Long-term outcomes of contralateral knees after unilateral total knee arthroplasty for osteoarthritis

doi:10.1016/0883-5403(94)90043-4

The Journal of Arthroplasty

Volume 9, Issue 4, August 1994, Pages 347-349

https://doi.org/10.1016/0883-5403(94)90043-4 Get rights and content

Abstract

One hundred fifty-six patients who underwent unilateral total knee arthroplasty (TKA) between 1970 and 1985 were evaluated for the development, progression, and eventual TKA in the contralateral knee. At the time of TKA, 113 patients were diagnosed with osteoarthritis in the opposite knee, while in the remaining patients, the opposite knee was normal. The probability of the normal knee developing osteoarthritis and requiring a TKA at 7 years is 21 and 5%, respectively. The chance of a knee diagnosed as osteoarthritic at the time of surgery needing a TKA at 10 years is 37%.

References (4)

KL Garvin et al.
Contralateral total hip arthroplasty in patients who have long-standing fusion of the hip
J Bone Joint Surg
(1989)
JW Smith et al.
Complications after total hip replacement
J Bone Joint Surg
(1989)

There are more references available in the full text version of this article.

Cited by (44)

Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty
2023, Journal of Arthroplasty
Patient-reported outcome measures (PROMs) are frequently used for evaluating patient satisfaction and function following total hip arthroplasty (THA). Functional measures along with chronologic modeling may help set expectations perioperatively. Our goal was to define the trajectory of recovery and function in the first year following THA.
Prospective data from 1,898 patients in a multicenter study was analyzed. The PROMs included the Hip disability and Osteoarthritis Score for Joint Replacement and EuroQol-5 dimension. Physical activity was recorded on a wearable technology. Data was collected preoperatively and at 1, 3, 6, and 12 months postoperatively. Generalized estimating equations were used to evaluate outcomes over time.
Significant improvement occurred between preoperative and postoperative time points for all PROMs. The PROMs showed the greatest proportional recovery within the first month postoperatively, each improving by at least 1 minimal clinically important difference (MCID). Daily steps and flights of stairs took longer to reach at least 1 MCID (3 months and 1 year, respectively). Gait speed and walking asymmetry returned to baseline by 3 months, but did not reach a MCID of improvement by 1 year.
Patients can be counseled that the greatest proportional improvement in PROMs is within 1 month after THA, while function surpasses preoperative baselines by 3 months, and gait quality may not improve until after 1 year. This can help set realistic expectations and target interventions toward patients deviating from the norm.
Recovery Curve for Patient Reported Outcomes and Objective Physical Activity After Primary Total Knee Arthroplasty—A Multicenter Study Using Wearable Technology
2023, Journal of Arthroplasty
This study aimed to describe the trajectory of recovery based on patient-reported outcomes (PROs) and objective metrics of physical activity measures over the first 12 months post–total knee arthroplasty (TKA).
In total, 1,005 participants who underwent a primary unilateral TKA surgery between November 2018 and September 2021 from a multisite prospective study were analyzed. Generalized estimating equations were used to evaluate PROs and objective physical activity measures over time.
All Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), EuroQol-5D (EQ-5D), and steps per day scores were greater than preoperative scores (P < .05). The flights of stairs per day, gait speed, and walking asymmetry all declined at 1 month (all, P < .001). However, all subsequent scores improved by 6 months (all, P < .01).
The greatest clinically important differences from previous visit in KOOS JR (β = 18.1; 95% Confidence Interval (CI) = 17.2, 19.0), EQ-5D (β = 0.11; 95% CI = 0.10, 0.12), steps per day (β = 1,169.3; 95% CI = 1,012.7, 1,325.9), gait speed (β = −0.05; 95% CI = −0.06, −0.03), and walking asymmetry (β = 0.00; 95% CI = −0.03, 0.03) were observed at 3 months.
The KOOS JR, EQ-5D, and steps per day measures showed earlier improvements than other physical activity metrics, with the greatest magnitude of improvement within the first 3 months post-TKA. The greatest magnitude of improvement in walking asymmetry was not observed until 6 months, while gait speed and flights of stairs per day were not observed until 12 months. This data may further help provide expectation setting information to patients before surgery, and may aid in identifying outliers to the normal recovery curve who may benefit from targeted interventions.
Knee biomechanics and contralateral knee osteoarthritis progression after total knee arthroplasty
