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Preoperative use of handrail strongest predictor of stair-climbing ability following TKA
Zeni JA. J Bone Joint Surg Am. doi:10.2106/JBJS.I.00299.
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Younger, stronger patients who do not use a handrail before unilateral total knee arthroplasty can anticipate the best results with regard to postoperative stair-climbing ability, according to the results of this Level I study.
“This information may provide patients with more realistic expectations after surgery and allow them to make more appropriate discharge plans,” Joseph A. Zeni Jr., PT, PhD, and Lynn Snyder-Mackler, PT, ScD, FAPTA, University of Delaware, Newark, Del., wrote in their study.
The researchers enrolled 105 consecutive patients who underwent primary unilateral total knee arthroplasty (TKA) performed by three different surgeons. All patients in this group had evidence of end-stage knee osteoarthritis (OA) in at least two compartments. The researchers also included 64 participants with no history of knee pain or OA as a control group.
All TKA patients received posterior cruciate ligament–sacrificing condylar implants with patellar resurfacing; therefore, outcomes were not affected by implant choice.
Before surgery, 63 of 105 patients required a handrail to ascend or descend stairs. Two years postoperatively, 60 patients still required a handrail. In the control group, 19 of 64 patients required a handrail at baseline; 10 out of 31 patients required a handrail at 2-year follow-up.
“At two years, the preoperative ability to ascend and descend stairs without a handrail was the best predictor of individuals who would not require a handrail after surgery, followed by younger age and greater quadriceps strength,” the authors wrote in their study. These variables accurately predicted handrail use in 90 of 105 participants 2 years postoperatively (P<.001).