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Persistence of Altered Movement Patterns During a Sit-to-Stand Task 1 Year Following Unilateral Total Knee Arthroplasty

SJ Farquhar, PT, MPT, is a doctoral student in the Graduate Program in Biomechanics and Movement Science and the Department of Physical Therapy, University of Delaware.
DS Reisman, PT, PhD, is Assistant Professor, Department of Physical Therapy, University of Delaware.
L Snyder-Mackler, PT, ScD, SCS, ATC, FAPTA, is Professor, Department of Physical Therapy, 301 McKinly Laboratory, University of Delaware, Newark, DE 19716 (USA).

Address all correspondence to Dr Snyder-Mackler at: smack{at}udel.edu

Background and Purpose: Following total knee arthroplasty (TKA), quadriceps femoris muscle strength (force-generating capacity) and functional test scores improve but continue to be lower than those in people without injury. Analysis of the sit-to-stand (STS) task demonstrated side-to-side differences in subjects with TKA, as well as differences between subjects with TKA and control subjects. It was hypothesized that, when using a self-selected starting position, subjects 1 year following TKA would show improvements in strength and movement patterns but would continue to show asymmetries of angles and moments at the hips and knees.

Subjects and Methods: Twenty-four subjects (12 subjects with unilateral TKA and 12 control subjects) were recruited; those with TKA were tested 3 months and 1 year following surgery. Motion analysis of an STS task was synchronized with 2 force platforms and electromyography. Outcome measures included joint angles and moments, electromyography, vertical ground reaction forces, muscle strength, and functional performance tests.

Results: Subjects with TKA showed improvements in symmetry of motion, strength, and functional performance from 3 months to 1 year following TKA. Compared with control subjects, subjects with TKA relied on increased hip flexion and a larger hip extensor moment to perform the STS task.

Discussion and Conclusion: The increased hip extensor moment demonstrated that subjects adopted a strategy to avoid the use of the quadriceps femoris muscle, yet this strategy persisted as quadriceps femoris muscle strength improved. This pattern may be a learned movement pattern that may not resolve without retraining.

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