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  • Title: Quadriceps/hamstrings co-activation increases early after total knee arthroplasty.
    Author: Thomas AC, Judd DL, Davidson BS, Eckhoff DG, Stevens-Lapsley JE.
    Journal: Knee; 2014 Dec; 21(6):1115-9. PubMed ID: 25218971.
    Abstract:
    UNLABELLED: Quadriceps and hamstrings weakness and co-activation are present following total knee arthroplasty (TKA) and may impair functional performance. How surgery and post-operative rehabilitation influence muscle activation during walking early after surgery is unclear. PURPOSE: Examine muscle strength and activation during walking before and one and 6-months post-TKA. METHODS: Ten patients (n=6 female; age: 64.7 ± 7.9 years; body mass index[BMI]:29.2 ± 2.5 kg/m(2)) and 10 healthy adults (n=6 female; age: 60.6 ± 7.4 years; BMI: 25.5 ± 4.0 kg/m(2)) participated. The patients underwent bilateral quadriceps and hamstrings strength testing and assessment of quadriceps/hamstrings co-activation and on/off timing using surface electromyography during a six-minute walk test (6MW). Groups, limbs, and changes with TKA surgery were compared. RESULTS: Patients reported greater 6MW knee pain pre- versus post-TKA and compared to controls (P<0.05). Patients had weaker surgical limb hamstrings (P<0.05) and bilateral quadriceps (P<0.05) strength than controls pre- and post-TKA. Before and 1-month post-TKA, patients had side-to-side differences in quadriceps and hamstrings strength (P<0.05). Controls walked farther than patients (P<0.01). Patients demonstrated greater surgical limb co-activation pre-operatively than controls (P<0.05). Co-activation was higher bilaterally one-month post-TKA compared to controls (P<0.05). Patients turned off their quadriceps later during stance than controls before and 1-month post-TKA (P<0.05). CONCLUSIONS: Muscle strength, co-activation, and timing differed between patients and controls before and early after surgery. Rehabilitation to improve strength and muscle activation seems imperative to restore proper muscle firing patterns early after surgery.
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