The Lundbeck Center for Fast-Track Hip- and Knee Arthroplasty, Copenhagen University Hospital at Hvidovre, Denmark.
Arch Phys Med Rehabil. 2010 Nov;91(11):1770-6. doi: 10.1016/j.apmr.2010.07.229.
To examine whether changes in knee-extension strength and functional performance are related to knee swelling after total knee arthroplasty (TKA).
Prospective, descriptive, hypothesis-generating study.
A fast-track orthopedic arthroplasty unit at a university hospital.
Patients (N=24; mean age, 66y; 13 women) scheduled for primary unilateral TKA were investigated 1 week before surgery and on the day of hospital discharge 2.4 days postsurgery.
Not applicable.
We assessed all patients for knee-joint circumference, knee-extension strength, and functional performance using the Timed Up & Go, 30-second Chair Stand, and 10-m fast speed walking tests, together with knee pain during all active test procedures.
All investigated variables changed significantly from pre- to postsurgery independent of knee pain. Importantly, knee circumference increased (knee swelling) and correlated significantly with the decrease in knee-extension strength (r=-.51; P=.01). Reduced fast-speed walking correlated significantly with decreased knee-extension strength (r=.59; P=.003) and decreased knee flexion (r=.52; P=.011). Multiple linear regression showed that knee swelling (P=.023), adjusted for age and sex, could explain 27% of the decrease in knee-extension strength. Another model showed that changes in knee-extension strength (P=.009) and knee flexion (P=.018) were associated independently with decreased performance in fast-speed walking, explaining 57% of the variation in fast-speed walking.
Our results indicate that the well-known finding of decreased knee-extension strength, which decreases functional performance shortly after TKA, is caused in part by postoperative knee swelling. Future studies may look at specific interventions aimed at decreasing knee swelling postsurgery to preserve knee-extension strength and facilitate physical rehabilitation after TKA.
探讨全膝关节置换术（TKA）后膝关节肿胀与伸膝力量和功能表现变化的关系。
前瞻性、描述性、产生假说的研究。
一家大学医院的快速通道矫形关节置换病房。
纳入 24 例（平均年龄 66 岁，女性 13 例）拟行单侧初次 TKA 的患者，分别在术前 1 周和术后 2.4 天（即出院当天）进行膝关节围度、伸膝力量和功能表现（采用计时起立-行走测试、30 秒椅立测试和 10m 快速步行速度测试）的评估，所有主动测试过程中都记录膝关节疼痛情况。
无。
所有患者的膝关节围度、伸膝力量和功能表现（采用计时起立-行走测试、30 秒椅立测试和 10m 快速步行速度测试），以及所有主动测试过程中的膝关节疼痛情况。
所有研究变量均在术前至术后发生显著变化，与膝关节疼痛无关。重要的是，膝关节围度增加（膝关节肿胀）与伸膝力量显著下降相关（r=-0.51；P=0.01）。快速步行速度降低与伸膝力量（r=-0.59；P=0.003）和膝关节屈曲度（r=-0.52；P=0.011）降低显著相关。多元线性回归显示，在调整年龄和性别后，膝关节肿胀（P=0.023）可解释伸膝力量下降的 27%。另一模型显示，伸膝力量（P=0.009）和膝关节屈曲度（P=0.018）的变化与快速步行速度降低独立相关，可解释快速步行速度变化的 57%。
本研究结果表明，TKA 后短期内出现的伸膝力量下降导致功能表现下降，部分原因是术后膝关节肿胀。未来的研究可能会着眼于术后膝关节肿胀的特定干预措施，以保留伸膝力量并促进 TKA 后的身体康复。
