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The Chitranjan Ranawat Award: The Nonoperated Knee Predicts Function 3 Years after Unilateral Total Knee Arthroplasty

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

The long-term functional abilities of patients after a unilateral total knee arthroplasty (TKA) are influenced by the status of the nonoperated knee at the time of the TKA. We hypothesized that in the 3 years after TKA, the nonoperated limb would become more painful, and the quadriceps muscles would weaken; pain and strength would influence performance on functional testing by 3 years after TKA. Healthy control subjects were tested over the same time interval; we hypothesized the controls would also decline in strength and function over time. Individuals with unilateral knee pain (less than 4/10 on a verbal analog scale) were recruited preoperatively. We tested patients 1, 2, and 3 years after TKA to determine changes in strength, self-report outcome measures, and performance on a stair climbing test and the 6-minute walk test. Control subjects without osteoarthritis were tested twice, 2 years apart. The nonoperated limb of patients with TKA weakened from 1 to 2 years, and further weakened from 2 to 3 years after TKA; by 3 years after TKA, the nonoperated limb was more painful compared to the operated limb. Three years after TKA, nonoperated knee pain contributed 44% of the variability in the 6-minute walk and 33% of the variability in the stair climbing test. Patients with TKA were weaker, slower, and had lower self-report outcome measures compared with control subjects at both time intervals. Control subjects also weakened over time, yet were stable on self-report outcome measures and the 6 minute walk test. Weakening of the quadriceps muscles in all participants represents changes due to ageing; however on average the nonoperated limb weakened over time, possibly representing not only changes resulting from aging, but progression of osteoarthrosis in some patients with unilateral TKA.

Level of Evidence: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Stuart Binder-Macleod, principle investigator of NIH T32-HD07490. We thank Leo Raisis, M.D., Alex Bodenstab, M.D., and William Newcomb, M.D., all of First State Orthopaedics for their patient referrals. We also thank Jennifer Stevens-Lapsley, PT, PhD, Ryan Mizner, PT, PhD, Stephanie Petterson, PT, PhD, and Yuri Yoshida, MS, for their assistance and support.

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Authors and Affiliations

  1. The Anderson Orthopaedic Clinic, Alexandria, VA, USA

    Sara Farquhar PhD, PT

  2. Department of Physical Therapy, Program in Biomechanics and Movement Science, University of Delaware, 301 McKinly Laboratory, Newark, DE, 19716, USA

    Lynn Snyder-Mackler PT, ScD, FAPTA

Authors
  1. Sara Farquhar PhD, PT
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  2. Lynn Snyder-Mackler PT, ScD, FAPTA
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Corresponding author

Correspondence to Lynn Snyder-Mackler PT, ScD, FAPTA.

Additional information

One or more of the authors (LSM) have received funding from the National Institutes of Health (R01-HD041055, T32-HD07490).

Each author certifies that his or her institution has 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.

This work was performed at the Department of Physical Therapy, University of Delaware, Newark, DE.

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Farquhar, S., Snyder-Mackler, L. The Chitranjan Ranawat Award: The Nonoperated Knee Predicts Function 3 Years after Unilateral Total Knee Arthroplasty. Clin Orthop Relat Res 468, 37–44 (2010). https://doi.org/10.1007/s11999-009-0892-9

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  • DOI: https://doi.org/10.1007/s11999-009-0892-9

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