Strength, Mobility, Function and Balance After a Total Knee Arthroplasty
Breena Berkland , SPT, CSCS; Michelle Claassen, SPT; Ethan Custer, SPT, CSCS; Emily Moehlmann, SPT; Brian Olmstead, SPT, CSCS
Faculty Mentors: Mohamed Kohia, PT, Ph.D., MS
Purpose/Hypothesis: The purpose of this study is to further follow up on the results of total knee arthroplasty (TKA) by comparing strength and range of motion between operative and non-operative lower extremities as well as measure balance and functional performance in patients after TKA. It was hypothesized that there will be no difference between the operative and non-operative extremities with regards to strength, range of motion, and balance. In addition, subjects post TKA will not show any functional deficits.
Subjects: A total of 19 subjects between the ages of 40 and 79, both male and female, who underwent a primary unilateral TKA were tested to compare their operative knee to their non-operative knee.
Methods: Bilateral knee flexion and extension range of motion as well as bilateral hamstring and quadriceps strength were assessed. Anticipatory, reactive, sensory, and dynamic balance were assessed using the mini-BEST test. The WOMAC questionnaire was administered to assess subject’s functional performance.
Results: There was no statistically significant difference in quadriceps (P=.531) and hamstrings (P=.076) strength between the operative and non-operative legs. There was a statistically significant difference between knee flexion (P=.000) and extension (P=.054) range of motion in the operative and non-operative legs with greater range of motion on the non-operative side. The average flexion range of motion on the non-operative and operative sides were 130.5 degrees (±8.78) and 111.9 degrees (±12.43) respectively. The average extension range of motion on the non-operative and operative sides were 1.37 (±1.4) degrees and 3.16 (±3.9) degrees respectively. The average total score on the mini-best test was a 23.16 (±1.83), with greatest deficit noted in the anticipatory subcategory. The average total score on the WOMAC was a 27.16 (±17.84), with the highest self-reported impairment in the stiffness subcategory.
Conclusions: The most significant impairment for patients post TKA was knee range of motion on the operative leg. There was no statistically significant difference in strength between operative and non-operative sides. Patients were found to have residual deficits in balance and function after TKA. However, when compared to age normative values, the subjects’ scores fell within the age predicted range for the mini-best and the WOMAC.
Clinical relevance: Based on the results of this study, it is recommended that physical therapists should focus more on range of motion, balance, and functional deficits in order to return patients to the highest level of functioning. Since patients had the most deficits in anticipatory balance this should be a target of balance training in patients after TKA. Additionally, patients had the most concerns about stiffness on the WOMAC, therefore, therapists should use interventions that target patient stiffness.
Breena Berkland , SPT, CSCS; Michelle Claassen, SPT; Ethan Custer, SPT, CSCS; Emily Moehlmann, SPT; Brian Olmstead, SPT, CSCS
Faculty Mentors: Mohamed Kohia, PT, Ph.D., MS
Purpose/Hypothesis: The purpose of this study is to further follow up on the results of total knee arthroplasty (TKA) by comparing strength and range of motion between operative and non-operative lower extremities as well as measure balance and functional performance in patients after TKA. It was hypothesized that there will be no difference between the operative and non-operative extremities with regards to strength, range of motion, and balance. In addition, subjects post TKA will not show any functional deficits.
Subjects: A total of 19 subjects between the ages of 40 and 79, both male and female, who underwent a primary unilateral TKA were tested to compare their operative knee to their non-operative knee.
Methods: Bilateral knee flexion and extension range of motion as well as bilateral hamstring and quadriceps strength were assessed. Anticipatory, reactive, sensory, and dynamic balance were assessed using the mini-BEST test. The WOMAC questionnaire was administered to assess subject’s functional performance.
Results: There was no statistically significant difference in quadriceps (P=.531) and hamstrings (P=.076) strength between the operative and non-operative legs. There was a statistically significant difference between knee flexion (P=.000) and extension (P=.054) range of motion in the operative and non-operative legs with greater range of motion on the non-operative side. The average flexion range of motion on the non-operative and operative sides were 130.5 degrees (±8.78) and 111.9 degrees (±12.43) respectively. The average extension range of motion on the non-operative and operative sides were 1.37 (±1.4) degrees and 3.16 (±3.9) degrees respectively. The average total score on the mini-best test was a 23.16 (±1.83), with greatest deficit noted in the anticipatory subcategory. The average total score on the WOMAC was a 27.16 (±17.84), with the highest self-reported impairment in the stiffness subcategory.
Conclusions: The most significant impairment for patients post TKA was knee range of motion on the operative leg. There was no statistically significant difference in strength between operative and non-operative sides. Patients were found to have residual deficits in balance and function after TKA. However, when compared to age normative values, the subjects’ scores fell within the age predicted range for the mini-best and the WOMAC.
Clinical relevance: Based on the results of this study, it is recommended that physical therapists should focus more on range of motion, balance, and functional deficits in order to return patients to the highest level of functioning. Since patients had the most deficits in anticipatory balance this should be a target of balance training in patients after TKA. Additionally, patients had the most concerns about stiffness on the WOMAC, therefore, therapists should use interventions that target patient stiffness.