An Improvement in Knee Disability does not Mean an Improvement in Functional Status in Geriatric Patients after Total Knee Arthroplasty

Abstract

Purpose: We aimed to investigate the relationship between the change in knee disability and change in functional status from before bilateral total knee arthroplasty (TKA) to discharge in geriatric patients. Methods: We retrospectively analyzed the data of 88 patients who underwent bilateral TKA. Before surgery and at discharge, the knee disability and functinal status of the patients were assessed using the Hospital for Special Surgery (HSS) knee score and the Iowa Level of Assistance Scale (ILAS), respectively. The Spearman correlation test was used to assess the correlation between the change in the HSS knee score and the change in the ILAS score. Results: A statistically significant difference was found in the HSS knee score between before surgery and at discharge (p<0.05). No statistically significant difference was found in the ILAS score (p>0.05). A moderate relationship was found between the change in the HSS knee score and the change in the ILAS score (r = –0.48, p<0.05). Conclusion: The change in knee disability from before surgery to discharge does not reflect the change in functional status in geriatric patients who underwent bilateral TKA.

Keywords

• Arthroplasty
• functional status
• knee joint
• disability

References

1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010; 26(3):355–369.
2. Lingard EA, Katz JN, Wright EA, Sledge CB. Predicting the outcome of total knee arthroplasty. J Bone Joint Surg Am 2004;86(10):2179–2186.
3. Wainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop 2020;91(1):3–19.
4. Denis M, Moffet H, Caron F, Ouellet D, Paquet J, Nolet L. Effectiveness of continuous passive motion and conventional physical therapy after total knee arthroplasty: a randomized clinical trial. Phys Ther 2006;86(2):174–185.
5. Finch E, Walsh M, Thomas SG, Woodhouse LJ. Functional ability perceived by individuals following total knee arthroplasty compared to age-matched individuals without knee disability. J Orthop Sports Phys Ther 1998;27(4):255–263.
6. Ritter MA, Lutgring JD, Davis KE, Berend ME. The effect of postoperative range of motion on functional activities after posterior cruciate-retaining total knee arthroplasty. J Bone Joint Surg Am 2008;90(4):777–784.
7. Ha CW, Park YB, Song YS, Kim JH, Park YG. Increased range of motion is important for functional outcome and satisfaction after total knee arthroplasty in Asian patients. J Arthroplasty 2016;31(6):1199–1203.
8. Miner AL, Lingard EA, Wright EA, Sledge CB, Katz JN, Gillespie W, et al. Knee range of motion after total knee arthroplasty: How important is this as an outcome measure? J Arthroplasty 2003;18(3):286–924.

9. Meneghini RM, Pierson JL, Bagsby D, Ziemba-Davis M, Berend ME, Ritter MA. Is there a functional benefit to obtaining high flexion after total knee arthroplasty? J Arthroplasty 2007;22(6 SUPPL.):43–46.
10. Mizner RL, Snyder-Mackler L. Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res 2005;23(5):1083–1090.
11. Jacobs CA, Christensen CP. Correlations between knee society function scores and functional force measures. Clin Orthop Relat Res 2009;467(9):2414–2419.
12. Elmallah RDK, Jauregui JJ, Cherian JJ, Pierce TP, Harwin SF, Mont MA. Effect of age on postoperative outcomes following total knee arthroplasty. J Knee Surg 2016;29(8):673–678.
13. Haynes J, Sassoon A, Nam D, Schultz L, Keeney J. Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty. Knee 2017;24(3):663–669.
14. Townsend LA, Roubion RC, Bourgeois DM, Leonardi C, Fox RS, Dasa V, et al. Impact of age on patient-reported outcome measures in total knee arthroplasty. J Knee Surg 208;31(6):580–584.
15. Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-Lawrence classification of osteoarthritis. Clin Orthop Relat Res 2016;474(8):1886–1893.
16. Ranawat C, Shine J. Duo-condylar total knee arthroplasty. Clin Orthop Relat Res 1973;94:185–195.
17. Narin S, Ünver B, Bakirhan S, Bozan Ö, Karatosun V. Cross-cultural adaptation, reliability and validity of the Turkish version of the hospital for special surgery (HSS) knee score. Acta Orthop Traumatol Turc 2014;48(3):241–248.
18. Na YG, Kang YG, Chang MJ, Chang CB, Kim TK. Must bilaterality be considered in statistical analyses of total knee arthroplasty? Clin Orthop Relat Res 2013;471(6):1970–1981.
19. Shields RK, Leo KC, Miller B, Dostal WF, Barr R. An acute care physical therapy clinical practice database for outcomes research. Phys Ther 1994;74(5):463–470.
20. Shields R, Enloe L, Evans R, Smith K, Steckel S. Reliability, validity, and responsiveness of functional tests in patients with total joint replacement. Phys Ther 1995;75(3):169–176.
21. Evans JD. Straightforward Statistics for the Behavioral Sciences. Brooks/Cole Publishing, Pacific Grove; 1996.
22. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:175–191.
23. Ranawat CS, Ranawat AS, Mehta A. Total knee arthroplasty rehabilitation protocol: What makes the difference? J Arthroplasty 2003;18:27–30.
24. Meier W, Mizner R, Marcus R, Dibble L, Peters C, Lastayo PC. Total knee arthroplasty: Muscle impairments, functional limitations, and recommended rehabilitation approaches. J Orthop Sports Phys Ther 2008;38(5):246–256.
25. Alexander NB, Grunawalt JC, Carlos S, Augustine J, Alexander N. Bed mobility task performance in older adults. J Rehab Res Dev 2000;37(5):633–638.
26. Frank JS, Patla AE. Balance and mobility challenges in older adults: Implications for preserving community mobility. Am J Prev Med 2003;25(3 Suppl 2):157–163.
27. Suri P, Kiely DK, Leveille SG, Frontera WR, Bean JF. Trunk muscle attributes are associated with balance and mobility in older adults: a pilot study. PM R 2009;1(10):916–924.
28. Kim M, Oh S, Kim K, Kwon T, Hong C. Biomechanıcal comparison of muscle use patterns of young adults and older adults in floor and bed transfer movements. J Mech Med Biol 2020;20(9).
29. Sano Y, Iwata A, Wanaka H, Matsui M, Yamamoto S, Koyanagi J, et al. An easy and safe training method for trunk function improves mobility in total knee arthroplasty patients: A quasi-randomized controlled trial. PLoS One 2018;13(10):e0204884.
30. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 2005;35(7):424–436.
31. Schmitt LC, Fitzgerald K, Reisman AS, Rudolph KS. Instability, laxity, and physical function in patients with medial knee osteoarthritis. Phys Ther 2008;88(12):1506–1516.
32. Sharma L, Chmiel JS, Almagor O, Moisio K, Chang AH, Belisle L, et al. Knee instability and basic and advanced function decline in knee osteoarthritis. Arthritis Care Res (Haboken) 2015;67(8):1095–1102.
33. Sosdian L, Hinman RS, Wrigley T v., Paterson KL, Dowsey M, Choong P, et al. Quantifying varus and valgus thrust in individuals with severe knee osteoarthritis. Clin Biomech (Briston, Avon) 2016;39:44–51.
34. Elmallah RDK, Cherian JJ, Robinson K, Harwin SF, Mont MA. The effect of comorbidities on outcomes following total knee arthroplasty. J Knee Surg 2015;28(5):411–416.
35. Hilton ME, Gioe T, Noorbaloochi S, Singh JA. Increasing comorbidity is associated with worsening physical function and pain after primary total knee arthroplasty. BMC Musculoskelet Disord 2016;17(1):421.