Digital Measurement of Individual Motor and Proprioceptive Skills in Patients with Osteoarthritis of the Knee Prior to Total Knee Replacement

Abstract

Purpose In spite of consistent improvement in operative methods for total knee arthroplasty, individual motor deficits may lead to a lower outcome. The preoperative classification in individual motoric capacity may get more significance for the future. Complementary to established questionnaires and clinical tests, this pilot study should demonstrate that it is possible to generate a preoperative motor score using a force platform measurement (KMP). Compared to questionnaires the new score represents digital values suitable for everyday clinical use.

Methods In total 63 Patients were randomized selected on the day before a bicondylar total knee replacement. A mobile force platform KMP (Motosana) measured the parameter maximum force, power and balance. Fluctuation area was measured in mm² and fluctuation path in mm. One leg standing without holding, transient help or permanent holding at armrests were registered. The force (Newton) was measured while a modified cross lift exercise and power (Watt) by performing five squads.

Results Based on comprehensive statistical consolidated data of maximum force, power and balance it was possible to create a new motor score “Knie Fit 1.0”. Depending on interindividual performance patients were divided into those with higher or lower results. Regarding to their individual motor proprioceptive capacity we could also graduate patients into 4 different groups for force/power and balance. In total 17 of 63 patients offered a complex motor deficit, but on the other hand 17 different patients showed superior results in all categories.

Conclusion It is possible to measure the motor capacity of patients using the mobile force platform (KMP) in everyday clinical practice. Based on this data a new motor score “KnieFit 1.0” was generated and groups of patients with different insufficiencies were created. Further follow-up studies should proof and compare the pre- and postoperative outcome in this field. With “KnieFit 1.0” it may be possible to create an individual perioperative rehabilitation program for compensation of detected deficits.

Key words

gonarthrosis - proprioceptive skills - motor score “KnieFit 1.0” - mobile force plate

Publikationsverlauf

Artikel online veröffentlicht:
30. Juni 2020

• References/Literatur

• 1 Statistisches Bundesamt. Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik), 2016. Im Internet (Stand: 21.10.2017): https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Gesundheit/Krankenhaeuser/Publikationen/Downloads-Krankenhaeuser/fallpauschalen-krankenhaus-2120640167004.html
• 2 Kurtz S, Ong K, Lau E. et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89: 780-785 doi:10.2106/JBJS.F.00222
• 3 Baker PN, van der Meulen JH, Lewsey J. et al. The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg Br 2007; 89: 893-900 doi:10.1302/0301-620x.89b7.19091
• 4 Planckaert C, Larose G, Ranger P. et al. Total knee arthroplasty with unexplained pain: new insights from kinematics. Arch Orthop Trauma Surg 2018; 138: 553-561 doi:10.1007/s00402-018-2873-5
• 5 Desmeules F, Hall J, Woodhouse LJ. Prehabilitation improves physical function of individuals with severe disability from hip or knee osteoarthritis. Physiother Can 2013; 65: 116-124 doi:10.3138/ptc.2011-60
• 6 Rooks DS, Huang J, Bierbaum BE. et al. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum 2006; 55: 700-708 doi:10.1002/art.22223
• 7 Heldens AF, Bongers BC, de Vos-Geelen J. et al. Feasibility and preliminary effectiveness of a physical exercise training program during neoadjuvant chemoradiotherapy in individual patients with rectal cancer prior to major elective surgery. Eur J Surg Oncol 2016; 42: 1322-1330 doi:10.1016/j.ejso.2016.03.021
• 8 Studenski S, Perera S, Wallace D. et al. Physical performance measures in the clinical setting. J Am Geriatr Soc 2003; 51: 314-322
• 9 Wilke C, Froböse I. Quantifizierung propriozeptiver Leistung von Kniegelenken. Dtsch Z Sportmed 2003; 54: 49-54
• 10 Collins NJ, Misra D, Felson DT. et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken) 2011; 63 (Suppl. 11) S208-S228 doi:10.1002/acr.20632
• 11 Veilleux LN, Rauch F. Reproducibility of jumping mechanography in healthy children and adults. J Musculoskelet Neuronal Interact 2010; 10: 256-266
• 12 Era P, Sainio P, Koskinen S. et al. Postural balance in a random sample of 7,979 subjects aged 30 years and over. Gerontology 2006; 52: 204-213 doi:10.1159/000093652
• 13 Dietzel R, Felsenberg D, Armbrecht G. Mechanography performance tests and their association with sarcopenia, falls and impairment in the activities of daily living – a pilot cross-sectional study in 293 older adults. J Musculoskelet Neuronal Interact 2015; 15: 249-256
• 14 Piirtola M, Era P. Force platform measurements as predictors of falls among older people – a review. Gerontology 2006; 52: 1-16 doi:10.1159/000089820
• 15 Haas BM, Burden AM. Validity of weight distribution and sway measurements of the Balance Performance Monitor. Physiother Res Int 2000; 5: 19-32 doi:10.1002/pri.181
• 16 Low DC, Walsh GS, Arkesteijn M. Effectiveness of exercise interventions to improve postural control in older adults: a systematic review and meta-analyses of centre of pressure measurements. Sports Med 2017; 47: 101-112 doi:10.1007/s40279-016-0559-0
• 17 Howcroft J, Lemaire ED, Kofman J. et al. Elderly fall risk prediction using static posturography. PLoS One 2017; 12: e0172398 doi:10.1371/journal.pone.0172398
• 18 Dohm-Acker M, Spitzenpfeil P, Hartmann U. Auswirkung propriozeptiver Trainingsgeräte auf beteiligte Muskulatur im Einbeinstand. Sportverletz Sportschaden 2008; 22: 52-57 doi:10.1055/s-2007-963614
• 19 Bean JF, Leveille SG, Kiely DK. et al. A comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more?. J Gerontol A Biol Sci Med Sci 2003; 58: 728-733 doi:10.1093/gerona/58.8.m728
• 20 Bean JF, Kiely DK, LaRose S. et al. Are changes in leg power responsible for clinically meaningful improvements in mobility in older adults?. J Am Geriatr Soc 2010; 58: 2363-2368 doi:10.1111/j.1532-5415.2010.03155.x