2022, Gait and Posture
Citation Excerpt :
Force platforms data were filtered at (40-Hz) while marker trajectories were low pass filtered at (6-Hz) using a second order phase-corrected butterworth filter. Given the previous work linking biomechanics to OA progression [7–10], the biomechanical variables of interest for study (Fig. 1) were overall peak external knee adduction moment (normalized to body mass and height), and knee flexion/extension excursions during stance. Since work from our lab has revealed that full knee ROM is a modifiable factor that can postpone the TKA need (population aged between 46 and 78) [17], we also measured other biomechanical factors, such as knee angle at initial contact and peak knee flexion/extension during stance (Fig. 1).
Despite the success rate of Total Knee Arthroplasty (TKA), many patients undergo contralateral TKA. It is possible that altered gait mechanics after unilateral TKA play a role in the progression of contralateral OA progression.
The purpose of this study was to identify biomechanical predictors of radiographic OA progression in the contralateral (non-surgical) knee after unilateral (primary/initial) TKA. In addition, this study quantified for patients who had contralateral OA progression.
Biomechanical outcomes were collected 6–24 months after unilateral primary TKA and were used to predict changes in contralateral OA severity at follow-up. Participants were divided into “Progressor” and “Non-Progressor” groups based on changes in Kellgren-Lawrence (KL) OA grade and Joint Space Width (JSW) between baseline and follow-up testing sessions. Biomechanical factors during walking were peak knee adduction moment, knee flexion/extension excursions, knee angle at initial foot contact, and peak knee flexion/extension. Multiple independent t-tests were used to examine the magnitude of differences in biomechanical variables between the groups. Logistic regression was used to examine the association between the biomechanical predictors and change in KL scores and JSW.
The mean time between surgery and follow-up x-rays was 8.8 (2.4) years. Of 40 participants, 62.5–78% had contralateral radiographic knee OA progression by follow-up. There were no significant differences in the biomechanical variables between groups. For the regression analysis, none of the biomechanical variables were found to be predictors for contralateral OA progression.
Although abnormal biomechanics are known risk factors for primary knee OA, it is possible that the mechanisms that result in OA progression of the contralateral limb are different than primary knee OA progression. Future work should evaluate other objective measures of OA progression and determine if cumulative measures of joint loading are related to OA worsening.
Influence of preoperative factors on timing for bilateral shoulder arthroplasty
2021, Journal of Shoulder and Elbow Surgery
In bilateral shoulder arthroplasty patients, it is unclear what features are responsible for the timing of their contralateral shoulder arthroplasty. This study hypothesized that patient factors (age, gender, and hand dominance), disease factors (diagnosis and radiographic severity of contralateral shoulder), and surgical factors (type of arthroplasty) impact the timing to contralateral surgery.
A retrospective review of 332 patients treated with bilateral anatomic (TSA) or reverse (RSA) shoulder arthroplasty (172 TSA/TSA, 107 RSA/RSA, or 53 TSA/RSA) were divided into groups depending on the interval timing between arthroplasty surgeries: group 1, n = 142 (≤1 year); group 2, n = 62 (1-2 years); and group 3, n = 128 (≥2 years). Preoperative factors were analyzed to determine associations between different time groups, including age, gender, hand dominance, diagnosis, radiographic severity of contralateral shoulder, and type of surgery. Bilateral diagnoses included 211 osteoarthritis (OA), 36 cuff tear arthropathy (CTA), 13 inflammatory arthritis, 12 massive cuff tears without OA, and 4 avascular necrosis.
OA patients had their contralateral shoulder arthroplasty sooner than CTA patients (P = .035). OA patients with arthritic changes on contralateral radiographs before the first arthroplasty had their contralateral arthroplasty sooner than those without contralateral radiographs (P < .0001). Patients who had TSA first had their contralateral arthroplasty sooner than patients who had RSA first (P = .037).
This study confirmed our hypothesis identifying preoperative variables associated with different time intervals between arthroplasties. The preoperative factors associated with the highest likelihood of having contralateral shoulder arthroplasty within 1 year included OA, radiographic bilateral shoulder disease, and TSA for the first surgery.
