TKR in quadriceps muscle force production during stair ascent. This result combined with greater flexor muscle forces resulted in similar compressive JRF during loading response between groups.
Highlights
Total knee replacement (TKR) is commonly used to correct end-stage knee osteoarthritis (OA) of the knee joint
No significant differences were found in stair ascent velocity, knee range of motion (ROM), timed up and go (TUG), and stair ascent time between healthy controls and TKR patients (Table 2)
The peak knee extensor moment was similar in TKR patients and healthy controls (p = 0.174, Table 3)
Summary
Total knee replacement (TKR) is commonly used to correct end-stage knee osteoarthritis (OA) of the knee joint. Knee Joint Loads of TKR in Stair Ascent activities of daily living. Several studies have reported reductions in the pain after a TKR [2,3,4]. Other studies have reported disappointed patients due to post-surgery pain [5, 6] and difficulties with stair negotiation [6]. Stair climbing is a common activity of daily living, with older adults utilizing stairs as frequently as younger adults [7]. Stair climbing is utilized in all clinical recovery assessments after a TKR including the original knee society scoring system [8], the new knee society scoring system [9], and the oxford knee [10]
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