Influence of Bicompartmental Knee Replacement on Stand-to-Sit Movement

By Wang, He; Frame, Jeff et al. | Research Quarterly for Exercise and Sport, June 2012 | Go to article overview

Influence of Bicompartmental Knee Replacement on Stand-to-Sit Movement


Wang, He, Frame, Jeff, Rolston, Lindsey, Research Quarterly for Exercise and Sport


Knee osteoarthritis often occurs in medial and patellofemoral compartments. A bicompartmental knee replacement system replaces these two affected knee compartments and keeps the lateral compartment and cruciate ligaments intact. It is yet to be determined whether limbs with bicompartmental knee systems can demonstrate frontal-plane knee mechanics and hamstring coactivation similar to healthy control limbs during daily activities requiring the weight-bearing knees to bend through a large range of motion (e.g., stand-to-sit). Three-dimensional knee mechanics and quadriceps and hamstring electromyographic data were collected from 8 patients with a unilateral bicompartmental knee system and 10 healthy control participants. No differences in frontal-plane knee mechanics and hamstring coactivation were found among the surgical, contralateral, and control limbs during stand-to-sit (p >. 05).

Key words: electromyography, knee mechanics, knee osteoarthritis

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Osteoarthritis (OA), a degenerative cartilage disease, causes more disability with respect to mobility than any other single disease in the elderly (Guccione et al., 1994). Knee OA typically affects joints in a non-uniform manner; the medial compartment of the knee is most frequently affected in both men and women (Windsor & Insall, 1994). Furthermore, the three most common areas where knee OA occurs are the medial compartment, patellofemoral compartment, and medial-patellofemoral compartment overlap (McAlindon, Cooper, Kirwan, & Dieppe, 1992). The predominance of medial knee OA is likely due to the high medial forces generated during weight-bearing activities (e.g., walking; Morrison, 1970; Schipplein & Andriacchi, 1991). It is believed that the increased knee varus loading is strongly associated with the risk of medial knee OA progression (Miyazaki et al., 2002). In fact, a radiographic study shows that varus knee alignment (bowlegged) increases medial knee OA progression in as little as 18 months (Sharma et al., 2001).

Medial knee OA causes severe knee pain and knee stiffness, reduces knee function, and leads to disability (Ashraf, Ackroyd, & Newman, 2003; Guccione et al., 1994). The most common surgical treatment is total knee replacement (TKR; Barnes, Mecko, Teeny, & York, 2006; Jacobs & Goldberg, 2000). TKR has been the gold standard for treating knee OA because it results in excellent pain relief and has a long-term success rate of 10-15 years (Diduch, Insall, Scott, Scuderi, & Font-Rodriguez, 1997; Sextro, Berry, & Rand, 2001). However, TKR alters the knee's entire articular geometry and sacrifices the cruciate ligaments, which often leads to abnormal knee kinematics (Banks, Fregly, Boniforti, Reinschmidt, & Romagnoli, 2005; Price et al., 2004). As the damage associated with medial knee OA is often limited to carulage degeneration in the medial and patellofemoral compartments (McAlindon et al., 1992), it is natural to consider replacing only the affected medial compartment, while preserving the intact portions of the joint and cruciate ligaments. One alternative to the TKR, especially for more active patients, is unicompartmental knee replacement (UKR), which leaves the lateral knee compartment and cruciate ligaments intact while replacing only the affected medial compartment. UKR results in fast recovery times, less bone loss, and normal knee mechanics (Ashraf et al., 2003; Banks et al., 2005; Chassin, Mikosz, Andriacchi, & Rosenberg, 1996; Price et al., 2004). Specifically, the UKR knee can maintain basic features of normal knee kinematics. During knee flexion, the UKR knee exhibits normal posterior translation of the femoral condyles and internal rotation of the tibia (Banks et al., 2005); it also exhibits a sagittal-plane patella-tendon angle (the angle between the patella-tendon and the longitudinal axis of the tibia) that is similar to a normal knee, whereas the TKR knee shows a reduction of the angle (Price et al. …

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