Elsevier

Gait & Posture

Volume 61, March 2018, Pages 130-134
Gait & Posture

Full length article
Reported balance confidence and movement reinvestment of younger knee replacement patients are more like younger healthy individuals, than older patients

https://doi.org/10.1016/j.gaitpost.2018.01.006Get rights and content

Highlights

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    Little is known regarding the growing number of younger patients undergoing TKR.

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    Functional mobility, balance confidence and movement reinvestment were examined.

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    Findings indicate younger TKR patients resemble healthy controls, not older patients.

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    Results may add to the discussion in the clinical community regarding age and TKR.

Abstract

This study focused on differences between the rapidly growing younger (<65 years old) and older (>65 years old) total knee replacement (TKR) patients for measures of balance confidence, movement reinvestment, and functional mobility. Fifty-nine participants, including twenty-nine primary unilateral TKR patients (six months post-TKR) formed the four experimental groups: 1) Younger TKR Patient (YP), 2) Younger Control (YC), 3) Older TKR Patient (OP), and 4) Older Control (OC). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Oxford Knee Score (OKS), Activities-specific Balance Confidence scale (ABC), the Movement-Specific Reinvestment Scale (MSRS), and the Timed Up and Go (TUG) test were measured. The YP group reported a significantly lower WOMAC score (p < 0.001), and higher perceived knee joint function (p = 0.001), compared to the OP group. The YP group also reported significantly higher balance confidence (p < 0.001) and less movement reinvestment (p = 0.001) than the OP group. TUG durations revealed that the YP group had significantly higher functional mobility compared to the OP group (p = 0.001). The YP group did not differ from the YC group across any of these measures (p > 0.05). These results identify a clear distinction between younger and older TKR patients for fall risk and TKR outcome, which argues that age should be a factor clinicians take into account when addressing the management and care of individuals recovering from TKR.

Introduction

Research has shown that total knee replacement (TKR) provides pain relief, improved physical function and enhanced quality of life for moderate and severe knee osteoarthritis (OA) patients; [[1], [2]] however, deficiencies in joint function and mobility persist when compared to healthy controls [[3], [4], [5]]. Further, fall rates and risk are higher in knee OA patients [6] and remain elevated after TKR surgery [4]. The factors underlying these negative outcomes are not well understood. Previous studies have reported that low balance confidence and a greater propensity for conscious control of movement (i.e., movement specific reinvestment) are associated with mobility impairment and falls in older adults and patients with neurological deficits [[7], [8], [9]], and these measures may help to explain the persistent mobility impairments and falls observed for TKR patients.

Balance confidence is associated with the physical and social function of older adults [[9], [10]] and is also predictive of functional performance in participants with knee OA [11]. To date, however, only a single cross-sectional study has investigated balance confidence for TKR patients; where patients with greater reported balance confidence had better functional performance and reported fewer difficulties completing activities of daily living [12]. Movement specific reinvestment is a measure of an individual’s propensity to shift from a more automatic to a more conscious control and monitoring of movement [13]. Different factors, such as anxiety and difficulty moving may act to increase movement reinvestment, and negatively impact movement automaticity [13]. One study has reported an association between self-reported knee pain and increased movement reinvestment among adults 18-to-55 years of age [14]. Therefore, anxiety, residual pain, and difficulty moving that remains after TKR surgery may be associated with greater movement reinvestment and ultimately elevated fall risk for TKR patients.

Currently, little is known regarding balance confidence, movement reinvestment, and functional mobility for patients after TKR surgery. Importantly, reports from national joint registries clearly show a rapidly growing population of younger ( < 65 years of age) TKR patients [[15], [16], [17]]. It is anticipated that the demand for TKR surgery will at least double within the next decade, and the average age at surgery will continue to decrease [18]. Scarce attention in the literature has examined the potential differences between the rapidly growing younger TKR population and our current knowledge, based on an older (>65 years of age) TKR population, which may influence the management and care for patients after surgery. To that end, the purpose of this study was to investigate the differences between younger and older TKR patients, and similar aged healthy controls for measures of balance confidence, movement reinvestment, and functional mobility.

Section snippets

Participants

A total of 59 participants, including 29 primary TKR patients, consisting of four groups volunteered to participate in this study: 1) Younger TKR patient (YP; n = 15 (11 F), age: 54.3 ± 7.9 years), 2) Younger control (YC; n = 15 (13 F), age: 55.2 ± 4.0 years), 3) Older TKR patient (OP; n = 14 (12 F), age: 76.9 ± 4.7 years), and 4) Older control (OC; n = 15 (11 F), age: 77.7 ± 4.1 years). Each participant provided informed consent to the potential risk factors associated with participation in

Participant demographics

Comparisons between the four groups revealed no significant differences for any of the participant demographics, except for age (Table 1).

Perceived pain, stiffness, and physical function

Results of the WOMAC and OKS are reported in Table 1. The YP group had a significantly lower total WOMAC score compared to the OP group (t27 = −10.28, p < 0.001, d = 3.81). Analysis of the WOMAC subscales revealed that the YP group reported lower pain (t27 = −8.11, p < 0.001, d = 2.95), lower stiffness (t27 = −5.90, p < 0.001, d = 2.01), and greater physical

Discussion

The current study is the first to examine differences in balance confidence and movement reinvestment, both predictors of fall risk, between older TKR patients and the rapidly growing younger TKR population. The results indicate that younger TKR patients report lower levels of pain, joint stiffness, and movement reinvestment, and elevated levels of physical function, functional mobility and balance confidence compared to the older TKR patient. These findings suggest that the younger TKR patient

Consent

The study was performed with informed consent and followed all the guidelines for experimental investigation involving human participants required by the local institution.

Conflicts of interest and source of funding

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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