Preoperative asymmetry in load distribution during quite stance persist following total knee arthroplasty

  • Dominic Thewlis
  • Susan Hillier
  • Sarah Jane Hobbs
  • Jim Richards



Preoperative function has been shown to persist posttotal knee arthroplasty. However, it remains unclear whether asymmetries are task specific. Therefore, we investigated postoperative asymmetries in loading during quiet stance and walking gait.


Ten patients with end-stage knee osteoarthritis scheduled for total knee arthroplasty were studied at baseline (preoperative), 6-week, 3- and 6-month postoperative. Load distribution and balance were quantified during quiet stance. Furthermore, dynamic loading was quantified during walking gait. Patient satisfaction was assessed using the Knee Osteoarthritis and injury Outcome Score.


Preoperatively, load distribution was significantly different between limbs, with approximately 70 % of the load through the contralateral or ‘good’ side. Asymmetries persisted and up to 6-month postoperative during quiet stance. No significant change was found in balance. During walking, preoperative loading asymmetry was present; however, no significant postoperative loading asymmetries were identified.


Total knee arthroplasty does not appear to significantly change load distribution or balance 6-month postoperative during quiet stance; however, during walking gait, symmetry appears to be restored. This could be potentially improved through enhanced rehabilitation.

Level of evidence

Therapeutic study, Level IV.


Postoperative asymmetry Weight distribution Total knee arthroplasty Function 


  1. 1.
    Badley E (1995) The impact of disabling arthritis. Arthritis Rheum 8:221–228CrossRefGoogle Scholar
  2. 2.
    Cho SD, Hwang CH (2012) Improved single-limb balance after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2144-x PubMedCentralGoogle Scholar
  3. 3.
    Gage W, Frank J, Prentice S (2008) Postural responses following a rotational support surface perturbation, following knee joint replacement: frontal plane rotations. Gait Posture 27:286–293PubMedCrossRefGoogle Scholar
  4. 4.
    Gauchard GC, Vançon G, Meyer P, Mainard D, Perrin PP (2010) On the role of knee joint in balance control and postural strategies: effects of total knee replacement in elderly subjects with knee osteoarthritis. Gait Posture 32:155–160PubMedCrossRefGoogle Scholar
  5. 5.
    Gerber H, Stuessi E (1987) A measuring system to assess and to compute the double stride. Biomech X-B Int Ser Biomech 24:1055–1085Google Scholar
  6. 6.
    Kee CC (2000) Osteoarthritis: manageable scourge of aging. Nurs Clin North Am 35:199–208PubMedGoogle Scholar
  7. 7.
    Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedCrossRefGoogle Scholar
  8. 8.
    Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ (2009) Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat R 467:2606–2612CrossRefGoogle Scholar
  9. 9.
    Levinger P, Menz HB, Morrow AD, Perrott MA, Bartlett JR, Feller JA, Bergman N (2011) Knee biomechanics early after knee replacement surgery predict abnormal gait patterns 12 months postoperatively. J Orthop Res 30:371–376PubMedCrossRefGoogle Scholar
  10. 10.
    Levinger P, Menz HB, Morrow AD, Wee E, Feller JA, Bartlett JR, Bergman N (2011) Lower limb proprioception deficits persist following knee replacement surgery despite improvements in knee extension strength. Knee Surg Sports Traumatol Arthrosc 8:1097–1103Google Scholar
  11. 11.
    Maki B, Holliday P (1994) A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol 49:M72–M84PubMedCrossRefGoogle Scholar
  12. 12.
    McClelland J, Webster K, Feller J (2007) Gait analysis of patients following total knee replacement: a systematic review. Knee 14:253–263PubMedCrossRefGoogle Scholar
  13. 13.
    Rasch A, Dalén N (2010) Muscle strength, gait, and balance in 20 patients with hip osteoarthritis followed for 2 years after THA. Acta Orthop 81:183–188PubMedCrossRefGoogle Scholar
  14. 14.
    Roos EM, Toksvig-Larsen S (2003) Knee injury and Osteoarthritis Outcome Score (KOOS)—validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes 1:17PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Shakoor N, Block J, Shott S (2002) Nonrandom evolution of end-stage osteoarthritis of the lower limbs. Arthritis Rheum 46:3185–3189PubMedCrossRefGoogle Scholar
  16. 16.
    Terwee CB, van der Slikke RMA, van Lummel RC, Benink RJ, Meijers WGH, de Vet HCW (2006) Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients. J Clin Epidemiol 59:724–731PubMedCrossRefGoogle Scholar
  17. 17.
    Winter D, Prince F, Frank J, Powell C, Zabjek K (1996) Unified theory regarding A/P and M/L balance in quiet standing. J Neurophysiol 23:2334–2343Google Scholar
  18. 18.
    (2011) MATLAB 2011b, The MathWorks Inc., MAGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Dominic Thewlis
    • 1
  • Susan Hillier
    • 1
  • Sarah Jane Hobbs
    • 2
  • Jim Richards
    • 3
  1. 1.School of Health SciencesUniversity of South AustraliaAdelaideAustralia
  2. 2.Centre for Applied Sport and Exercise SciencesUniversity of Central LancashirePrestonUK
  3. 3.School of Sport, Tourism and the OutdoorsUniversity of Central LancashirePrestonUK

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