Dynamic Balance, Pain and Functional Performance in Cruciate Retaining, Posterior Stabilized and Uni-Compartmental Knee Arthroplasty
Background: With the perceived pain and poor function experienced following knee arthroplasty, patients usually feel un-satisfied. Yet, a controversy still persists on the appropriate operative technique that doesn’t affect proprioception much.
Purpose: This study compared the effects of Cruciate Retaining (CR) and Posterior Stabilized (PS) total knee arthroplasty (TKA) and uni-compartmental knee arthroplasty (UKA) on dynamic balance, pain and functional performance following rehabilitation.
Methods: Fifteen patients with CRTKA (group I), fifteen with PSTKA (group II), fifteen with UKA (group III) and fifteen indicated for arthroplasty but weren’t operated on yet (group IV) participated in the study. The mean age was 54.53±3.44, 55.13±3.48, 52.8±1.93 and 55.33±2.32 years and BMI 35.7±3.03, 35.7±1.99, 35.6±1.88 and 35.73±1.03 kg/m2 for group I, II, III and IV respectively. The Berg Balance Scale (BBS), WOMAC pain subscale and Timed Up-and-Go (TUG) and Stair-Climbing (SC) tests were used for assessment. Assessments were conducted four and eight weeks pre- and post-operatively with the control group being assessed at the same time intervals. The post-operative rehabilitation involved hospitalization (1st week), home-based (2nd-4th weeks), and outpatient clinic (5th-8th weeks) programs.
Results: The Mixed design MANOVA revealed that group III had significantly higher BBS scores, and lower pain scores and TUG and SC time than groups I and II four and eight weeks post-operatively. In addition, group I had significantly lower pain scores and SC time compared with group II eight weeks post-operatively. Moreover, the BBS scores increased significantly and the pain scores and TUG and SC time decreased significantly eight weeks post-operatively compared with the three other assessments in group I, II and III with the opposite being true four weeks post-operatively.
Interpretation/Conclusion: CRTKA is preferable to PSTKA with UKA being generally superior to TKA, possibly due to the preserved human proprioceptors in the un-excised compartmental articular surface.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1090699Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 1939
 D. J. Hunter, J. J. McDougall, and F. J. Keefe, "The symptoms of osteoarthritis and the genesis of pain,” Med. Clin. North Am, vol. 93, no. 1, pp. 83-100, Jan. 2009.
 D. Diracoglu, R. Aydin, A. Baskent, and A. Celik, "Effects of kinesthesia and balance exercises in knee osteoarthritis,” J. Clin. Rheumatol, vol. 11, no. 6, pp. 303-310, Dec. 2005.
 M. F. Pisters, C. Veenhof, L. U. N. L. van Meeteren, R. W. Ostelo, D. H. de Bakker, et al., "Long-term effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review,” Arthritis Rheum, vol. 57, no. 7, pp. 1245-1253, Oct. 2007.
 P. W. Stratford, D. M. Kennedy, and L. J. Woodhouse, "Performance measures provide assessments of pain and function in people with advanced osteoarthritis of the hip or knee,” Phys. Ther, vol. 86, no. 11, pp. 1489-1496, Nov. 2006.
 J. P. Leigh, W. Seavey, and B. Leistikow, "Estimating the costs of job related arthritis,” J. Rheumatol, vol. 28, no. 7, pp. 1647-1654, Jul. 2001.
 Y. Zhang, and J. M. Jordan, "Epidemiology of osteoarthritis,” Clin. Geriatr. Med, vol. 26, no. 3, pp. 355-369, Aug. 2010.
 D. S. Rooks, J. Huang, B. E. Bierbaum, S. A. Bolus, J. Rubano, et al., "Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty,” Arthitis Rheum, vol. 55, no. 5, pp. 700-708, Oct. 2006.
 S. M. Isaac, K. L. Barker, I. N. Danial, D. J. Beard, C. A. Dodd, et al., "Does arthroplasty type influence knee joint proprioception? A longitudinal prospective study comparing total and unicompartmental arthroplasty,” Knee, vol. 14, no. 3, pp. 212-217, Jun. 2007.
 G. S. Gill, and A. B. Joshi, "Long-term results of cemented, posterior cruciate ligament-retaining total knee arthroplasty in osteoarthritis,” Am. J. Knee Surg, vol. 14, no. 4, pp. 209-214, Fall 2001.
 A. Konig, M. Walther, S. Kirschner, and F. Gohlke, "Balance sheets of knee and functional scores 5 years after total knee arthroplasty for osteoarthritis: a source for patient information,” J. Arthroplasty, vol. 15, no. 3, pp. 289-294, Apr. 2000.
 V. A. Brander, S. D. Stulberg, A. D. Adams, R. N. Harden, S. Bruehl, et al.,, "Predicting total knee replacement pain. A prospective, observational study,” Clin. Orthop. Rel. Res, no. 416, pp. 27-36, Nov. 2003.
