Reliability, Concurrent Validity, and Minimal Detectable Change of the Hand-Held Dynamometry for the Assessment of Knee Muscle Strength in Patients With Revision Total Knee Arthroplasty.

OBJECTIVE: To determine the concurrent validity, reliability, and minimal detectable change (MDC) of the hand-held dynamometry (HHD) for knee strength measurement in patients with revision total knee arthroplasty (r-TKA). DESIGN: A reliability and validity analysis. SETTING: Orthopedic and physical therapy services of university hospital. PARTICIPANTS: The study included 42 patients with r-TKA (N=42). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Knee muscle strength assessments were performed by 2 physiotherapists in 3 different sessions by using HHD. Participants were instructed to exert a maximal force for lasting 5 seconds against HHD. The first examiner performed the strength testing, and after 30-minutes rest, the second examiner performed the same procedure for inter-examiner reliability. One hour after the initial testing, the first examiner reperformed the strength testing for intra-examiner reliability. The correlations of the knee extensors and knee flexors strength with 50-foot walking test and 30-second chair stand test were assessed for concurrent validity. RESULTS: The inter-examiner reliabilities of knee extensors and flexors strength measurements were 0.97 and 0.95, respectively. The SEM and the minimal detectable changes at 95% confidence level (MDC95) for knee extensors were 10.39 and 28.65 Newton-meters (Nm), and SEM and MDC95 for knee flexors were 8.70 and 23.99 Nm, respectively. The intra-examiner reliabilities of knee extensors and flexors strength measurements were 0.96. SEM and MDC95 for knee extensors were 12.00 and 33.09 Nm, and SEM and MDC95 for knee flexors were 7.78 and 21.45 Nm, respectively. The knee muscle strength showed strong significant correlations with physical performance tests (all, P<.05). CONCLUSIONS: The HHD is a reliable and valid method for assessment of static knee strength after r-TKA. The HHD can be used to quantify changes in knee strength and also assists the clinicians to determine the effect of rehabilitation programs on muscle strength following r-TKA surgery.

The reliability and validity of the Lie­To­Sit­To­Stand­To­Walk transfer test in total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is the standard procedure for treating end-stage knee osteoarthritis. Nevertheless, some residual issues can persist, leading to various problems, including pain, compromised strength, impaired proprioception, postural instability, dynamic balance issues, and gait deficiencies. The Lie-to-Sit-to-Stand-to-Walk Transfer Test (LSSWT) implements a multi-faceted methodology to evaluate basic transfer abilities. The purpose of this study is to investigate the validity, reliability, and minimal clinically important difference of the LSSWT in TKA patients. METHODS: Twenty-two patients with TKA were enrolled in this study. The patients were administered the LSSWT, the Timed Up and Go Test (TUG), and the Hospital for Special Surgery (HSS) knee score. Patients rested between the tests for an hour to prevent fatigue. RESULTS: The mean age was 68.1 ± 2.59 years and the mean HSS Knee Score was 85.43 ± 3.47 of the patients. The relative (ICC coefficient) and absolute (SEM and SRD95) reliability values were 0.88, 1.21, and 3.33 respectively. The Spearman correlation coefficient of the LSSWT with the TUG was 0.63. CONCLUSIONS: The LSSWT displays excellent reliability and high validity in assessing fall risk, complex dynamic balance, and mobility required for daily activities in patients post-TKA. The low MCID value (3.33) indicates its sensitivity and ability to identify minor changes in a patient's status over time or in response to rehabilitation applications. Therefore, it is recommended to use the LSSWT when evaluating fall risk, dynamic balance, and mobility for community living, discharge planning, or facility admission.

Comparison of kinesio taping and cold therapy in patients with total knee arthroplasty: A randomized controlled trial.

OBJECTIVE: To investigate the effects of kinesio taping and cold therapy on pain, edema, range of motion, muscle strength, functional level and quality of life in patients with total knee arthroplasty. DESIGN: Randomised controlled trial. SETTING: A university hospital. SUBJECTS: One-hundred patients were included. INTERVENTION: Patients were allocated into three groups; control group, kinesio group and cold therapy group. The control group received a standard rehabilitation program. Kinesio taping group received two fan-shaped kinesio taping bands and cold therapy group received cold packs in addition to the standard rehabilitation program. MAIN MEASURES: The outcome measures were pain, edema, range of motion, muscle strength, functional level and quality of life. Participants were assessed at preoperative, discharge and postoperative third month. RESULTS: The groups were similar at preoperative. A significant difference was determined in terms of pain in kinesio taping group compared to the control group at the discharge. Cold therapy was efficient in reducing postoperative swelling but kinesio taping had no significant effects on swelling control. There was no difference between the groups in terms of range of motion, muscle strength, functional level and quality of life. The groups were similar in all parameters at the postoperative third month measurements. CONCLUSION: Fan-shaped kinesio taping is an effective technique in terms of postoperative pain relief. Cold therapy is an effective method in terms of edema control. Kinesio taping and cold therapy has no specific beneficial effect on functional level, muscle strength and quality of life compared to control group.

