Knee extensor muscle strength, physical function and patient-reported outcomes
the first year after total knee arthroplasty: a prospective longitudinal study
#MMPMID41121108
Sjöström P
; Nordeman L
; Rolfson O
; Larsson A
BMC Musculoskelet Disord
2025[Oct]; 26
(1
): 980
PMID41121108
show ga
BACKGROUND: Knee extensor muscle strength is crucial for optimal knee function.
Understanding the recovery process after total knee arthroplasty (TKA) and the
impact of preoperative factors on recovery is therefore clinically significant.
The primary aim was to investigate changes in knee extensor muscle strength in
men and women during the first year after TKA. The secondary aim was to describe
changes in physical function and patient-reported outcomes. METHODS: A
prospective observational study, with data collection before and at 12, 26 and 52
weeks after TKA. Participants (n?=?57) were scheduled for elective primary TKA
due to knee osteoarthritis. The primary outcome was changes in absolute and
normalised maximum voluntary isometric contraction (AMVIC and NMVIC) for knee
extensors in the operated knee, which was analysed with a linear-mixed effect
model. Changes in physical function (6MWT and 30CST) were analysed with a paired
samples t-test, and KOOS-scores were analysed with the Wilcoxon signed rank test.
RESULTS: The change in estimated marginal means for AMVIC at 12 weeks was ??27 N
(95% CI -43;-11, p?=?.001) and ??3.1 percentage points for NMVIC (-5.7;-0.5,
p?=?.013). At 52 weeks, the change was 42 N (21;63, p?.001) for AMVIC and 5.4
percentage points (2.1;8.6, p?.001) for NMVIC. The change at 26 weeks for AMVIC
and NMVIC was not significant. AMVIC was affected by time, sex (both p?.001),
statistical interaction between time and sex (p?=?.043) and the baseline
covariates age (p?=?.010), BMI (p?=?.011) and 30CST (p?=?.048). NMVIC was
affected by time, sex (both p?.001) and the baseline covariates BMI (p?=?.004),
6MWT (p?=?.023) and 30 CST (p?=?.036). 6MWT and KOOS-scores increased at all time
points. 30CST increased from 26 weeks. CONCLUSIONS: Better preoperative physical
function and lower BMI appear beneficial for postoperative recovery of normalised
knee extensor muscle strength. Following TKA, patient-reported outcomes
(symptoms, pain, ADL and knee-related QoL) and gait performance appear to improve
more rapidly than knee extensor muscle strength and 30CST. Preoperative exercise
and weight loss (if obese), as well as continued postoperative exercise even if
pain is alleviated and walking is improved may be advisable. TRIAL REGISTRATIONS:
Retrospectively registered 9 February 2022 (http://clinicaltrials.gov, ID:
NCT05248815).