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Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background/rationale

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.

Questions/purposes

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

We acknowledge Pam Wolfe, MS, for statistical consultation in preparing this manuscript.

Author information

Authors and Affiliations

  1. Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO, USA

    Jennifer E. Stevens-Lapsley PT, MPT, PhD & Jaclyn E. Balter MS

  2. Division of Geriatrics, University of Colorado Denver, Aurora, CO, USA

    Wendy M. Kohrt PhD

  3. Department of Orthopedics, University of Colorado Denver, 1635 Aurora Court, MS F722, Aurora, CO, 80045, USA

    Donald G. Eckhoff MD

Authors
  1. Jennifer E. Stevens-Lapsley PT, MPT, PhD
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  2. Jaclyn E. Balter MS
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  3. Wendy M. Kohrt PhD
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  4. Donald G. Eckhoff MD
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Corresponding author

Correspondence to Donald G. Eckhoff MD.

Additional information

One or more of the authors received funding from a New Investigator Award from the American College of Rheumatology (JSL) and National Institutes of Health Grant UL1 RR025780 (Clinical Translational Research Center).

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Stevens-Lapsley, J.E., Balter, J.E., Kohrt, W.M. et al. Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty. Clin Orthop Relat Res 468, 2460–2468 (2010). https://doi.org/10.1007/s11999-009-1219-6

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  • DOI: https://doi.org/10.1007/s11999-009-1219-6

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