Longitudinal study of knee load avoidant movement behavior after total knee arthroplasty with recommendations for future retraining interventions
2021, Knee
Citation Excerpt :
Protective gait compensation that shifts the physical demands of mobility away from the surgical knee can limit the efficacy of exercises and training that normally increase quadriceps strength in healthy populations [7,8]. Subsequently, inadequate strength recovery and enduring load avoidant gait compensation are associated with greater physical function decline [9,10] and increased osteoarthritic changes of the non-surgical hip and knee joints [11,12]. The value of biomechanical measures of gait compensations remains unrealized as there is inadequate evidence to support the use of these methods, despite the negative sequela associated with load avoidant movement behavior.
This study aimed to evaluate clinical and biomechanical changes in self-report survey, quadriceps strength and gait analysis over 3- and 6-months post-total knee arthroplasty (TKA) and confirm the immediate effects of two forms of kinetic biofeedback on improving inter-limb biomechanics during a physically demanding decline walking task.
Thirty patients with unilateral TKA underwent testing at 3- and 6-months following surgery. All underwent self-report survey, quadriceps strength and gait analysis testing. Patients were assigned to one of two types of biofeedback [vertical ground reaction force (vGRF), knee extensor moment (KEM)].
No decrease in gait asymmetry was observed in non-biofeedback trials over time (p > 0.05), despite significant improvements in self-report physical function (p < 0.01, Cohen d = 0.44), pain interference (p = 0.01, Cohen d = 0.68), numeric knee pain (p = 0.01, Cohen d = 0.74) and quadriceps strength (p = 0.01, Cohen d = 0.49) outcomes. KEM biofeedback induced significant decrease in total support moment (p = 0.05, Cohen f² = 0.14) and knee extensor moment (p = 0.05, Cohen f² = 0.21) asymmetry compared to using vGRF biofeedback at 6-months. vGRF biofeedback demonstrated significant decrease in hip flexion kinematic asymmetry compared to KEM biofeedback (p = 0.05, Cohen f² = 0.18) at 6-months.
Gait compensation remained similar from 3- to 6-months during a task requiring greater knee demand compared to overground walking post-TKA, despite improvements in self-report survey and quadriceps strength. Single session gait symmetry training at 6-month supports findings at 3-month testing that motor learning is possible. KEM biofeedback is more effective at immediately improving joint kinetic loading compared to vGRF biofeedback post-TKA.
Worker compensation status increases the risk for presence of pain in the contralateral knee at final follow-up after arthroscopic knee surgery
2019, Journal of ISAKOS
In patients undergoing arthroscopic knee surgery, it is not uncommon to complain of pain in both the ipsilateral and the contralateral knee. The primary aim of the present study was to evaluate the prevalence of contralateral knee pain in patients undergoing arthroscopic knee surgery. The secondary aim was to identify risk factors for contralateral knee pain in this population.
All patient who underwent arthroscopic knee surgery between 2015 and 2017 were included. The prevalence of pain in the contralateral knee prior to and at the final follow-up after ipsilateral knee surgery was assessed. The following potential risk factors for contralateral knee pain were evaluated: age, gender, worker comp status, duration of symptoms, pre-operative diagnosis, activity level, history of a fall, use of a walking aid and findings during surgery.
A total of 142 patients met the inclusion criteria. The average age was 45±11 years, 104 patients (73%) were men. Prior to the surgery on the ipsilateral knee, only 1 patient (<1%) reported pain in the contralateral knee, which increased to 113 patients (80%) at final follow-up surgery. Of the assessed risk factors, only worker compensation status was significant for the development of contralateral knee pain (OR 2.93 95% CI 1.08 to 7.95, p=0.040).
Pain in the contralateral knee is uncommon prior to arthroscopic knee surgery, but common after. The risk for the development of contralateral knee pain is increased if the index injury was workers compensation related.
Level IV case series.

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Original articleLong-term outcomes of contralateral knees after unilateral total knee arthroplasty for osteoarthritis

Abstract

Contralateral total hip arthroplasty in patients who have long-standing fusion of the hip

J Bone Joint Surg

Complications after total hip replacement

J Bone Joint Surg

Original article
Long-term outcomes of contralateral knees after unilateral total knee arthroplasty for osteoarthritis