Quadriceps/hamstrings Co-activation Increases Early After Total Knee Arthroplasty

Overview

Journal Knee

Publisher Elsevier

Specialty Orthopedics

Date 2014 Sep 15

PMID 25218971

Citations 19

Authors

Abbey C Thomas

Dana L Judd

Bradley S Davidson

Donald G Eckhoff

Jennifer E Stevens-Lapsley

Affiliations

Soon will be listed here.

Abstract

Unlabelled: Quadriceps and hamstrings weakness and co-activation are present following total knee arthroplasty (TKA) and may impair functional performance. How surgery and post-operative rehabilitation influence muscle activation during walking early after surgery is unclear.

Purpose: Examine muscle strength and activation during walking before and one and 6-months post-TKA.

Methods: Ten patients (n=6 female; age: 64.7 ± 7.9 years; body mass index[BMI]:29.2 ± 2.5 kg/m(2)) and 10 healthy adults (n=6 female; age: 60.6 ± 7.4 years; BMI: 25.5 ± 4.0 kg/m(2)) participated. The patients underwent bilateral quadriceps and hamstrings strength testing and assessment of quadriceps/hamstrings co-activation and on/off timing using surface electromyography during a six-minute walk test (6MW). Groups, limbs, and changes with TKA surgery were compared.

Results: Patients reported greater 6MW knee pain pre- versus post-TKA and compared to controls (P<0.05). Patients had weaker surgical limb hamstrings (P<0.05) and bilateral quadriceps (P<0.05) strength than controls pre- and post-TKA. Before and 1-month post-TKA, patients had side-to-side differences in quadriceps and hamstrings strength (P<0.05). Controls walked farther than patients (P<0.01). Patients demonstrated greater surgical limb co-activation pre-operatively than controls (P<0.05). Co-activation was higher bilaterally one-month post-TKA compared to controls (P<0.05). Patients turned off their quadriceps later during stance than controls before and 1-month post-TKA (P<0.05).

Conclusions: Muscle strength, co-activation, and timing differed between patients and controls before and early after surgery. Rehabilitation to improve strength and muscle activation seems imperative to restore proper muscle firing patterns early after surgery.

Citing Articles

Effect of total knee arthroplasty on quadriceps and hamstring muscle recovery in individuals with knee osteoarthritis: A proposed systematic review and meta-analysis protocol.

Shetty S, Gudi N, S E, Maiya G, Kg M, Vijayan S MethodsX. 2024; 13:103057.

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Therapeutic effect of knee extension exercise with single-joint hybrid assistive limb following total knee arthroplasty: a prospective, randomized controlled trial.

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There is more to the knee joint than just the quadriceps: A systematic review with meta-analysis and evidence gap map of hamstring strength, flexibility, and morphology in individuals with gradual-onset knee disorders.

Lopes H, Waiteman M, Priore L, Glaviano N, Bazett-Jones D, Briani R J Sport Health Sci. 2023; 13(4):521-536.

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Comparable in vivo joint kinematics between self-reported stable and unstable knees after TKA can be explained by muscular adaptation strategies: A retrospective observational study.

Rao L, Horn N, Meister N, Preiss S, Taylor W, Santuz A Elife. 2023; 12.

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Singla R, Niederer D, Franz A, Happ K, Zilkens C, Wahl P Arch Orthop Trauma Surg. 2023; 143(8):5303-5322.

PMID: 36637491 PMC: 10374784. DOI: 10.1007/s00402-022-04750-5.

References

Loughead J, Malhan K, Mitchell S, Pinder I, McCaskie A, Deehan D . Outcome following knee arthroplasty beyond 15 years. Knee. 2008; 15(2):85-90. DOI: 10.1016/j.knee.2007.11.003. View

Lewek M, Stevens J, Snyder-Mackler L . The use of electrical stimulation to increase quadriceps femoris muscle force in an elderly patient following a total knee arthroplasty. Phys Ther. 2001; 81(9):1565-71. DOI: 10.1093/ptj/81.9.1565. View

