Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Rehabilitation and Care, Seijoh University, 2-172 Fukinodai, Tokai, 476-8588, Aichi, Japan.
BMC Musculoskelet Disord. 2024 Feb 27;25(1):178. doi: 10.1186/s12891-024-07306-3.
After total knee arthroplasty (TKA), patients' physical activity (PA) levels at 6 months are lower than those of healthy subjects. Few studies have investigated the factors associated with PA at 6 months after TKA by objectively measuring preoperative and postoperative PA intensity using an accelerometer and knee function using a goniometer and dynamometer. The purpose of this study was to determine the factors associated with PA levels at 6 months after TKA based on objective data.
Eighty-two patients (mean [SD] age 74.5 [6.4] years) with moderate-to-severe knee osteoarthritis (OA) who were scheduled for TKA at the Nagoya Orthopaedic and Joint Replacement Clinic from July 2018 to July 2019 were enrolled in this longitudinal study. All patients underwent evaluations of knee function, including range-of-motion and knee-extension muscle strength; knee pain; performance in the timed up-and-go test; and accelerometer-measured PA both preoperatively and 6 months postoperatively. Factors associated with PA at 6 months after TKA were assessed using a hierarchical multiple linear regression analysis adjusted for age, sex, body mass index, and presence of diabetes mellitus.
A higher average daily step count at 6 months after TKA was significantly associated with greater preoperative knee-extension muscle strength on the operated side (β = 0.155, p = 0.028) as well as a higher preoperative average daily step count (β = 0.834, p < 0.001). Furthermore, average daily time spent in moderate-to-vigorous-intensity PA postoperatively was significantly associated only with time spent in moderate-to-vigorous-intensity PA preoperatively (β = 0.723, p < 0.001).
These findings indicate that a higher preoperative daily step count and greater preoperative knee-extension muscle strength on the operated side may be associated with a higher daily step count at 6 months after TKA. Factors associated with PA differed by the PA intensity level. Rehabilitation and interventions for psychosocial factors before TKA beginning when mild knee OA first occurs are expected to lead to increased PA in TKA patients.
全膝关节置换术后（TKA）患者 6 个月时的身体活动（PA）水平低于健康受试者。很少有研究通过使用加速度计客观测量术前和术后 PA 强度以及使用量角器和测力计测量膝关节功能来调查 TKA 后 6 个月时与 PA 相关的因素。本研究的目的是基于客观数据确定与 TKA 后 6 个月 PA 水平相关的因素。
2018 年 7 月至 2019 年 7 月，名古屋矫形与关节置换诊所计划接受 TKA 的 82 例中重度膝关节骨关节炎（OA）患者（平均[标准差]年龄 74.5[6.4]岁）纳入本纵向研究。所有患者均接受膝关节功能评估，包括关节活动度和膝关节伸肌力量；膝关节疼痛；计时起立行走测试表现；以及术前和术后 6 个月的加速度计测量的 PA。使用调整年龄、性别、体重指数和糖尿病存在的分层多元线性回归分析评估与 TKA 后 6 个月 PA 相关的因素。
TKA 后 6 个月的平均每日步数较高，与手术侧术前膝关节伸肌力量较大（β=0.155，p=0.028）以及术前平均每日步数较高（β=0.834，p<0.001）显著相关。此外，术后平均每日中度至剧烈强度 PA 时间仅与术前中度至剧烈强度 PA 时间显著相关（β=0.723，p<0.001）。
这些发现表明，术前较高的每日步数和手术侧较大的膝关节伸肌力量可能与 TKA 后 6 个月较高的每日步数相关。与 PA 相关的因素因 PA 强度水平而异。当轻度膝关节 OA 首次发生时，开始 TKA 之前对康复和心理社会因素的干预有望增加 TKA 患者的 PA。
