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Quadriceps strength impairment in the mid- to long-term follow-up period after total knee arthroplasty

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Quadriceps strength impairment after total knee arthroplasty (TKA) continues to be a concern. However, most studies of quadriceps strength have short-term follow-up periods. Whether quadriceps strength impairment occurs in the long-term follow-up period after TKA remains unclear. The purpose of this study was to compare the quadriceps strength between posterior cruciate ligament-retaining (CR) and substituting (PS) design mobile-bearing TKA (1) in the same patients after an average of 10 years and (2) between TKA patients and age-matched controls.

Methods

A prospective, quasi-randomized design was used. Thirty-four patients (68 knees) who underwent bilateral TKA (CR on one side and PS on the other) were followed for a minimum of 5 years, and 35 age-matched controls (70 knees) were evaluated. A handheld dynamometer was used to measure quadriceps isometric strength. For each patient, the maximum value of three trials was used. The ratio of muscle strength to body weight (MS/BW ratio; N/kg) was used to evaluate outcomes.

Results

The median MS/BW ratio was 3.3 (range 1.4–10.5) for CR 3.4 (range 0.9–9.3) for PS, and 4.6 (range 0.4–8.8) for controls. The MS/BW ratio did not differ between prosthesis designs, but was significantly smaller in both CR (p = 0.020) and PS (p = 0.024) than in controls.

Conclusions

Posterior cruciate ligament-retaining TKA does not confer a substantial advantage an average of 10 years postoperatively. In addition, quadriceps strength, as measured using a hand-held dynamometer, was significantly lower in both TKA patient groups than in age-matched controls. Clinically, the results of this study indicate that quadriceps-strengthening exercises should be continued in the long term after TKA.

Level of evidence

II.

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Authors and Affiliations

  1. Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan

    Yoshinori Ishii, Hideo Noguchi, Junko Sato & Tetsuya Sakurai

  2. Division of Information Science and Biostatistics, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan

    Shin-ichi Toyabe

Authors
  1. Yoshinori Ishii
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  2. Hideo Noguchi
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  3. Junko Sato
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  4. Tetsuya Sakurai
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  5. Shin-ichi Toyabe
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Corresponding author

Correspondence to Yoshinori Ishii.

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Conflict of interest

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical standard

The local institutional review board approved this study. All patients provided informed consent.

Additional information

The present work was performed at the Ishii Orthopaedic and Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan.

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Ishii, Y., Noguchi, H., Sato, J. et al. Quadriceps strength impairment in the mid- to long-term follow-up period after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 25, 3372–3377 (2017). https://doi.org/10.1007/s00167-016-4333-5

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  • DOI: https://doi.org/10.1007/s00167-016-4333-5

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