Schmitt L, Rudolph K . Muscle stabilization strategies in people with medial knee osteoarthritis: the effect of instability. J Orthop Res. 2008; 26(9):1180-5. PMC: 3112363. DOI: 10.1002/jor.20619. View

Lamontagne A, Richards C, Malouin F . Coactivation during gait as an adaptive behavior after stroke. J Electromyogr Kinesiol. 2000; 10(6):407-15. DOI: 10.1016/s1050-6411(00)00028-6. View

Mizner R, Petterson S, Snyder-Mackler L . Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005; 35(7):424-36. DOI: 10.2519/jospt.2005.35.7.424. View

Burden A . How should we normalize electromyograms obtained from healthy participants? What we have learned from over 25 years of research. J Electromyogr Kinesiol. 2010; 20(6):1023-35. DOI: 10.1016/j.jelekin.2010.07.004. View

Li X, Aruin A . Muscle activity onset time detection using teager-kaiser energy operator. Conf Proc IEEE Eng Med Biol Soc. 2007; 2005:7549-52. DOI: 10.1109/IEMBS.2005.1616259. View

Yoshida Y, Mizner R, Snyder-Mackler L . Association between long-term quadriceps weakness and early walking muscle co-contraction after total knee arthroplasty. Knee. 2013; 20(6):426-31. PMC: 3692574. DOI: 10.1016/j.knee.2012.12.008. View

Brown M, Sinacore D, Host H . The relationship of strength to function in the older adult. J Gerontol A Biol Sci Med Sci. 1995; 50 Spec No:55-9. DOI: 10.1093/gerona/50a.special_issue.55. View

10.

Woollacott M, Shumway-Cook A . Changes in posture control across the life span--a systems approach. Phys Ther. 1990; 70(12):799-807. DOI: 10.1093/ptj/70.12.799. View

11.

Chmielewski T, Stackhouse S, Axe M, Snyder-Mackler L . A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture. J Orthop Res. 2004; 22(5):925-30. DOI: 10.1016/j.orthres.2004.01.007. View

12.

Cash R, Gonzalez M, Garst J, Barmada R, STERN S . Proprioception after arthroplasty: role of the posterior cruciate ligament. Clin Orthop Relat Res. 1996; (331):172-8. View

13.

Hirokawa S, Solomonow M, Luo Z, Lu Y, DAmbrosia R . Muscular co-contraction and control of knee stability. J Electromyogr Kinesiol. 2010; 1(3):199-208. DOI: 10.1016/1050-6411(91)90035-4. View

14.

Walsh M, Woodhouse L, Thomas S, Finch E . Physical impairments and functional limitations: a comparison of individuals 1 year after total knee arthroplasty with control subjects. Phys Ther. 1998; 78(3):248-58. DOI: 10.1093/ptj/78.3.248. View

15.

Stevens-Lapsley J, Balter J, Kohrt W, Eckhoff D . Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clin Orthop Relat Res. 2010; 468(9):2460-8. PMC: 2919870. DOI: 10.1007/s11999-009-1219-6. View

16.

Mizner R, Petterson S, Stevens J, Vandenborne K, Snyder-Mackler L . Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005; 87(5):1047-53. PMC: 1167681. DOI: 10.2106/JBJS.D.01992. View

17.

Steffen T, Hacker T, Mollinger L . Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002; 82(2):128-37. DOI: 10.1093/ptj/82.2.128. View

18.

Walker S, Peltonen H, Avela J, Hakkinen K . Kinetic and electromyographic analysis of single repetition constant and variable resistance leg press actions. J Electromyogr Kinesiol. 2011; 21(2):262-9. DOI: 10.1016/j.jelekin.2010.12.004. View

19.

Stevens J, Mizner R, Snyder-Mackler L . Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series. J Orthop Sports Phys Ther. 2004; 34(1):21-9. DOI: 10.2519/jospt.2004.34.1.21. View

20.

Judd D, Eckhoff D, Stevens-Lapsley J . Muscle strength loss in the lower limb after total knee arthroplasty. Am J Phys Med Rehabil. 2012; 91(3):220-6. PMC: 4140618. DOI: 10.1097/PHM.0b013e3182411e49. View