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Sit-to-Stand Movement as a Performance-Based Measure for Patients With Total Knee Arthroplasty

M.C. Boonstra, PT, MSc, is a PhD student in the Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
P.J.A. Schwering, MD, is Orthopaedic Surgeon, Department of Orthopaedics, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
M.C. De Waal Malefijt, MD, PhD, is Orthopaedic Surgeon, Department of Orthopaedics, Radboud University Nijmegen Medical Centre.
N. Verdonschot, PhD, is Professor and Head of the Biomechanics Department, Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands. Dr Verdonschot also is Professor, Laboratory for Biomechanical Engineering, University of Twente, Department CTW, Enschede, the Netherlands.

Address all correspondence to Dr Verdonschot at: n.verdonschot{at}orthop.umcn.nl.

Background: Functional recovery of patients after a total knee arthroplasty (TKA) usually is measured with questionnaires. However, these self-report measures assess the patient's perspective on his or her ability to perform a task. Performance-based tests are needed to assess the patient's actual ability to perform a task.

Objective: The main purpose of this study was to quantify improvement in performance of the sit-to-stand movement of patients with a TKA.

Design and Methods: In this prospective study of 16 patients with end-stage knee osteoarthritis followed by a TKA, the maximal knee angular extension velocity and amount of unloading (shifting weight) of the affected leg during the sit-to-stand movement and the visual analog scale score for pain were assessed preoperatively and 6 months and 1 year postoperatively. These data were compared with data for a control group of individuals who were healthy (n=27).

Results: Before surgery, the participants in the TKA group unloaded their affected leg, but within 6 months after implantation, the affected leg was almost fully loaded again and comparable to the loading symmetry ratio of the control group. Furthermore, knee extension velocity also had increased, but remained lower than that of the control group. The changes in knee extension velocity took place during the first 6 months, after which a plateau was visible.

Limitations: A potential limitation of the study design was that the patients were not perfectly matched with the control subjects.

Conclusions: Implantation of a total knee prosthesis partly improved performance of the sit-to-stand movement. Participants in the TKA group could fully load their operated leg, but they could not generate enough knee angular velocity during rising compared with the control group.

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