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Changes of body balance before and after total knee arthroplasty in patients who suffered from bilateral knee osteoarthritis

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Purpose

It is still controversial whether simultaneous or staged total knee arthroplasty (TKA) is most desirable for patients with bilateral knee osteoarthritis. We retrospectively evaluated changes in balance among patients with bilateral osteoarthritis who underwent staged TKA using a gravicorder.

Methods

Patients were stratified into two groups: the unilateral group (UG) (22 patients) consisted of patients who did not undergo a second TKA within 24 months of the first TKA, and the bilateral group (BG) (20 patients) were those who had a second TKA within 12 months after initial TKA.

Results

The mean gravity center position (GCP), which indicates the translation of GCP in the mediolateral direction between pre- and post-TKA shifted to the operative side in both groups after initial surgery. While the GCP was maintained on the same side in UG over 2 years follow-up, in BG it moved to the opposite side and approached a central position after the second TKA. Locus length of GCP (LG), which indicates postural control function by proprioceptive reflex showed significant improvement after initial TKA in UG, while BG showed significant improvement after the second TKA.

Conclusions

The degree of LG improvement after initial TKA may indicate the necessity of a second TKA for patients with bilateral osteoarthritis. The current study suggests that simultaneous bilateral TKA is not always necessary for patients with bilateral knee arthritis, and that properly performed rehabilitation such as improving postural sway after initial TKA might attenuate the timing for the second TKA.

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References

  1. Ersozlu S, Akkaya T, Ozgur AF, Sahin O, Senturk I, Tandogan R. Bilateral staged total knee arthroplasty in obese patients. Arch Orthop Trauma Surg. 2008;128:143–8.

    Article  PubMed  Google Scholar 

  2. Fabi DW, Mohan V, Goldstein WM, Dunn JH, Murphy BP. Unilateral vs. bilateral total knee arthroplasty. J Arthroplast. 2011;26:668–73.

    Article  Google Scholar 

  3. Hu J, Liu Y, Lv Z, Li X, Qin X, Fan W. Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg. 2011;131:1291–8.

    Article  PubMed  Google Scholar 

  4. Hutchinson JRM, Parish EN, Cross MJ. A comparison of bilateral uncemented total knee arthroplasty. Simultaneous or staged? J Bone Joint Surg (Br). 2006;88:40–3.

    CAS  Google Scholar 

  5. McLaughlin TP, Fisher RL. Bilateral total knee arthroplasties. Comparison of simultaneous (two-team), sequential, and staged knee replacements. Clin Orthop Relat Res. 1985;199:220–5.

    PubMed  Google Scholar 

  6. Ritter MA, Harty LD, Davis KE, Meding JB, Berend M. Simultaneous bilateral, staged bilateral, and unilateral total knee arthroplasty. A survival analysis. J Bone Joint Surg (Am). 2003;85:1532–7.

    Google Scholar 

  7. Ritter MA, Mamlin LA, Melfi CA, Katz BP, Freund DA, Arthur DS. Outcome implications for the timing of bilateral total knee arthroplasties. Clin Orthop Relat Res. 1997;345:99–105.

    Article  PubMed  Google Scholar 

  8. Stefánsdóttir A, Lidgren L, Robertsson O. Higher early mortality with simultaneous rather than staged bilateral TKAs: results from the Swedish Knee Arthroplasty Register. Clin Orthop Relat Res. 2008;466:3066–70.

    Article  PubMed  Google Scholar 

  9. Yoon HS, Han CD, Yang IH. Comparison of simultaneous bilateral and staged bilateral total knee arthroplasty in terms of perioperative complications. J Arthroplast. 2010;25:179–85.

    Article  Google Scholar 

  10. Tanavalee A, Thiengwittayaporn S, Ngarmukos S, Siddhiphongse B. Contralateral total knee arthroplasty after unilateral surgery in bilateral varus gonarthrosis. J Med Assoc Thai. 2004;37:902–9.

    Google Scholar 

  11. Swanik CB, Lephart SM, Rubash HE. Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses. J Bone Joint Surg (Am). 2004;86:328–34.

    Google Scholar 

  12. Swinkels A, Newman JH, Allain TJ. A prospective observational study of falling before and after knee replacement surgery. Age Ageing. 2009;38:175–81.

    Article  PubMed  Google Scholar 

  13. Wegener L, Kisner C, Nichols D. Static and dynamic balance responses in person with bilateral knee osteoarthritis. J Orthop Sports Phys Ther. 1997;25:13–8.

    Article  PubMed  CAS  Google Scholar 

  14. Kellgren JH, Lawrence JS. Radiographical assessment of osteoarthritis. Ann Rheum Dis. 1957;16:494–501.

    Article  PubMed  CAS  Google Scholar 

  15. Kumar PJ, McPherson EJ, Dorr LD, Wan Z, Baldwin K. Rehabilitation after total knee arthroplasty. A comparison of two rehabilitation techniques. Clin Orthop Relat Res. 1996;331:93–101.

    Article  PubMed  Google Scholar 

  16. Quagliarella L, Sasanelli N, Monaco V, Belgiovine G, Spinarelli A, Notarnicola A, Moretti L, Moretti B. Relevance of orthostatic posturography for clinical evaluation of hip and knee joint arthroplasty patients. Gait Posture. 2011;34:49–54.

    Article  PubMed  Google Scholar 

  17. Bakirhan S, Angin S, Karatosun V, Ünver B, Günal İ. A comparison of static and dynamic balance in patients with unilateral and bilateral total knee arthroplasty. Eklem Hastalik Cerrahisi. 2009;20:93–101.

    PubMed  Google Scholar 

  18. Ishii Y, Yagisawa K, Ikezawa Y. Changes in bone mineral density of the proximal femur after total knee arthroplasty. J Arthroplast. 2000;15:519–22.

    Article  CAS  Google Scholar 

  19. Ishii Y, Matsuda Y, Ishii R, Sakata S, Ichimura K. Effect of total knee arthroplasty on patients’ bone quality - ultrasound measurement of the calcaneus. Knee. 2004;11:293–5.

    Article  PubMed  CAS  Google Scholar 

  20. Berth A, Urbach D, Awiszus F. Improvement of voluntary quadriceps muscle activation after total knee arthroplasty. Arch Phys Med Rehabil. 2002;83:1432–6.

    Article  PubMed  Google Scholar 

  21. Zeni JA Jr, Snyder-Mackler L. Early postoperative measures predict 1- and 2-year outcomes after unilateral total knee arthroplasty: importance of contralateral limb strength. Phys Ther. 2010;90:43–54.

    Article  PubMed  Google Scholar 

  22. McMahon M, Block JA. The risk of contralateral total knee arthroplasty after knee replacement for osteoarthritis. J Rheumatol. 2003;30:1822–4.

    PubMed  Google Scholar 

  23. Ritter MA, Carr KD, Keating EM, Faris PM. Long-term outcomes of contralateral knees after total knee arthroplasty for osteoarthritis. J Arthroplast. 1994;9:347–9.

    Article  CAS  Google Scholar 

  24. Mont MA, Mitzner DL, Jones LC, Hungerford DS. History of the contralateral knee after primary knee arthroplasty. Clin Orthop Relat Res. 1995;321:145–50.

    PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Yoshinori Ishii.

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Ishii, Y., Noguchi, H., Takeda, M. et al. Changes of body balance before and after total knee arthroplasty in patients who suffered from bilateral knee osteoarthritis. J Orthop Sci 18, 727–732 (2013). https://doi.org/10.1007/s00776-013-0430-1

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  • DOI: https://doi.org/10.1007/s00776-013-0430-1

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