Clinical Orthopaedics and Related Research®

, Volume 468, Issue 9, pp 2460–2468

Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty

  • Jennifer E. Stevens-Lapsley
  • Jaclyn E. Balter
  • Wendy M. Kohrt
  • Donald G. Eckhoff
Clinical Research

DOI: 10.1007/s11999-009-1219-6

Cite this article as:
Stevens-Lapsley, J.E., Balter, J.E., Kohrt, W.M. et al. Clin Orthop Relat Res (2010) 468: 2460. doi:10.1007/s11999-009-1219-6



Although TKA reliably reduces pain from knee osteoarthritis, full recovery of muscle strength and physical function to normal levels is rare. We presumed that a better understanding of acute changes in hamstrings and quadriceps muscle performance would allow us to enhance early rehabilitation after TKA and improve long-term function.


The purposes of this study were to (1) evaluate postoperative quadriceps and hamstrings muscle strength loss after TKA and subsequent recovery using the nonoperative legs and healthy control legs for comparison, and (2) measure hamstrings coactivation before and after TKA during a maximal isometric quadriceps muscle contraction and compare with nonoperative and healthy control legs.


We prospectively followed 30 patients undergoing TKA at 2 weeks preoperatively and 1, 3, and 6 months postoperatively and compared patient outcomes with a cross-sectional cohort of 15 healthy older adults. Bilateral, isometric strength of the quadriceps and hamstrings was assessed along with EMG measures of hamstrings coactivation during a maximal isometric quadriceps contraction.


There were no differences in strength loss or recovery between the quadriceps and hamstrings muscles of the operative leg throughout the followup, although differences existed when compared with nonoperative and healthy control legs. Hamstrings muscle coactivation in the operative leg during a maximal quadriceps effort was elevated at 1 month (144.5%) compared to the nonoperative leg.


Although quadriceps dysfunction after TKA typically is recognized and addressed in postoperative therapy protocols, hamstrings dysfunction also is present and should be addressed.

Clinical Relevance

Quadriceps and hamstrings muscle strengthening should be the focus of future rehabilitation programs to optimize muscle function and long-term outcomes.

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Jennifer E. Stevens-Lapsley
    • 1
  • Jaclyn E. Balter
    • 1
  • Wendy M. Kohrt
    • 2
  • Donald G. Eckhoff
    • 3
  1. 1.Physical Therapy Program, Department of Physical Medicine and RehabilitationUniversity of Colorado DenverAuroraUSA
  2. 2.Division of GeriatricsUniversity of Colorado DenverAuroraUSA
  3. 3.Department of OrthopedicsUniversity of Colorado DenverAuroraUSA

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