Efficacy of Total Knee Arthroplasty in Elderly Patients With Locomotive Syndrome: a Prospective Longitudinal Study

Abstract Background: To preserve the ability to perform physical activities among the elderly, the concept of locomotive syndrome and its evaluation method, the locomotive syndrome risk test, have been applied in an integrated manner to capture the decline in mobility resulting from musculoskeletal disorders. During treatment, physicians can use the locomotive syndrome risk test to evaluate the impact of each therapy such as total knee arthroplasty for knee osteoarthritis, a common disorder found in locomotive syndrome. The purpose of this study was to evaluate the impact of total knee arthroplasty in the elderly with respect to locomotive syndrome.Methods: A total of 111 patients were registered at six hospitals prior to total knee arthroplasty and postoperatively followed up for 1 year. Three components of the locomotive syndrome risk test (the two-step test, stand-up test, and geriatric locomotive function scale-25) were assessed together with the EuroQol-5 Dimension scores pre- and postoperatively.Results: Post surgery, all three components of the locomotive syndrome　risk test as well as the EuroQol-5 Dimension utility score showed significant improvements from the baseline (two-step test, 1.01±0.25 to 1.12±0.21; stand-up test, 2.02±1.14 to 2.38±1.20; geriatric locomotive function scale-25, 38.3±15.8 to 18.7±16.6, mean ± standard deviation). The ratio of stage 3 locomotive syndrome patients (progressed stage of decrease in mobility, restricting social engagement) reduced from 82.3% to 33.9% postoperatively. There was no significant difference in the degree of change in the three test scores between the younger (60-74 years) and older (≥75 years) age groups. Conclusions: We found that total knee arthroplasty has a major impact in preventing the progression of locomotive syndrome in patients with knee osteoarthritis. The locomotive syndrome risk test is a feasible tool for longitudinal evaluation of patients with musculoskeletal diseases of varying severity and with multiple symptoms.Trial registration: This study was registered as UMIN000023595 (10/08/2016)

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Total Knee Arthroplasty Improved Locomotive Syndrome in Knee Osteoarthritis Patients: A Prospective Cohort Study Focused on Total Clinical Decision Limits Stage 3

BioMed Research International ◽

10.1155/2021/3919989 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Shigeaki Miyazaki ◽

Saori Yoshinaga ◽

Kurumi Tsuruta ◽

Amy Hombu ◽

Yoshinori Fujii ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Cohort Study ◽

Knee Osteoarthritis ◽

Motor Function ◽

Knee Arthroplasty ◽

Clinical Decision ◽

Step Test ◽

Locomotive Syndrome ◽

Improvement Rate ◽

Total Knee

Purpose. The purpose of this study is to investigate the treatment efficacy of total knee arthroplasty (TKA) on locomotive syndrome (LS) focusing on total clinical decision limit (CDL) stage 3 leading to revealing the motor function indicators that can predict LS improvement in knee osteoarthritis patients who had received TKA. Methods. This prospective cohort study was conducted in 47 patients evaluated as total CDL stage 3 before TKA who received primary TKA on the operated side and were diagnosed with Kellgren-Lawrence grade 2, 3, or 4 knee osteoarthritis on the nonoperated side. LS was evaluated using stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale. In addition, the motor function indicators which could predict the LS improvement were examined. All assessments were conducted before TKA and three months after TKA. Results. Of the 47 subjects who were evaluated to be in total CDL stage 3 before TKA, 13 patients (27.7%) were determined to show improvements in total CDL. From the result of the decision tree analysis, when the CDL of the two-step test before TKA was 1 or less, the improvement rate was 83.3%. Even if the CDL of the two-step test before TKA was higher than 1 and if the 3 m-Timed Up and Go test (3m-TUG) before TKA was 9.6 or less, the improvement rate was 50%. Conclusions. As of three months after surgery, TKA can improve LS in about 30% of knee osteoarthritis patients. A two-step test before TKA and 3m-TUG before TKA can be used as motor function indicators to predict LS improvement. This study provides useful information for setting the goal for rehabilitation prior to surgery.