 R. Dickstein, Y. Heffes, E. I. Shabtai, and E. Markowitz, "Total knee arthroplasty in the elderly: patients’ self-appraisal 6 and 12 months postoperatively,” Gerontology, vol. 44, no. 4, pp. 204-210, 1998.
 C. A. Jones, D. C. Voaklander, D. W. Johnston, and M. E. Suarez-Almazor, "Health related quality of life outcomes after total hip and knee arthroplasties in a community based population,” J. Rheumatol, vol. 27, no. 7, pp. 1745-1752, Jul. 2000.
 R. B. Bourne, R. S. Laskin, and J. S. Guerin, "Ten-year results of the first 100 Genesis II total knee replacement procedures,” Orthopedics, vol. 30, Suppl. no., 8, pp. 83-85, Aug. 2007.
 M. F. Brassard, J. N. Insall, G. R. Scuderi, and W. Colizza, "Does modularity affect clinical success: a comparison with a minimum 10-year follow-up,” Clin. Orthop. Relat. Res, no. 388, pp. 26-32, Jul. 2001.
 M. A. Ritter, M. E. Berend, J. B. Meding, E. M. Keating, P. M. Faris, et al., "Long-term follow up of anatomic graduated components posterior cruciate-retaining total knee replacement,” Clin. Orthop. Rel. Res, no. 388, pp. 51-57, Jul. 2001.
 M. A. Ritter, J. D. Lutgring, K. E. Davis, P. M. Faris, and M. E. Berend, "Total knee arthroplasty effectiveness in patients 55 years old and younger: osteoarthritis vs. rheumatoid arthritis,” Knee, vol. 14, no. 1, pp. 9-11, Jan. 2007.
 S. Matsuda, H. Miura, R. Nagamine, K. Urabe, T. Matsunobu, et al., "Knee stability in posterior cruciate ligament retaining total knee arthroplasty,” Clin. Orthop. Rel. Res, no. 366, pp. 169-173, Sep. 1999.
 J. I. Sorger, D. Federie, P. G. Kirk, E. Grood, J. Cochran, et al., "The posterior cruciate ligament in total knee arthroplasty,” J. Arthroplasty, vol. 12, no. 8, pp. 869-879, Dec. 1997.
 S. Yoshiya, N. Matsui, R. D. Komistek, D. A. Dennis, M. Mahfouz, et al., "In vivo kinematic comparison of posterior-cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions,” J. Arthroplasty, vol. 20, no. 6, pp. 777-783, Sep. 2005.
 S. Fantozzi, F. Catani, A. Ensini, A. Leardini, and S. Giannini, ‘Femoral rollback of cruciate-retaining and posterior-stabilized total knee replacements: in vivo fluoroscopic analysis during activities of daily living,” J. Orthop. Res, vol. 24, no. 12, pp. 2222-2229, Dec. 2006.
 R. Nabeyama, S. Matsuda , H. Miura , T. Kawano, R. Nagamine, et al., "Changes in anteroposterior stability following total knee arthroplasty,” J. Orthop. Sci, vol. 8, no. 4, pp. 526-531, 2003.
 S. Maruyama,S. Yoshiya, N. Matsui, R. Kuroda, and M. Kurosaka, "Functional comparison of posterior cruciate retaining versus posterior stabilized total knee arthroplasty,” J. Arthroplasty, vol. 19, no. 3, pp. 349-353, Apr. 2004.
 M. Arabori, N. Matsui, R. Kuroda, K. Mizuno, M. Doita, et al., "Posterior condylar offset and flexion in posterior cruciate-retaining and posterior stabilized TKA,” J. Orthop. Sci, vol. 13, no. 1, pp. 46-50, Jan. 2008.
 R. J. Sierra, and D. J. Berry, "Surgical technique differences between posterior-substituting and cruciate-retaining total knee arthroplasty”, J. Arthroplasty, vol. 23, Suppl. 7, pp. 20-23, Oct. 2008.
 D. S. Barrett, A. G. Cobb, and G. Bentley, "Joint proprioception in normal osteoarthritic and replaced knees,” J. Bone Joint Surg. Br, vol. 73, no. 1, pp. 53-6, Jan. 1991.
 P. J. Warren, T. K. Olanlokun, A. G. Cobb, and G. Bentley, "Proprioception after knee arthroplasty. The influence of prosthetic design,” Clin. Orthop. Rel. Res, no. 297, pp. 182-187, Dec. 1993.
 S. Fuchs, L. Thorwesten, and S. Niewerth, "Proprioceptive function in knees with and without total knee arthroplasty,” Am. J. Phys. Med. Rehabil, vol. 78, no. 1, pp. 39-45, Jan.-Feb. 1999.
