title: Quadriceps strength and the time course of functional recovery after total knee arthroplasty.
abstract: METHODS
  Prospective study with repeated measures.
  
  
  OBJECTIVE
  The overall goal of this investigation was to describe the time course of recovery of impairments and function after total knee arthroplasty (TKA), as well as to provide direction for rehabilitation efforts. We hypothesized that quadriceps strength would be more strongly correlated with functional performance than knee flexion range of motion (ROM) or pain at all time periods studied before and after TKA.
  
  
  BACKGROUND
  TKA is a very common surgery, but very little is known regarding the influence of impairments on functional limitations in this population.
  
  
  METHODS
  Forty subjects who underwent unilateral TKA followed by rehabilitation, including 6 weeks of outpatient physical therapy, were studied. Testing occurred at 5 time periods: preoperatively, and at 1, 2, 3, and 6 months after surgery. Test measures included quadriceps strength, knee ROM, timed up-and-go test, timed stair-climbing test, bodily pain, and general health and knee function questionnaires.
  
  
  RESULTS
  Subjects experienced significant worsening of knee ROM, quadriceps strength, and performance on functional tests 1 month after surgery. Quadriceps strength went through the greatest decline of all the physical measures assessed and never matched the strength of the uninvolved limb. All measures underwent significant improvements following the 1-month test. Quadriceps strength was the most highly correlated measure associated with functional performance at all testing sessions.
  
  
  CONCLUSIONS
  Functional measures underwent an expected decline early after TKA, but recovery was more rapid than anticipated and long-term outcomes were better than previously reported in the literature. The high correlation between quadriceps strength and functional performance suggests that improved postoperative quadriceps strengthening could be important to enhance the potential benefits of TKA.
authors.affiliation: Department of Physical Therapy, University of Delaware, Newark, DE, USA.
authors.forename: Ryan L
authors.initials: RL
authors.lastname: Mizner
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Petterson
authors.forename: Lynn
authors.initials: L
authors.lastname: Snyder-Mackler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology*; D020370:Osteoarthritis, Knee / Q000534:rehabilitation* / Q000601:surgery*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020127:Recovery of Function; D011795:Surveys and Questionnaires