Artikel
Proprioception before and after total knee replacement. Comparison of posterior stabilized and rotational hinged knee prosthesis
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Autoren
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Carlos Maria Autorino
- Hospital Universitario Austral, Pilar, Argentina
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Emiliano Luis Alvarez Salinas
- Hospital Universitario Austral, Pilar, Argentina
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Mauricio Chiotta Romano
- Hospital Universitario Austral, Pilar, Argentina
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Marcos Sormani
- Banco de Protesis, Montevideo, Uruguay
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Horacion Rivarola Etcheto
- Hospital Universitario Austral, Pilar, Argentina
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Fernando Motta
- Banco de Protesis, Montevideo, Uruguay
| Veröffentlicht: | 10. Oktober 2016 |
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Gliederung
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Objectives: Functional consequences of impaired proprioception may include shorter stride length, changes in gait pattern and increased risk of falls. It is unknown whether there is a relation between increasingly constrained prosthesis and proprioception.
The objective of this study consisted is evaluating proprioception in patients with knee osteoarthritis before and after receiving a total knee replacement using posterior stabilized and rotational hinged knee prosthesis.
Methods: We designed a prospective multicentric study. Patients undergoing a total knee replacement with a diagnosis of osteoarthritis were included. All procedures were performed by the same trained surgeons in 2 university hospitals.
Groups were divided as follows:
GROUP I: 34 patients. Mean age: 71, 38 years. Optetrak NR (Exactech, USA)
GROUP II: 30 Patients. Mean age: 73, 5 years. PFC SIGMA (Johnson-Johnson, USA).
GROUP III: 12 Patients. Mean age: 70, 2 years ("major deformity": more than 20º valgus deformity, ligament instability, segmental uncontained bone stock loss). Endomodel NR rotational hinged (Link, Hamburg).
A "yes/no" questionnaire form was performed to record perception of knee instability preoperatively.
All patients were evaluated preoperatively and postoperatively at 8 and 12 weeks. Functional evaluation included the ¨Knee Society Score¨ (KSS) and its functional form (KSSf), an angular deviation precision test performed actively and passively at 0º, 20º and 40º, "time up and go" test (TUG) and the "four square step test" (FSST).
Results and Conclusion: 76, 4%, 69% and 91, 6% of patients in Groups I, II and III respectively, reported preoperative knee instability.
KSS y functional KSS: we recorded statistical differences between the 3 groups p <0.0001 (Gr I KSS 56-88 y KSSf 50-88; Gr II KSS 56 - 85, KSSf 42- 82; Gr III KSS 42,8 - 86 y KSSf 40-91).
Active angular deviation: we recorded statistical differences between the 3 groups (Gr I 0º p 0, 0002, 20º p 0, 0208, 40º p 0, 0030; Gr II 0º p 0.0158, 20º p 0,006, 40º p <0.0001; Gr III 0ºp <0, 0001, 20º p<0, 0001, 40º p 0, 0058).
Passive angular deviation: we recorded statistical differences between the 3 groups. (Gr I 0º, 20º, 40º p 0, 0001; Gr II 0º p: 0,025, 20º p: 0, 0386, 40º p <0.0001; Gr III 0º, 20º, 40º p <0.0001).
Patients in group III presented the worst preoperative passive angular deviation test performance; however the long term improvement was higher after receiving a total knee replacement than patients in the "posterior stabilized prosthesis" groups.
TUG and FSST tests improved after surgery in the 3 groups. FSST (Gr I 17,05 - 12,54 seg., Gr II 19,21-13,88 seg, Gr III 17,6 - 12,5seg., p <0.0001) y TUG (Gr I 16,45 - 11,51seg. p <0.0001, Gr II 19,44 - 13,07 p 0.0002, Gr III 17,67 - 14,16 p <0.0001).
Total knee replacement improves knee joint proprioception resulting in a better functional performance regardless of the type of constriction. Endomodel provides the possibility to improve proprioception in patients with greater deformity.
