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Quadriceps/hamstrings co-activation increases early after total knee arthroplasty

  • Author Footnotes
    1 Present address: Biodynamics Research Laboratory, Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC 28233.
    Abbey C. Thomas
    Footnotes
    1 Present address: Biodynamics Research Laboratory, Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC 28233.
    Affiliations
    University of Colorado, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, Aurora, CO 80045, United States
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  • Dana L. Judd
    Affiliations
    University of Colorado, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, Aurora, CO 80045, United States
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  • Bradley S. Davidson
    Affiliations
    Department of Mechanical and Materials Engineering, University of Denver, Denver, CO 80208, United States
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  • Donald G. Eckhoff
    Affiliations
    Department of Orthopaedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
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  • Jennifer E. Stevens-Lapsley
    Correspondence
    Corresponding author. Tel.: +1 303 724 9170.
    Affiliations
    University of Colorado, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, Aurora, CO 80045, United States
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  • Author Footnotes
    1 Present address: Biodynamics Research Laboratory, Department of Kinesiology, University of North Carolina at Charlotte, Charlotte, NC 28233.
Published:August 16, 2014DOI:https://doi.org/10.1016/j.knee.2014.08.001

      Highlights

      • Muscle co-activation is elevated bilaterally in patients one month after TKA.
      • Muscle co-activation is greater in patients than healthy adults.
      • Quadriceps activity is prolonged during stance before and early after TKA.
      • Rehabilitation should integrate strength and neuromuscular control retraining.

      Abstract

      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/m2) and 10 healthy adults (n = 6 female; age: 60.6 ± 7.4 years; BMI: 25.5 ± 4.0 kg/m2) 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.

      Keywords

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