Biomechanical and clinical influences on recovery and osteoarthritis progression after total knee arthroplasty

Flowers, Portia P. E.
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University of Delaware
Total knee arthroplasty (TKA) is the most common treatment for end-stage knee osteoarthritis (OA). Despite reduced pain in the operated limb, strength, biomechanical and functional deficits persist after TKA. Such long-term deficiencies may contribute to the non-random progression of end-stage OA and joint replacement, most commonly in the contralateral cognate joint. Therefore, it is imperative for clinicians to understand the impairments and joint movement strategies that contribute to long term dysfunction and risk for contralateral TKA. The overall goal of this work is to determine the asymmetrical movement and impairments that contribute to short- and long-term dysfunction and ultimately contralateral TKA use. The central hypothesis is that operated limb function will improve, while non-operated limb function will decline with time, leading to more symmetrical movement in the sagittal plane and less symmetrical movement in the frontal plane. Such biomechanical limb asymmetries, along with clinical impairments, will ultimately determine functional outcomes and contralateral TKA use. This work will help to advance the understanding of post-surgical outcomes in the TKA population. A definitive characterization of short- and long-term joint biomechanics will be determined, filling a critical gap in the literature. In addition, clinicians will be able to better address poor functional outcomes associated with TKA by determining how disability is influenced not only by physical impairments, but also by irregular movement between limbs. Such unresolved abnormalities may ultimately contribute to the unacceptably high rate of contralateral TKA. Therefore, determining the factors that lead to additional surgery may aid clinicians in developing targeted rehabilitation protocols designed to decrease the risk for contralateral TKA.