Multi-Joint Compensatory Effects of Unilateral Total Knee Arthroplasty During High-Demand Tasks.
Multi-Joint Compensatory Effects of Unilateral Total Knee Arthroplasty During High-Demand Tasks.
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DOI：
10.1007/s10439-015-1524-z
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发表时间：
2016-08
影响因子：
3.8
通讯作者：
Shelburne KB
中科院分区：
文献类型：
--
作者：
Gaffney BM;Harris MD;Davidson BS;Stevens-Lapsley JE;Christiansen CL;Shelburne KB
全膝关节置换术(TKA)的患者在术后一年的日常工作中表现出股四头肌无力和功能受限，如行走和爬楼梯。对TKA术后患者的生物力学分析大多集中在股四头肌功能上，很少研究其他肢体肌肉或日常生活中高要求的步行活动。这项研究的目的是量化单侧全膝关节置换术患者在高要求的旋转和下楼梯任务中的下肢肌力。5例单侧TKA患者和5例年龄、性别匹配的对照组完成了3个双侧高要求任务：1)从8英寸平台上下来，2)内枢转：朝向植入肢90°，3)外枢转：远离植入肢90°。在OpenSim中创建了特定于受试者的肌肉骨骼模拟，以确定关节角度、力矩和下肢肌力。结果表明，TKA患者在髋关节和膝关节上均采取了代偿策略。TKA患者在所有三个任务中都表现出髋外旋度增加，膝关节屈曲减少，股四头肌力量减少，髋外展肌力量减少。这些策略可能是股四头肌回避的结果，这可能源于TKA术后的不稳定，或者是在骨关节炎晚期形成的习惯性策略。
Patients with total knee arthroplasty (TKA) demonstrate quadriceps weakness and functional limitations one year after surgery during daily tasks such as walking and stair climbing. Most biomechanical analyses of patients after TKA focus on quadriceps function and rarely investigate other lower-extremity muscles or high-demand ambulatory activities of daily living. The purpose of this investigation was to quantify lower-extremity muscle forces in patients with unilateral TKA during high-demand tasks of pivoting and descending stairs. Five patients with unilateral TKA and five age and sex-matched controls performed three bilateral high-demand tasks: 1) step down from an 8-inch platform, 2) inside pivot: 90° direction change toward planted limb, and 3) outside pivot: 90° direction change away from planted limb. Subject-specific musculoskeletal simulations were created in OpenSim to determine joint angles, moments, and lower-extremity muscle forces. The results indicate that patients with TKA adopt compensatory strategies at both the hip and knee. Patients with TKA demonstrated increased hip external rotation, decreased knee flexion, decreased quadriceps force, and decreased hip abductor force in all three tasks. These strategies are likely a result of quadriceps avoidance, which may stem from instability after TKA or a habitual strategy developed during the late stages of osteoarthritis.