Relaxation exercise therapy improves pain, muscle strength, and kinesiophobia following total knee arthroplasty in the short term: a randomized controlled trial.

PURPOSE: This study aimed to compare progressive muscle relaxation (PMR) + standard physiotherapy (PT) to standard PT during inpatient rehabilitation of total knee arthroplasty (TKA) patients in terms of post-operative outcomes. The hypothesis was that PMR + standard PT would lead to better pain, function, and neuromuscular outcomes than standard PT. METHODS: A total of 106 patients were randomly allocated into PMR or standard rehabilitation (SR) groups. Both groups received standard PT during their hospital stay. PMR group additionally performed PMR exercise on post-operative days 1, 2, and 3. Patients were evaluated regarding pain intensity, functional outcomes, muscle strength, active range of motion, knee edema, anxiety, depression, and kinesiophobia. RESULTS: There were no differences between groups at baseline (n.s.). During the inpatient period and at discharge, the PMR group had better results in terms of pain relief (p < 0.05), quadriceps strength (p = 0.001), kinesiophobia level (p = 0.011) compared to the SR group. No difference was detected between groups regarding other evaluation parameters during the inpatient period, at discharge, and third post-operative month (n.s.). The within-group analysis showed statistically significant differences over time in both groups in each variable (p < 0.05). CONCLUSION: Our findings support that PMR therapy offers beneficial results in subjective and objective measures of TKA patients during the inpatient period. Therefore, PMR therapy could be implemented into the rehabilitation program of TKA patients to enhance their early recovery from various symptoms following TKA. LEVEL OF EVIDENCE: II.

Evaluation of Extensor Mechanism in Revision Knee Arthroplasty.

BACKGROUND: The success of revision total knee arthroplasty depends on adequate exposure that does not produce complications. The purpose of this study was to compare the results of revision total knee arthroplasty between V-Y quadricepsplasty (QP) and quadriceps snip (QS) approaches. METHODS: In the study, 92 knees with follow-up of 12-108 months which were operated by using QP (55) and QS (37) were evaluated retrospectively. Measurements were taken by using universal transparent goniometer, also varus valgus deformities, knee flexion angles, instability, Hospital for Special Surgery and Lower Extremity Functional Scale scores, functional condition of the knee and activity levels of the patients were evaluated cross-sectionally. RESULTS: Statistically significant difference was not found regarding extensor restriction, varus or valgus deformities, knee flexion angles, flexor and extensor muscular strength, Hospital for Special Surgery and Lower Extremity Functional Scale score (P > .05). CONCLUSION: QP is a preferable method which allows a wider arthrotomy for stiff knees and revision knee surgery, and provides larger access to the joint. Choosing this incision does not bring disadvantage in terms of extensor mechanism.

Assessing Minimal Detectable Changes and Test-Retest Reliability of the Timed Up and Go Test and the 2-Minute Walk Test in Patients With Total Knee Arthroplasty.

BACKGROUND: Two-minute walk test (2MWT) and the Timed Up and Go test (TUG) are simple, quick, and can be applied in a short time as part of the routine medical examination. They were shown to be reliable and valid tests in many patient groups. The aims of the present study were: (1) to determine test-retest reliability of data for the TUG and 2MWT and (2) to determine minimal detectable change (MDC) scores for the TUG and 2MWT in patients with TKA. METHODS: Forty-eight patients with total knee arthroplasty, operated by the same surgeon, were included in this study. Patients performed trials for TUG and 2MWT twice on the same day. Between the first and second trials, patients waited for an hour on sitting position to prevent fatigue. RESULTS: The TUG and 2MWT showed an excellent test-retest reliability in this study. Intraclass correlation coefficient [ICC(2,1)] for TUG and 2MWT were 0.98 and 0.97, respectively. Standard error of measurement and MDC95 for TUG were 0.82 and 2.27, respectively. Standard error of measurement and MDC95 for 2MWT were 5.40 and 14.96, respectively. CONCLUSION: The TUG and 2MWT have an excellent test-retest reliability in patients with TKA. Clinicians and researchers can be confident that changes in TUG time above 2.27 seconds and changes in 2MWT distances above 14.96 meters, represent a "real" clinical change in an individual patient with TKA. We, therefore, recommend the use of these 2 tests as complementary outcome measures for functional evaluation in patients TKA.

Test-retest reliability of the 50-foot timed walk and 30-second chair stand test in patients with total hip arthroplasty.

The purpose was to investigate the test-retest reliability of the 50-Foot Timed Walk (50FWT), and 30-Second Chair Stand Test (30CST) in the patients with total hip arthroplasty (THA). The study was a test-retest study. Thirty-seven patients with THA performed two trials for both the 30CTS and 50FWT on the same day with one hour interval. To assess reliability, the intra-class correlation coefficient [ICC(2,1)], standard error of measurement (SEM), the smallest real difference at the 95% confidence level (SRD95) were calculated. The ICCs for the 50FWT and 30CTS were 0.98 and 0.94, respectively. The SEM and SRD95 for the 50FWT and 30CTS were 0.3 and 0.8 seconds and 0.4 and 1.2 repeats, respectively. The test-retest reliability of the tests was very high. The 50FWT and 30CST are very reliable to measure the functional performance in patients with THA in the clinical settings.

