Increased knee loading in stair ambulation in patients dissatisfied with their total knee replacement

Abstract

Background: Total knee replacement patients have shown reductions in knee flexion range of motion, knee extensor moments, and gait speed during stair ascent and stair descent. However, it is unknown how patients dissatisfied with their total knee replacement differ from those who are satisfied during more difficult activities such as stair negotiation. Therefore, the purpose of this study was to compare knee biomechanics of patients who are dissatisfied with their joint replacement to those who are satisfied and healthy participants during stair negotiation.

Methods: Nine dissatisfied, fifteen satisfied patients and fifteen healthy participants participated, completing stair ascent and descent trials on an instrumented staircase. A 2 × 3 ANOVA was used to analyze biomechanical differences between groups and limbs during both activities.

Findings: The dissatisfied group showed reduced 2nd peak vertical GRF (P ≤ 0.0040) and loading-response knee extension moments (P ≤ 0.0041) in their operated limb compared to their non-operated limb and to satisfied and healthy groups during stair ascent. First peak vertical GRF (P < 0.0088) and both loading-response (P < 0.0117) and push-off abduction moments (P < 0.0028) showed reduced values in operated limbs compared to non-operated limbs for all groups. During stair descent, the dissatisfied group showed reduced loading-response and push-off knee extension moments (P ≤ 0.006) in their operated limb compared to their non-operated limb and the healthy group. The loading-response knee extension (P < 0.0379) and abduction moments (P ≤ 0.0048) were also reduced in the dissatisfied group compared to the satisfied group.

Interpretation: Patients who were dissatisfied showed asymmetrical loading of the knees in conjunction, which may have contributed to their dissatisfaction.

Keywords: Arthroplasty; Asymmetry; Satisfaction; Stair biomechanics; Total knee replacement.