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Quadriceps strength asymmetry predicts loading asymmetry during sit-to-stand task in patients with unilateral total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to examine interlimb differences in muscle strength and sit-to-stand (STS) kinetics in persons who underwent unilateral total knee arthroplasty (TKA) and to determine whether knee pain, quadriceps or hip abductor weakness contributes to altered STS performance. It was hypothesized that the operated limb would have weaker muscles, lower mechanical loading and that operated knee pain and muscle strength symmetry would predict loading symmetry between limbs during STS.

Methods

One hundred and forty-two patients, 6 or 12 months post-unilateral TKA, underwent 3D motion analysis (VICON) of the STS task and isometric strength testing of the quadriceps and hip abductors. Knee pain was also quantified using a question from the Knee Outcome Survey-Activities of Daily Living Scale.

Results

The operated limb had weaker quadriceps (P < 0.001), lower hip (P = 0.004) and knee extension moments (P < 0.001), and lower vertical ground reaction forces (P < 0.001). Operated knee pain and quadriceps strength symmetry were related to symmetry in knee extension moment (P < 0.04), and vertical ground reaction forces (P < 0.02) 6 months after surgery, while quadriceps strength symmetry was related to symmetry in vertical ground reaction forces (P = 0.03), 1 year after surgery.

Conclusion

Patients with unilateral TKA unload the operated limb and shift the mechanical load to the joints of the contralateral limb even 1 year after surgery. Knee pain and quadriceps strength asymmetry may play a role in the asymmetrical loading during STS post-TKA. Clinicians should consider addressing these modifiable impairments to resolve the loading asymmetry.

Level of evidence

III.

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Acknowledgments

This study was supported by the National Institute of Health grants (P20RR016458, S10RR022396). The authors extend their appreciation to the College of Applied Medical Sciences Research Center and the Deanship of Scientific Research at King Saud University for funding Dr. Alnahdi’s participation in this research.

Author information

Authors and Affiliations

  1. Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia

    Ali H. Alnahdi

  2. Department of Physical Therapy, University of Delaware, Newark, DE, USA

    Joseph A. Zeni & Lynn Snyder-Mackler

Authors
  1. Ali H. Alnahdi
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  2. Joseph A. Zeni
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  3. Lynn Snyder-Mackler
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Corresponding author

Correspondence to Ali H. Alnahdi.

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The authors declare that they have no conflict of interest.

Additional information

The study was approved by the Human Subjects Review Board at the University of Delaware.

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Alnahdi, A.H., Zeni, J.A. & Snyder-Mackler, L. Quadriceps strength asymmetry predicts loading asymmetry during sit-to-stand task in patients with unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24, 2587–2594 (2016). https://doi.org/10.1007/s00167-015-3827-x

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  • DOI: https://doi.org/10.1007/s00167-015-3827-x

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