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Differences of 2-year longitudinal changes of locomotive syndrome among patients treated with thoracolumbar interbody fusion, total hip arthroplasty, and total knee arthroplasty for degenerative diseases

Modern Rheumatology ◽

10.1093/mr/roab033 ◽

2021 ◽

Author(s):

Naofumi Taniguchi ◽

Tetsuya Jinno ◽

Tetsuro Ohba ◽

Hiroshi Endo ◽

Masanori Wako ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Total Hip Arthroplasty ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Interbody Fusion ◽

Step Test ◽

Degenerative Diseases ◽

Locomotive Syndrome ◽

Total Hip ◽

Total Knee

ABSTRACT Objectives To clarify the longitudinal changes in patients with preoperative Stage-3 locomotive syndrome (LS) according to different types of surgeries, we investigated the changes in the LS stage in patients who underwent surgery for degenerative musculoskeletal diseases. Methods A prospective cohort study was conducted on 168 patients with degenerative diseases [46 spinal deformities treated with thoracolumbar interbody fusion (T/LIF), 86 hips with osteoarthritis treated with total hip arthroplasty (THA), and 36 knees with osteoarthritis treated with total knee arthroplasty (TKA)]. The results for the LS stage, stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25) were evaluated preoperatively and at 6 months, 1 year, and 2 years postoperatively. Results Preoperatively, most patients had Stage-3 LS (89.1, 90.8, and 80.6% in the T/LIF, THA, and TKA groups, respectively). At 2 years postoperatively, the Stage-3 LS improved in 41.5, 75.6, and 55.2% of patients in the T/LIF, THA, and TKA groups, respectively. All groups showed similar improvements in the two-step test. The THA group showed the best result in the GLFS-25. Conclusions LS stage improved in different patterns over 2 years postoperatively and the LS risk test revealed differences in postoperative movement ability according to the type of surgery.

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Total Knee Arthroplasty Improves Locomotive Syndrome in Patients with Knee Disease: A Prospective Cohort Study Focused on Total Clinical Decision Limits Stage 3

10.21203/rs.3.rs-136953/v1 ◽

2021 ◽

Author(s):

Shigeaki Miyazaki ◽

Saori Yoshinaga ◽

Kurumi Tsuruta ◽

Amy Hombu ◽

Yoshinori Fujii ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Cohort Study ◽

Motor Function ◽

Knee Arthroplasty ◽

Prospective Cohort ◽

Clinical Decision ◽

Step Test ◽

Locomotive Syndrome ◽

Improvement Rate ◽

Total Knee

Abstract Background:In 2020, the Japanese Orthopaedic Association added a new clinical decision limit (CDL), stage 3, to evaluate the stages of locomotive syndrome (LS). However, so far there has been no study of total knee arthroplasty (TKA) to examine the efficacy of LS treatment and there are no motor function indicators to predict LS improvement, focusing on stage 3. The purpose of this study is to investigate the treatment efficacy of TKA on LS focusing on total CDL stage 3 leading to revealing the motor function indicators that can predict LS improvement in patients who had received TKA.Methods:This prospective cohort study was conducted with 59 patients among 70 patients who underwent TKA, with total CDL stage 3 before TKA evaluation. LS was evaluated using stand-up test, two-step test, and 25-Question Geriatric Locomotive Function Scale. In addition, the motor function indicators which could predict the LS improvement were examined. All assessments were conducted before TKA and three months after TKA.Results:Of the 59 subjects who were evaluated to be in total CDL stage 3 before TKA, 17 patients (28.8%) were determined to show improvements in total CDL. From the result of the decision tree analysis, when the CDL of the two-step test before TKA was 1 or less, the improvement rate was 77.8%. Even if the CDL of the two-step test before TKA was higher than 2 and if the 3m-Timed Up & Go test (3m-TUG) before TKA was 9.15 or less, the improvement rate was 60%.Conclusions:As of three months after surgery, TKA can improve LS in about 30% of patients. A two-step test before TKA and 3m-TUG before TKA can be used as motor function indicators to predict LS improvement. This study provides useful information for setting the goal for rehabilitation prior to surgery.

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Reduction of Falls and Factors Affecting Falls a Year After Total Knee Arthroplasty in Elderly Patients with Severe Knee Osteoarthritis

The Open Orthopaedics Journal ◽

10.2174/1874325001610010522 ◽

2016 ◽

Vol 10 (1) ◽

pp. 522-531 ◽

Cited By ~ 9

Author(s):

T. Tsonga ◽

M. Michalopoulou ◽

S. Kapetanakis ◽

E. Giovannopoulou ◽

P. Malliou ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Elderly Patients ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Fall Risk ◽

