Short-term knee flexion during stair ascent in total knee arthroplasty patients

Govind, C. and Komaris, D. and Riches, P. and Clarke, J. and Picard, F. and Ewen, A. (2016) Short-term knee flexion during stair ascent in total knee arthroplasty patients. In: British Orthopaedic Research Society, 2016-09-05 - 2016-09-06, University of Glasgow.

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Stair ascent is a demanding activity which requires around 85° of knee flexion. Analysing this task may give an indication of Total Knee Arthroplasty (TKA) joint function. This study looked at short-term outcomes to give information regarding initial recovery after TKA surgery. Three-dimensional motion analysis was carried out on five healthy control participants and five TKA patients (Columbus®, B. Braun Aesculap, Tuttlingen) performing five stair ascents at their own self-selected pace, choosing whether or not to use handrails. Control data were recorded at one assessment and patient data both pre-operatively and at mean follow up of 10 weeks (8 to 12) post-operatively. The maximum knee flexion achieved during stair ascent was calculated. Four patients walked with a step over step strategy enabling comparison with the control group. There was no change in mean flexion angle from pre-operative to post-operation for either the operated side [mean pre-operatively=84° (76°-94°) vs. 82° (79°-86°) post-operatively , paired t-test p=0.67] or the non-operated side [mean pre-operatively=81° (61°-87°) vs. 81° (70°-95°) postoperatively, paired t-test p=0.56]. This was lower than mean for the control group, 97° (90°-106°) t-test p<0.001. The pre- and post-operative flexion angles of the patient who walked with a step by step strategy was 55° and 56° on the operated side and 43° and 52° on the non-operated side. Knee flexion during stair ascent was similar both pre- and at 10 weeks post operation. Post-operative function did not reach control group values. The large variation between individuals for flexion of the non-operated side may represent different strategies for stair ascent: higher angles to achieve a greater ground clearance for safety, or lower angles to allow the patient to ascend faster so the operated support leg spends less time under load. Further work on a larger number of patients is required to understand this finding.