Effects of Weight-Bearing Biofeedback Training on Functional Movement Patterns Following Total Knee Arthroplasty: A Randomized Controlled Trial

Abstract

Study design: Randomized controlled trial.

Objectives: To examine the effects of weight-bearing biofeedback training on weight-bearing symmetry and functional joint moments following unilateral total knee arthroplasty.

Background: Individuals after unilateral total knee arthroplasty place more weight on the nonsurgical limb compared to the surgical limb during function. It is unknown whether targeted intervention can improve function in the surgical limb and resolve altered movement patterns.

Methods: Twenty-six patients were randomly assigned to 2 groups (reload or control). The reload group had a standard-of-care rehabilitation augmented with weight-bearing biofeedback training, and the control group had a dose-matched standard-of-care rehabilitation. Lower-limb weight-bearing ratios were measured preoperatively and 6 and 26 weeks after total knee arthroplasty during a 5-time sit-to-stand test (FTSST) and walking. Secondary outcomes were FTSST time, walking speed, and lower-limb joint moments during the FTSST and walking.

Results: No between-group differences were found in weight-bearing ratios. Five-time sit-to-stand test time improved in the reload group compared to the control group at 6 (P = .021) and 26 weeks (P = .021). There were no between-group differences in knee extension moment during the FTSST. Surgical-limb knee extension moments during walking increased from baseline to 26 weeks in the reload group and decreased in the control group (P = .008).

Conclusion: Weight-bearing biofeedback training had no effect on functional weight-bearing symmetry or knee extension moments during the FTSST. However, the biofeedback training resulted in increases of knee extension moments during gait and improved FTSST times. Trial registered at ClinicalTrials.gov (NCT01333189). Level of Evidence Therapy, level 2b.

Keywords: TKA; gait; joint moments; movement asymmetry; sit-to-stand.

FIGURE 1

Participant flow diagram

Figure 2

Mean +/− SD changes in peak surgical-limb knee extension moment over time, compared to pre-op, for both groups during the Five-Times Sit-to-Stand Test.

FIGURE 3

Mean +/− SE changes in peak surgical-limb knee extension moment over time, compared to pre-op, for both groups during walking. * = significant differences between groups from baseline to 26 weeks (P=.007)