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Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty.

ABSTRACT: Although total knee arthroplasty improves functional mobility in persons with end-stage knee osteoarthritis, many subjects have reported continued difficulty with stair ascent and descent after surgery. The purpose of the present study was to determine preoperative predictors of handrail use during stair ascent and descent following primary unilateral total knee arthroplasty.One hundred and five adults who were scheduled for unilateral total knee arthroplasty participated in the study. Postoperative handrail use during stair ascent or descent was predicted on the basis of preoperative functional measures. Preoperative age, body mass index, knee strength, knee flexion active range of motion, Knee Outcome Survey scores, time to complete a stair-climbing task, and previous handrail use were entered as covariates into a binary logistic regression. Forward logistic regression was performed to determine which preoperative factors best predicted handrail use at three months and two years after surgery. Handrail use in a control group was also evaluated at baseline and at the time of the two-year follow-up.Prior to surgery, sixty-three of the 105 subjects required a handrail. Two years after surgery, sixty of the 105 subjects required a handrail. In the control group, nineteen of the sixty-four subjects required a handrail at baseline and ten of thirty-one required a handrail at the time of the two-year follow-up. At two years, the preoperative ability to ascend and descend stairs without a handrail was the best predictor of individuals who would not require a handrail after surgery, followed by younger age and greater quadriceps strength. Collectively, these variables correctly predicted the ability of ninety of 105 persons to negotiate stairs without a handrail at two years after surgery (p < 0.001).Younger, stronger patients who do not use a handrail prior to unilateral total knee arthroplasty can expect the best outcomes in terms of ascending and descending stairs following surgery. This information may provide patients with more realistic expectations after surgery and allow them to make more appropriate discharge plans.

SUBMITTER: Zeni JA

PROVIDER: S-EPMC2859903 | biostudies-literature | 2010 May

REPOSITORIES: biostudies-literature

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Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty.

Zeni Joseph A JA Snyder-Mackler Lynn L

The Journal of bone and joint surgery. American volume 20100501 5

<h4>Background</h4>Although total knee arthroplasty improves functional mobility in persons with end-stage knee osteoarthritis, many subjects have reported continued difficulty with stair ascent and descent after surgery. The purpose of the present study was to determine preoperative predictors of handrail use during stair ascent and descent following primary unilateral total knee arthroplasty.<h4>Methods</h4>One hundred and five adults who were scheduled for unilateral total knee arthroplasty p ...[more]

PMID: 20439658

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Project description:PurposeTo investigate the differences of patellofemoral joint pressure and contact area between the process of stair ascent and stair descent.MethodsThe finite element models of 9 volunteers without disorders of knee (9 males) to estimate patellar cartilage pressure during the stair ascent and the stair descent. Simulations took into account cartilage morphology from magnetic resonance imaging, joint posture from weight-bearing magnetic resonance imaging, and ligament model. The three-dimension models of the patella, femur and tibia were developed with the medical image processing software, Mimics 11.1. The ligament was established by truss element of the non-linear FE solver. The equivalent gravity direction (-z direction) load was applied to the whole end of femur (femoral head) according to the body weight of the volunteers, and the force of patella was observed. A paired-samples t-test or Wilcoxon rank sum test to make comparisons between stair ascent and stair descent. Statistical analyses were performed using SPSS 22.0 using a P value of 0.05 to indicate significance.ResultsDuring the stair descent (knee flexion at 30°), the contact pressure of the patella was 2.59 ± 0.06Mpa. The contact pressure of femoral trochlea cartilage was 2.57 ± 0.06Mpa. During the stair ascent (knee flexion at 60°), the contact pressure with patellar cartilage was 2.82 ± 0.08Mpa. The contact pressure of the femoral trochlea cartilage was 3.03 ± 0.11Mpa. The contact area between patellar cartilage and femoral trochlea cartilage was 249.27 ± 1.35mm2 during the stair descent, which was less than 434.32 ± 1.70mm2 during the stair ascent. The area of high pressure was located in the lateral area of patella during stair descent and the area of high pressure was scattered during stair ascent.ConclusionThere are small change in the cartilage contact pressure between stair ascent and stair descent, indicating that the joint adjusts the contact pressure by increasing the contact area.

Dataset Information

Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty.

Publications

Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty.

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