End-stage knee osteoarthritis with and without sarcopenia – and the effect of knee arthroplasty

Abstract Background Sarcopenia often accompanies osteoarthritis but the relationship between them is still unclear and no strong consensus can be reached. Previous studies revealed that OA in the hip or knee is associated with declines in muscle mass and strength. This study aims to examine the status of sarcopenia in individuals with symptomatic end-stage OA of the knee, the effect of this condition on their peri-operative TKA rehabilitation and functional outcome. Methods This prospective study was conducted between 2015 to 2018 at our hospital. Patients with end-stage osteoarthritis of the knee on queue for total knee arthroplasty were recruited into the study. Primary outcome measures were DEXA in lean muscle mass, muscle strength, knee motion and function. Secondary outcomes measures were Quality of Life (QOL) measurements in pain, psychological and physical health. Results Fifty-eight patients were recruited, of which 79.3% were female and 32.8% already had sarcopenia at baseline. The average age of sarcopenic subjects and non-sarcopenic subjects were comparable (67.89±7.07 vs. 67.92±6.85; p=0.99) but sarcopenic subjects tend to have lower BMI (25.64±2.64 vs. 28.57±4.04; p=0.01). There was a statistically significant improvement in walking speed and range of movement in both sarcopenic and non-sarcopenic patients after TKA (p<0.01). This was accompanied by an improvement trend in muscle mass in all subjects. A sarcopenic female that were overweight or obese had statistically significant improvement in both Appendage Lean Mass Index and Lean Mass Index after total knee arthroplasties in 12 months (p=0.04). There was no change in handgrip power before and after TKA and subsequent follow-up (p=0.97). Quality of life measured with WOMAC, SF12v2 and IPAQ revealed progressive significant improvement (p≤0.01). Further analysis at the IPAQ also found increased engagement of high-intensity activities. Conclusions To conclude, our study showed that sarcopenia among patients with end-stage OA of the knee is not uncommon. The mechanical mal-alignment and degenerative process in OA of the knee can be corrected with TKA. However, the rehabilitation and recovery in the elderly population may never fully recover. Further studies focusing on this group of patient and employment of multimodal therapy with a supervised exercise program is warranted.

Download Full-text

Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04205-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jake von Hintze ◽

Mika Niemeläinen ◽

Harri Sintonen ◽

Jyrki Nieminen ◽

Antti Eskelinen

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Survival Rate ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Patient Reported ◽

Total Knee ◽

Revision Tka

Abstract Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

Download Full-text

The Effectiveness of Client-Centered Intervention With Telerehabilitation Method After Total Knee Arthroplasty

OTJR Occupation Participation and Health ◽

10.1177/15394492211038293 ◽

2021 ◽

pp. 153944922110382

Author(s):

Berkan Torpil ◽

Özgür Kaya

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Intervention Program ◽

Nottingham Health Profile ◽

Performance Measure ◽

Occupational Performance ◽

Significant Difference ◽

Total Knee

There is known to be a decrease in quality of life and perceived occupational performance and satisfaction following total knee arthroplasty (TKA). This study was planned to examine the effectiveness of a client-centered (CC) intervention with the telerehabilitation (TR) method on the quality of life, perceived occupational performance, and satisfaction after TKA. A total of 38 patients who had undergone TKA were randomly assigned to the CC and control groups. A 12-day intervention program was applied to the CC group. The Nottingham Health Profile (NHP) and Canadian Occupational Performance Measure (COPM) were applied before and after intervention. The 12-day intervention showed a strong effect on all parameters in the CC group ( p<.001). In the postintervention comparisons, a significant difference was found in favor of the CC group ( p < .001). CC interventions with the TR method can be used in post-TKA interventions.

Download Full-text

Improved knee biomechanics among patients reporting a good outcome in knee-related quality of life one year after total knee arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-017-1479-3 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 15

Author(s):

Josefine E. Naili ◽

Per Wretenberg ◽

Viktor Lindgren ◽

Maura D. Iversen ◽

Margareta Hedström ◽

...

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Biomechanics ◽

Good Outcome ◽

Related Quality ◽

Total Knee ◽

One Year

Download Full-text

The influence of obesity on functional outcome and quality of life after total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.100b5.bjj-2017-1263.r1 ◽

2018 ◽

Vol 100-B (5) ◽

pp. 579-583 ◽

Cited By ~ 16

Author(s):

S. Xu ◽

J. Y. Chen ◽

N. N. Lo ◽

S. L. Chia ◽

D. K. J. Tay ◽

...

