Document Detail


Preoperative predictors of persistent impairments during stair ascent and descent after total knee arthroplasty.
MedLine Citation:
PMID:  20439658     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although total knee arthroplasty improves functional mobility in persons with end-stage knee osteoarthritis, many subjects have reported continued difficulty with stair ascent and descent after surgery. The purpose of the present study was to determine preoperative predictors of handrail use during stair ascent and descent following primary unilateral total knee arthroplasty.
METHODS: One hundred and five adults who were scheduled for unilateral total knee arthroplasty participated in the study. Postoperative handrail use during stair ascent or descent was predicted on the basis of preoperative functional measures. Preoperative age, body mass index, knee strength, knee flexion active range of motion, Knee Outcome Survey scores, time to complete a stair-climbing task, and previous handrail use were entered as covariates into a binary logistic regression. Forward logistic regression was performed to determine which preoperative factors best predicted handrail use at three months and two years after surgery. Handrail use in a control group was also evaluated at baseline and at the time of the two-year follow-up.
RESULTS: Prior to surgery, sixty-three of the 105 subjects required a handrail. Two years after surgery, sixty of the 105 subjects required a handrail. In the control group, nineteen of the sixty-four subjects required a handrail at baseline and ten of thirty-one required a handrail at the time of the two-year follow-up. At two years, the preoperative ability to ascend and descend stairs without a handrail was the best predictor of individuals who would not require a handrail after surgery, followed by younger age and greater quadriceps strength. Collectively, these variables correctly predicted the ability of ninety of 105 persons to negotiate stairs without a handrail at two years after surgery (p < 0.001).
CONCLUSIONS: Younger, stronger patients who do not use a handrail prior to unilateral total knee arthroplasty can expect the best outcomes in terms of ascending and descending stairs following surgery. This information may provide patients with more realistic expectations after surgery and allow them to make more appropriate discharge plans.
Authors:
Joseph A Zeni; Lynn Snyder-Mackler
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  92     ISSN:  1535-1386     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-04     Completed Date:  2010-05-21     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1130-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA. Joseph.Zeni@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living*
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee / rehabilitation*
Biomechanics
Humans
Middle Aged
Muscle Strength
Osteoarthritis, Knee / surgery*
Range of Motion, Articular
Recovery of Function
Treatment Outcome
Grant Support
ID/Acronym/Agency:
P20RR016458/RR/NCRR NIH HHS; R01HD041055/HD/NICHD NIH HHS
Comments/Corrections

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