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Cut-off values of preoperative knee extensor strength and hip abductor strength for predicting good walking ability after total knee arthroplasty

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Total knee arthroplasty (TKA) reduces pain and improves physical function; however, not all patients have successful outcomes after surgery. To identify these patients would be critical information for improving rehabilitation programs. The purpose of this study was to clarify the cut-off values of lower extremity muscle strength for predicting postoperative good walking ability.

Materials and methods

Timed Up and Go test of 105 patients was measured at 6 months postoperatively, and participants were divided into good (< 9.1 s) and poor (≥ 9.1 s) walking ability. Both sides of knee extensor strength (KES) and hip abductor strength (HAS) were measured using hand-held dynamometer preoperatively. Receiver operating characteristic (ROC) curve analysis was used to identify cut-off values for classifying the participants into the two groups.

Results

Of the 105 patients, 54 were allocated in the poor walking ability group, whereas 51 were allocated in the good walking ability group. KES and HAS were significantly greater in the good walking ability group than in the poor walking ability group. ROC curve analysis revealed that the cut-off value for KES was 0.79 Nm/kg (area under the curve (AUC) 0.68; sensitivity 64.7%; specificity 68.5%) on the involved side and 0.86 Nm/kg (AUC 0.73; sensitivity 84.6%; specificity 55.6%) on the uninvolved side, and for HAS was 0.57 Nm/kg (AUC 0.71; sensitivity 60.8%; specificity 71.7%) on the involved side and 0.61 Nm/kg (AUC 0.76; sensitivity 66.7%; specificity 77.4%) on the uninvolved side.

Conclusion

The cut-off values of preoperative KES and HAS for predicting good walking ability after TKA are 0.79 Nm/kg on the involved side and 0.86 Nm/kg on the uninvolved side, and 0.57 Nm/kg on the involved side and 0.61 Nm/kg on the uninvolved side, respectively. We should provide enhanced pre- and post-operative rehabilitation programs for patients with muscle strength lower than these values.

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Availability of data and materials

The dataset of the current study is available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Center for Clinical Research and Innovation for the advice on statistical methods. We also thank Atsuko Takahama, Misaki Ueyama, Kimiko Yokoyama, Ryo Horiguchi, and other physical therapists in Kobe City Medical Center General Hospital for their assistance in the outcome measurements. We also wish to thank Katsuya Ohnishi and Yasuto Mukai for their help in taking pictures for making Figures.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Rehabilitation, Kobe City Medical Center General Hospital, Minatojima Minamimachi 2-1-1, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan

    Daisuke Takamura, Kentaro Iwata, Yuma Yajima, Kentaro Suzuki, Kanta Satsuki & Tsubasa Itoh

  2. Department of Rehabilitation Science, Graduate School of Health Science, Kobe University, Tomogaoka 7-10-2, Suma-Ku, Kobe, Hyogo, 654-0142, Japan

    Daisuke Takamura

  3. Department of Orthopedic Surgery, Kobe City Medical Center General Hospital, Minatojima Minamimachi 2-1-1, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan

    Tadashi Yasuda

  4. Life and Medical Science Area, Health Science Discipline, Kobe University, Tomogaoka 7-10-2, Suma-Ku, Kobe, Hyogo, 654-0142, Japan

    Hideki Moriyama

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  1. Daisuke Takamura
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Contributions

DT and HM conceived and designed this study. DT, YY, KS, KS, and TI collected and analyzed the data. DT wrote the first draft of the manuscript and KI, TY, and HM commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hideki Moriyama.

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The authors declare that they have no conflict of interest.

Ethical approval and consent to participate

Ethics approval for this study was obtained from the Ethics Committee of Kobe City Medical Center General Hospital (No. zn210608). Informed consent was obtained in the form of opt-out on the web-site of Kobe City Medical Center General Hospital.

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The authors provided informed consent for publication in the form of opt-out on the web-site of Kobe City Medical Center General Hospital.

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Takamura, D., Iwata, K., Yajima, Y. et al. Cut-off values of preoperative knee extensor strength and hip abductor strength for predicting good walking ability after total knee arthroplasty. Arch Orthop Trauma Surg 144, 377–384 (2024). https://doi.org/10.1007/s00402-023-05067-7

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