 R. L. Barrack, H. B. Skinner, S. D. Cook, and R. J. Jr. Haddad, "Effect of articular disease and total knee arthroplasty on knee joint-position sense,” J. Neurophysiol, vol. 50, no. 3, pp. 684-687, Sep. 1983.
 Y. Ishii, K. Terajima, S. Terashima, J. E. Bechtold, and R. S. Laskin, "Comparison of joint position sense after total knee arthroplasty,” J. Arthroplasty, vol. 12, no. 5, pp. 541-545, Aug. 1997.
 P. Clark, P. B. MacDonald, and K. Sutherland, "Analysis of proprioception in the posterior cruciate ligament-deficient knee,” Knee Surg. Sports Traumatol. Arthrosc, vol. 4, no. 4, pp. 225-227, 1996.
 J. P. Corrigan, W. F. Cashman, and M. P. Brady, "Proprioception in the cruciate deficient knee,” J. Bone Joint Surg Br, vol. 74, no. 2, pp. 247-250, Mar. 1992.
 M. E. Del Valle, S. F. Harwin, A. Maestro, A. Murcia, and J. A. Vega, "Immunohistochemical analysis of mechanoreceptors in the human posterior cruciate ligament: a demonstration of its proprioceptive role and clinical relevance,” J. Arthroplasty, vol. 13, no. 8, pp. 916-922, Dec. 1998.
 S. Simmons, S. Lephart, H. Rubash, P. Borsa, and R. L. Barrack, "Proprioception following total knee arthroplasty with and without the posterior cruciate ligament,” J. Arthroplasty, vol. 11, no. 7, pp. 763-768, Oct. 1996.
 R. Marks, "Further evidence of impaired position sense in knee osteoarthritis,” Physiother. Res. Int, vol. 1, no. 2, pp. 127-136, 1996.
 L. Sharma, and Y. C. Pai, "Impaired proprioception and osteoarthritis,” Curr. Opin. Rheumatol, vol. 9, no. 3, pp. 253-258, May 1997.
 E. Aydog, A. Bal, S. T. Aydog, and A. Cakci, "Evaluation of dynamic postural balance using the Biodex Stability System in rheumatoid arthritis patients,” Clin. Rheumatol, vol. 25, no. 4, pp. 462-467, Jul. 2006.
 N. Sarabon, B. Mlaker, and G. Markovic, "A novel tool for the assessment of dynamic balance in healthy individuals,” Gait Posture, vol. 31, no. 2, pp. 261-264, Feb. 2010.
 R. M. Cash, M. H. Gonzalez, J. Garst, R. Barmada, and S. H. Stern, "Proprioception after arthroplasty: role of the posterior cruciate ligament,” Clin. Orthop. Rel. Res, no. 331, pp. 172-178, Oct. 1996.
 S. Fuchs, C. O. Tibesku, M. Genkinger, H. Laass, and D. Rosenbaum, "Proprioception with bicondylar sledge prostheses retaining cruciate ligaments,” Clin. Orthop. Rel. Res, no. 406, pp. 148-154, Jan. 2003.
 P. J. Lattanzio, D. G. Chess, and J. C. MacDermid, "Effect of the posterior cruciate ligament in knee-joint proprioception in total knee arthroplasty,” J. Arthroplasty, vol. 13, no. 5, pp. 580-585, Aug. 1998.
 G. Pap, M. Meyer, H. T. Weiler, A. Machner and F. Awiszus, "Proprioception after total knee arthroplasty: a comparison with clinical outcome,” Acta Orthop Scand, vol. 71, no. 2, pp. 153-159, Apr. 2000.
 C. B. Swanik, S. M. Lephart, and H. E. Rubash, "Proprioception, kinesthesia, and balance after total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses,” J. Bone Joint Surg. Am, vol. 86-A, no. 2, pp. 328-334, Feb. 2004.
 M. Wada, H. Kawahara, S. Shimada, T. Miyazaki, and H. Baba, "Joint proprioception before and after total knee arthroplasty,” Clin. Orthop. Rel. Res, no. 403, pp. 161-167, Oct. 2002.
 I. Bascuas, M. Tejero, S. Monleón, R. Boza, J. M. Muniesa, et al., "Balance 1 year after TKA: correlation with clinical variables,” Orthopedics, vol. 36, no. 1, e6-12, Jan. 2013.
 R. S. Hinman, K. L. Bennell, B. R. Metcalf, and K. M. Crossley, "Balance impairments in individuals with symptomatic knee osteoarthritis: a comparison with matched controls using clinical tests,” Rheumatology (Oxford), vol. 41, no. 12, 1388-1394, Dec. 2002.
 K. Jadelis, M. E. Miller, W. H. Jr. Ettinger, and S. P. Messier, "Strength, balance, and the modifying effects of obesity and knee pain: results from the Observational Arthritis Study in Seniors (OASIS),” J. Am. Geriatr. Soc, vol. 49, no. 7, pp. 884-891, Jul. 2001.