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Functional Outcome ◽

Knee Arthroplasty ◽

Obese Group ◽

Control Group ◽

Obese Patients ◽

Knee Score ◽

Total Knee

AimsThis study investigated the influence of body mass index (BMI) on patients’ function and quality of life ten years after total knee arthroplasty (TKA).Patients and MethodsA total of 126 patients who underwent unilateral TKA in 2006 were prospectively included in this retrospective study. They were categorized into two groups based on BMI: < 30 kg/m2(control) and ≥ 30 kg/m2(obese). Functional outcome was assessed using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), and Oxford Knee Score (OKS). Quality of life was assessed using the Physical (PCS) and Mental Component Scores (MCS) of the 36-Item Short-Form Health Survey.ResultsPatients in the obese group underwent TKA at a younger age (mean, 63.0 years, sd 8.0) compared with the control group (mean, 65.6 years, sd 7.6; p = 0.03). Preoperatively, both groups had comparable functional and quality-of-life scores. Ten years postoperatively, the control group had significantly higher OKS and MCS compared with the obese group (OKS, mean 18 (sd 5) vs mean 22 (sd 10), p = 0.03; MCS, mean 56 (sd 10) vs mean 50 (sd 11), p = 0.01). After applying multiple linear regression with the various outcomes scores as dependent variables and age, gender, and Charlson Comorbidity Index as independent variables, there was a clear association between obesity and poorer outcome in KSFS, OKS, and MCS at ten years postoperatively (p < 0.01 in both KSFS and OKS, and p = 0.03 in MCS). Both groups had a high satisfaction rate (97.8% in the control group vs 87.9% in the obese group, p = 0.11) and fulfillment of expectations at ten years (98.9% in the control group vs 100% in the obese group, p = 0.32).ConclusionAlthough both obese and non-obese patients have significant improvements in function and quality of life postoperatively, obese patients tend to have smaller improvements in the OKS and MCS ten years postoperatively. It is important to counsel patients on the importance of weight management to achieve a more sustained outcome after TKA. Cite this article: Bone Joint J 2018;100-B:579–83.

Download Full-text

Impact of Hospital Rehabilitation on Functional Outcomes and Quality of Life after Total Knee Arthroplasty

Türkiye Fiziksel Tıp ve Rehabilitasyon Dergisi ◽

10.5152/tftrd.2015.68790 ◽

2015 ◽

Vol 61 (2) ◽

pp. 111-115 ◽

Cited By ~ 1

Author(s):

Ahmet Ozgur Yildirim ◽

Oznur Oken ◽

Ozdamar Fuad Oken ◽

Belma Fusun Koseoglu ◽

Nebahat Sezer ◽

...

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Functional Outcomes ◽

Total Knee ◽

Hospital Rehabilitation

Download Full-text

Osteoarthritis of the knee joint. Etiology, treatment, rehabilitation (analytical review of the literature)

TRAUMA ◽

10.22141/1608-1706.3.22.2021.236317 ◽

2021 ◽

Vol 22 (3) ◽

pp. 5-11

Author(s):

Khaled Obeidat ◽

O.D. Karpinska

Keyword(s):

Quality Of Life ◽

Total Knee Arthroplasty ◽

Knee Joint ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Gait Parameters ◽

Total Knee ◽

The Difference ◽

Knee Pathology

According to epidemiological studies, osteoarthritis accounts for 10–12 % of all cases of musculoskeletal diseases. In the general structure of knee pathology, degenerative diseases make up 57.8 %. The urgency of the problems of gonarthrosis is due to not only its widespread prevalence, but also the high risk of developing knee dysfunction, accompanied by a significant reduction in the quality of life of patients and often leading to partial or permanent disability of patients. Gonarthrosis has significant gender features. Women account for about 70 % of the number of patients, while men had this disease almost 2 times less often, but other data indicate that the incidence of gonarthrosis in men under 60 years of age is higher, and in women it begins to increase after 65 years. Knee replacement is a leading method in the treatment of knee osteoarthritis stages III–IV. The tendency towards an increase in the total number of surgeries leads to an increase in the frequency of complications and unsatisfactory results: according to some authors, from 3.3 to 13.2 % of patients complain of knee replacement outcomes. Studies of long-term complaints after arthroplasty have shown that in addition to pain reduction, some patients had an increase in varus angle when bending the knee while walking but they didn’t mark an improvement in gait parameters compared to preoperative examination. After unilateral total knee arthroplasty, the load patterns of the frontal plane in the operated knee remain pathological in the long run. After knee arthroplasty, there is muscle weakness, and studies have shown changes in all muscles of the lower extremity. Weakening of some muscles led to compensatory strengthening of others. Studies of the effect of preoperative rehabilitation on the outcome of knee arthroplasty have shown its low efficiency. Many studies have studied motor activity of patients after total knee arthroplasty in recent years. Not only gait features, but also movements of the pelvis, trunk and upper extremities are studied. Modern methods of diagnosing spatial oscillations of the body when walking have shown that disorders of body movements — excessive hand movements, pelvic loosening, asymmetrical flexion of the knee joints, etc., after arthroplasty are preserved in patients and restore slowly, and some disorders remain forever. Conclusions. Knee arthroplasty relieves pain, improves quality of life, but according to many authors, patients complain of incomplete restoration of the functionality of the prosthetic limb. According to the researchers, the main cause for incomplete reco-very of gait parameters is the difference in the frontal angles of the knee joint flexion and the difference in the length of the steps. Special training exercises can reduce the asymmetry of the steps, but it is difficult to completely restore the symmetry of the steps within 2 years. Studies of the effect of preoperative rehabilitation on the outcome of knee arthroplasty have shown its low effectiveness.

Download Full-text