Influence of Patient Satisfaction of Total Knee Replacement Patients on Stair Negotiation and Walking Biomechanics, Strength, and Balance

Total knee replacement (TKR) patients have shown alterations in lower extremity biomechanics during level ground walking and stair negotiation, strength levels, and balance abilities, however, it is unknown how dissatisfied TKR patients compare to satisfied TKR patients in these activities. Study One examined the lower extremity biomechanics of dissatisfied and satisfied TKR patients during level ground walking. Study Two investigated knee biomechanics during stair ascent and descent activities. Study Three compared isokinetic strength, balance abilities, deep knee flexion abilities, and functional abilities of the dissatisfied patients to the satisfied patients. Study Four performed a logistic regression as a means of examining significant variables in models designed to predict patient satisfaction.

Study One found reduced 1st and 2nd peak VGRF, knee flexion ROM, and peak loadingresponse knee extension and abduction moments in the dissatisfied patients compared to healthy controls. First and 2nd peak VGRFs and flexion ROM were reduced in the replaced limb of the dissatisfied patients compared to their non-replaced limb. Study Two showed reduced 2nd peak VGRF and loading-response knee extension moments in the replaced limb of the dissatisfied group compared to their non-replaced limb and to satisfied and healthy groups during stair ascent. 1st peak VGRF and both loading-response and push-off abduction moments showed reduced values in replaced limbs compared to non-replaced limbs for all groups. During stair descent, the dissatisfied group showed reduced loading-response and push-off knee extension moments in their replaced limb compared to their non-replaced limb and the healthy group. The loading-response knee extension and abduction moments were also reduced in the dissatisfied group compared to the satisfied group. Study Three showed reduced peak extension (180°/s) and flexion (60°/s) torque in dissatisfied patients compared to satisfied patients. No balance differences were evident, although an increased percentage of dissatisfied patients were unable to complete the unilateral balance tests. Study Four produced models via the logistic regression analysis which often included peak VGRFs and knee extension moments. Future research should examine the effects of attempting to alter the physical differences between patient satisfaction groups and whether it improves patient satisfaction rates.