Effect of Cane on the Knee and Thorax Biomechanics in the Early Postoperative Period Following Total Knee Arthroplasty
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 3, Issue 5
Abstract
Background: Although total knee arthroplasty (TKA) reliably reduces pain and improves knee function, several months are needed for the damaged quadriceps muscles to recover to preoperative strength. Patients with weak muscle strength often use a walking aid to prevent from falling after TKA. The aim of this study is to investigate the biomechanical effect of contralateral cane use on the knee and trunk movement in patients after TKA. Methods: Twenty people with knee osteoarthritis scheduled to undergo unilateral TKA were enrolled in the study. The movements of knee joint and trunk were measured using three-dimensional motion analysis during walking. The kinematic and kinetic variables were statistically compared between aided walking and unaided walking using two-tailed paired t-tests. Results: The peak knee adduction moment was significantly smaller in aided walking than in unaided walking. The peak trunk flexion angle and the peak trunk angle to the non-operated side were significantly smaller in aided walking than in unaided walking. The amount of coronal displacement of trunk in aided walking was significantly smaller than the unaided walking. Conclusion: The use of a cane during walking decreases GRF by 5.6% and knee adduction moment by 15.8%. Also, the amount of coronal displacement of the trunk decreased with the use of a cane. Using a cane for walking during the initial rehabilitation period after TKA decrease the load on the knee joint, stabilize the movement of the trunk, and may useful for preventing patients from falls. Knee osteoarthritis (OA) is one of the leading causes of disability among elderly people over 65 years old. The incidence of knee OA increases with age and is characterized by joint instability, muscle weakness, joint deformity, pain and stiffness [1-3]. Total knee arthroplasty (TKA) is a common surgery for the management of severe pain in knee OA. TKA is a surgical intervention that eliminates pain and knee deformity and improves patient quality of life. Furthermore, TKA not only reduces pain in knee OA patients, but improves gait performance and balance function [4,5]. Elderly patients who have undergone TKA have been found to have some increased risk of falls. Older adults who undergo joint replacement surgery may have reduced proprioception, as well as a short-term increase in pain and reduction in muscle strength following surgery [6-8]. These deficits as well as the hospital admission itself may affect older adults who have less physical reserve and ability to compensate for these deficits than younger adults. Previous studies conducted with TKA patients have presented postoperative fall rate starting from 22% up to 40% [9-12]. According to the literature the intrinsic risk factors responsible for 39%-53% to falls in the elderly people are history of falls [12-14], advanced age [15,16], gender [15,16], muscle weakness [17], reduced physical activity [17], mobility disorders and abnormal gait [18], and fear of falling [12,13,19]. Although TKA reliably reduces pain and improves knee function, several months are needed for the damaged quadriceps muscles to recover to preoperative strength. Quadriceps muscle weakness is most pronounced during the first month after surgery, and patients with weak muscle strength often use a walking aid to prevent from falling [20]. Previous biomechanical studies have found that patients frequently exhibit changes in gait biomechanics after TKA [21-25]. Patients after TKA exhibited a quadriceps avoidance gait pattern as the quadriceps muscles contribute less to the knee extension moment. A previous biomechanical study has revealed that, although there was a significant decrease in the contribution of the quadriceps muscles to the vertical acceleration and forward deceleration of the center of mass during walking, the patients with TKA compensated for this deficiency by leaning their trunks forward [21]. Furthermore the control of trunk movement was found to be critical to maintain balance and prevent falls [22-25]. The trunk constitutes two-thirds of the body weight; even slightly uncoordinated movement of the trunk may increase the risk of balance loss and falls after TKA. Until now, few studies have been performed on the variation of knee and trunk movement in TKA patients using a three-dimensional gait analysis system. The aim of this study is to investigate the biomechanical effect of cane use on the knee and trunk movement in patients after TKA. Our hypothesis was that using a cane in the early postoperative period following TKA affects the knee and trunk biomechanics in the way of decreasing knee joint load and increasing trunk balance during walking.
Authors and Affiliations
Hidenori Tanikawa, Ryo Ogawa, Kengo Harato, Yasuo Niki, Shu Kobayashi, Kazunari Okuma, Takeo Nagura
Keywords
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- EP ID EP590775
- DOI 10.26717/BJSTR.2018.03.000965
- Views 154
- Downloads 0
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