2 Assistant Professor, Department of Physical Therapy, Eastern Washington University, Cheney, WA. ... habilitation programs with intensive exer- ...... Kuster MS.
[
CLINICAL COMMENTARY
]
WHITNEY MEIER, DPT, OCS1HO7DC?PD;H"PhD, MPT2HE8?DC7H9KI"PT, PhD, OCS3 B;;:?88B;"PT, PhD, ATC39>H?IJEF>;HF;J;HI"MD4F7KB9$B7IJ7OE"PT, PhD, CHT5
Total Knee Arthroplasty: Muscle Impairments, Functional Limitations, and Recommended Rehabilitation Approaches otal knee arthroplasty (TKA) is a commonly performed surgical procedure designed to alleviate knee pain and improve function in individuals with knee osteoarthritis (OA) or rheumatoid arthritis. More than 450 000 TKAs are performed each year in the United States and this number is expected to nearly double by 2020.2,69 Despite the high incidence of knee replacement and the availability of postoperative rehabilitative approaches, the resultant
T
muscle impairments are not well defined and are an understudied area of postoperative care.1 Of particular interest to rehabilitation professionals is the acute profound postoperative deficit in quadriceps muscle strength5,42,52,55,67,70,79,85 TIODEFI?I0 The number of total knee arthroplasty (TKA) surgeries performed each year is predicted to steadily increase. Following TKA surgery, self-reported pain and function improve, though individuals are often plagued with quadriceps muscle impairments and functional limitations. Postoperative rehabilitation approaches either are not incorporated or incompletely address the muscular and functional deficits that persist following surgery. While the reason for quadriceps weakness is not well understood in this patient population, it has been suggested that a combination of muscle atrophy and neuromuscular activation deficits contribute to residual strength impairments. Failure to adequately address the chronic muscle impairments has the potential to limit the long-term functional gains that may be possible following TKA.
(J78B;') that fails to completely resolve even years after surgery5,6,29,71,72,85 (J78B; 2). Hamstring strength deficits have also been reported after TKA surgery5,29,42,51,72; however, the focus on the quadriceps is due to the association of the quadriceps Postoperative rehabilitation addressing quadriceps strength should mitigate these impairments and ultimately result in improved functional outcomes. The purpose of this paper is to describe these quadriceps muscle impairments and to discuss how these impairments can contribute to the related functional limitations following TKA. We will also describe the current concepts in TKA rehabilitation and provide recommendations and clinical guidelines based on the current available evidence.
TB;L;BE
