Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty

Purpose: Total knee arthroplasty (TKA) successfully reduces pain, but has not achieved comparable improvements in function. We hypothesized that quadriceps strength affects performance by altering loading and movement patterns during functional tasks. Methods: Fourteen subjects with isolated, unilateral TKA were tested three months after surgery. Quadriceps strength was assessed isometrically and kinematics, kinetics, and EMG were collected during level walking and sit-to-stand (STS). Function was assessed using the timed up and go test (TUG), stair climbing test (SCT), and the 6 min walk test (6MW). Results: Functional performance was significantly related to the quadriceps strength of both legs, but was more strongly related to the uninvolved strength (involved rho = -0.43 with TUG; -0.65 with SCT; 0.64 with 6MW) (uninvolved rho = -0.63 with TUG; -0.68 with SCT; 0.77 with 6MW). During STS, subjects shifted weight away from the operated limb (p < 0.01). Quadriceps muscle activity and the extension moments at the knee and hip were smaller in the involved compared to the uninvolved (p < 0.05). The amount of asymmetry in knee excursion during weight acceptance in gait, the asymmetry in weight bearing from sit-to-stand, and the uninvolved hip extension moment during STS were related to the amount of asymmetry in quadriceps strength (rho > 0.56, p < 0.05). Conclusions: Quadriceps weakness in patients with TKA has a substantial impact on the movement patterns and performance of the knee during functionally important tasks.