Prospective Longitudinal Study ◽

Factors Affecting ◽

Knee Oa ◽

Total Knee ◽

Prospective Longitudinal

Background:Total Knee Arthroplasty (TKA)1is a common surgical treatment for severe knee Osteoarthritis (OA)2, which generally improves pain, physical function, quality of life and possibly fall risk. Fall risk increases for older adults with severe knee OA; however it has not been studied extensively whether this parameter is improved after TKA.Objective:To investigate: a) the history and frequency of falls, including mechanism or causes of falls, injuries sustained from falls reported, activity during falling and location of falls and, b) the factors affecting falls, a year after TKA in elderly patients with severe knee OA.Patients and Method:An observational prospective longitudinal study of 68 patients (11 males and 57 females) was conducted. The frequency of falls was recorded every month after knee replacement for a year period. A year after the TKA patients completed self-administered questionnaires (SF-36, Womac, FOF, ABC, PASE) and were assessed in physical performance tests (TUG and BBS).Results:There was significant improvement in falls frequency (p<0.001), differentiation of falling status to the benefit of non fallers (p<0.001) and risk of serious injuries (p<0.001). The factors that affected falling status was history of falls (p<0.0005), fear of falls (p<0.017) and advanced age, marginally (p<0.097).Conclusion:TKA generally improved a lot of aspects in patients’ life. One of these was the reduction of fall risk, which always co-exists in this population and can cause devastating problems threatening the benefits of the procedure.

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Perioperative management of elderly patients with osteoarthritis requiring total knee arthroplasty

Journal of Perioperative Practice ◽

10.1177/1750458920936940 ◽

2021 ◽

pp. 175045892093694

Author(s):

Jiang An Lim ◽

Azeem Thahir

Keyword(s):

Total Knee Arthroplasty ◽

Elderly Patients ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Conservative Management ◽

Perioperative Management ◽

Functional Limitation ◽

Cartilage Degeneration ◽

The Elderly ◽

Total Knee

Knee osteoarthritis is a common arthritic disease which mainly affects the elderly (≥65 years old) population. As a result of the cartilage degeneration, it can cause a significant amount of pain and functional limitation. In patients who are refractory to conservative management, total knee arthroplasty is being utilised as the last resort in management. In this review, we discuss the perioperative management of elderly patients with osteoarthritis requiring total knee arthroplasty.

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Clinical and Radiological Changes of Ankle in Knee Osteoarthritis With Varus After Total Knee Arthroplasty: A Systematic Review

Frontiers in Surgery ◽

10.3389/fsurg.2021.713055 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zhiwei Feng ◽

Ming Ma ◽

Yaobin Wang ◽

Chenfei Yang ◽

Zhongcheng Liu ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Ankle Joint ◽

Knee Arthroplasty ◽

Varus Deformity ◽

Cochrane Library ◽

Total Knee ◽

Radiological Changes ◽

The Impact

Background: Arthritis with severe varus deformity remains a challenge in total knee arthroplasty (TKA). Until recently, surgeons aimed at a neutral lower limb alignment when performing a TKA. However, the impact of TKA on the ankle joint has been ignored. Therefore, we conducted a systematic review to assess the clinical and radiological changes in the ankle joint after TKA on knees with severe varus deformity.Methods: A systematic search was conducted in four English (PubMed, Embase, Cochrane Library, and Web of Science) and four Chinese (CBM, VIP, CNKI, and Wan Fang Database) databases. Screening of literature and extraction of data were independently performed by two researchers. The modified methodological index for non-randomized studies (MINORS) was used to assess the quality.Results: A total of eight studies were eligible, namely, four prospective and four retrospective studies. TKA resulted in a negative clinical effect in the ankle joint in patients with ankle osteoarthritis. Seven studies reported changes in the mechanical tibiofemoral angle, and four studies reported radiological changes in the hindfoot. The mean score of the MINORS was 9.8 out of eight (9–11).Conclusion: As a result of the correction of the knee osteoarthritis with severe varus deformity following mechanically aligned TKA, the radiological malalignment of the ankle joint was improved. However, some patients experience increased ankle pain after undergoing TKA, especially, if there was a residual knee varus deformity, a stiff hindfoot with varus deformity, or ankle arthritis.

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Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

The Journal of Knee Surgery ◽

10.1055/s-0040-1712100 ◽

2020 ◽

Author(s):

Antonio Klasan ◽

Sven Edward Putnis ◽

Wai Weng Yeo ◽

Darli Myat ◽

Brett Andrew Fritsch ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patient Selection ◽

Knee Arthroplasty ◽

Major Complication ◽

The Elderly ◽

Complication Rates ◽

Bilateral Total Knee Arthroplasty ◽

Proper Patient Selection ◽

Patient Reported ◽

Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

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Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04512-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

K Giesinger ◽

JM Giesinger ◽

DF Hamilton ◽

J Rechsteiner ◽

A Ladurner

Keyword(s):

Body Mass Index ◽

Total Knee Arthroplasty ◽

Pain Relief ◽

Body Mass ◽

Knee Arthroplasty ◽

Normal Weight ◽

World Health ◽

Obese Patients ◽

Total Knee ◽

The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

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