 P. Salmon, G. M. Hall, D. Peerbhoy, A. Shenkin, and C. Parker, "Recovery from hip and knee arthroplasty: Patients' perspective on pain, function, quality of life, and well-being up to 6 months postoperatively,” Arch. Phys. Med. Rehabil, vol. 82, no. 3, pp. 360-366, Mar. 2001.
 J. H. Kellgren, and J. S. Lawrence, "Radiological assessment of osteoarthrosis,” Ann. Rheum. Dis, vol. 16, no. 4, pp. 494-502, Dec. 1957.
 A. M. Noren, U. Bogren, J. Bolin, and C. Stenstrom, "Balance assessment in patients with peripheral arthritis: applicability and reliability of some clinical assessments,” Physiother. Res. Int, vol. 6, no. 4, pp. 193-204, 2001.
 D. Podsiadlo, and S. Richardson, "The timed "Up & Go”: a test of basic functional mobility for frail elderly persons,” J. Am. Geriatr. Soc, vol. 39, no. 2, pp. 142-148, Feb. 1991.
 S. R. Piva, A. B. Gil, G. J. Almeida, A. M. 3rd. DiGioia, T. J. Levison, et al., "A balance exercise program appears to improve function for patients with total knee arthroplasty: a randomized clinical trial,” Phys. Ther, vol. 90, no. 6, pp. 880-894, Jun. 2010.
 S. McConnell, P. Kolopack, and A. M. Davis, "The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): A review of the utility and measurement properties,” Arthritis Rheum, vol. 45, no. 5, pp. 453-461, Oct. 2001.
 J. E. Stevens, R. L. Mizner, and L. Snyder-Mackler, "Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series,” J. Orthop. Sports Phys. Ther, vol. 34, no. 1, pp. 21-29, January 2004.
 J. Romero, T. Stahelin, C. Binkert, C. Pfirrmann, J. Hodler, et al., "The clinical consequences of flexion gap asymmetry in total knee arthroplasty,” J. Arthroplasty, vol. 22, no. 2, pp. 235-240, Feb. 2007.
 R. L. Mizner, S. C. Petterson, and L. Snyder-Mackler, "Quadriceps strength and the time course of functional recovery after total knee arthroplasty,” J. Orthop. Sports Phys. Ther, vol. 35, no. 7, pp. 424-436, Jul. 2005.
 R. L. Mizner, S. C. Petterson, K. E. Clements, J. A. Jr. Zeni, J. J. Irrgang, et al., "Measuring functional improvement after total knee arthroplasty requires both performance-based and patient-report assessments: a longitudinal analysis of outcomes,” J. Arthroplasty, vol. 26, no. 5, pp. 728-737, Aug. 2011.
 S. J. Farquhar, D. S. Reisman, and L. Snyder-Mackler, "Persistence of altered movement patterns during a sit-to-stand task I year following unilateral total knee arthroplasty,” Phys. Ther, vol. 88, no. 5, pp. 567-579, May 2008.
 D. M. Kennedy, P. W. Stratford, D. L. Riddle, S. E. Hanna, and J. D. Gollish, "Assessing recovery and establishing prognosis following total knee arthroplasty,” Phys. Ther, vol. 88, no. 1, pp. 22-32, Jan. 2008.
 G. D. Deyle, S. C. Allison, R. L. Matekel, M. G. Ryder, J. M. Stang, et al., "Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program,” Phys. Ther, vol. 85, no. 12, pp. 1301 -1317, Dec. 2005.
 R.S. Hinman, S.E. Heywood, and A.R. Day, "Aquatic physical therapy for hip and knee osteoarthritis: results of a single-blind randomized controlled trial,” Phys. Ther, vol. 87, no. 1, pp. 32-43, Jan. 2007.
 G. Jamtvedt, K. T. Dahm, A. Christie, R. H. Moe, E. Haavardsholm, et al., "Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews,” Phys. Ther, vol. 88, no. 1, pp. 123-136, Jan. 2008.
 M. E. van Baar, W. J. Assendelft, J. Dekker, R. A. Oostendorp, and J. W. Bijlsma, "Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials,” Arthritis Rheum, vol. 42, no. 7, pp. 1361-1369, Jul. 1999.
 T. P. Andriacchi, and C. O. Dyrby, "Gait analysis and total knee replacement,” in Total knee arthroplasty. A guide to get better performance, 1st ed., J. Bellemans et al., Ed. Germany: Springer, 2005, pp. 38-41.
 A. A. Bolanos, W. A. Colizza, P. D. McCann, R. S. Gotlin, M. E. Wootten, et al., "A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties,” J. Arthroplasty, vol. 13, no. 8, pp. 906-915, Dec. 1998.