Nailing or plating for subtrochanteric femoral fractures: a non-randomized comparative study.

BACKGROUND: The aim of the present study was to compare the outcomes of reverse less invasive stabilization system for distal femur (LISS-DF) plates and proximal femoral nail antirotation (PFNA) in the treatment of patients with subtrochanteric fracture. METHODS: Thirty-one patients with 32 fractures were included in this study. The PFNA group consisted of 16 patients, and the reverse LISS-DF plate group consisted of 15 patients. Intraoperative data such as surgical time (min), amount of blood transfusion (units and erythrocyte suspensions) and radiation time (seconds) were noted. Time elapsed until fracture consolidation (weeks), time until full weight bearing (weeks), mean Harris hip score and length of stay (LOS) at hospital (days) were recorded postoperatively. RESULTS: The reverse LISS-DF group had a significantly longer elapsed time until fracture consolidation (p < 0.05). The mean radiation time was significantly longer (p < 0.05), and the Harris hip scores at last control were significantly higher (p < 0.05) compared with the PFNA group. No significant differences were determined in terms of complications and re-operation rates. CONCLUSION: This study demonstrated that in the reverse LISS-DF-treated group, the mean time for bone union was longer and weight bearing was delayed. Considering the surgical technique, minimal surgical approach, reduced amount of blood transfusion and superior functional results following surgery, we concluded that the PFNA system offers advantages over reverse LISS-DF plating in the treatment of subtrochanteric femur fractures.

Subtrochanteric shortening in total hip arthroplasty: biomechanical comparison of four techniques.

Safe reduction of the femoral head into the true acetabulum requires a certain amount of femoral shortening in patients with high dislocation of the hip. In subtrochanteric shortening applications, to reduce complications it is necessary to maintain a stable fixation at the osteotomy line. The purpose of this study is to investigate frequently used methods from a biomechanical point of view. Four osteotomy groups were created with composite femurs to investigate subtrochanteric osteotomies; transverse, oblique, z-subtrochanteric and double Chevron. All loading tests were carried out with two implant types both with and without strut graft and cable fixation. No single inherent feature increasing the stability of the investigated osteotomy types was found. Additionally graft application did not have a significant contribution to stability.

Morphometric evaluation of proximal femur in patients with unilateral total hip prosthesis.

It is important to know the morphometric characteristics of the proximal femur. This is necessary to reduce the risk of complications related to surgical procedures performed in the area due to vascular, metabolic, or traumatic causes. It is of importance for achieving the alignment of the prosthesis to be implanted as well. The aim of this study was to evaluate the morphometric characteristics of the proximal femur and to establish a database for making and performing total hip prosthesis. Anteroposterior (AP) pelvic radiographs of 162 cases, with a mean age of 65.6 years, who had undergone unilateral total hip arthroplasty were used in this study. Femoral head diameter (FHD), femoral neck width (FNW), femoral neck length (FNL), femoral neck axis length (FNAL), intertrochanteric line length (ILL), and neck-shaft angle (NSA) were measured on radiographs obtained digitally using setrapacs media. FHD was found to be 48.1 ± 3.7 mm, FNW 35.4 ± 4.2 mm, FNL 30.8 ± 6.1 mm, FNAL 98.6 ± 9.4 mm, ILL 81.1 ± 7.9 mm, and NSA 130.4 ± 5.1° on average. The comparison of the mean values for females and males revealed a statistically significant difference between the FHD, FNW, FNL, FNAL, and ILL (P = 0.000). There was no statistically significant difference in NSA between males and females (P = 0.356). A weak correlation was found between age and parameter values using correlation analysis (r < 0.24, P > 0.05). In morphometric assessment of the proximal femur, taking into consideration regional and sexual differences is of importance for prosthesis design and surgical success.

The effects of balance training in patients with total hip arthroplasty : A randomized controlled pilot study.

BACKGROUND: Total hip arthroplasty (THA) causes damage to hip joint mechanoceptors, which in turn leads to decrease in proprioception and increase in balance disorders. Few research has focused on balance training in patients with arthroplasty and none investigated the long-term effect of balance training using objective balance assessment methods in THA patients. The purpose of our study was to investigate the effects of balance training in patients with THA until 26 weeks postoperatively. METHOD: For this study 24 patients with hip osteoarthritis, who were candidates for THA were recruited. Of the patients with THA 16 completed the study protocol and the patients were randomized to 2 groups: conventional rehabilitation (CR, n = 8) or conventional rehabilitation plus balance training (CR + BT, n = 8). The CR group completed typical surgery-specific exercise programs, while the CR + BT group completed the CR plus balance exercises. The patients were evaluated by a hand-held dynamometer, single leg stance test (SLST), Tetrax balance system, Harris hip score, lower extremity function scale, 5 times sit to stand test and 50-foot timed walk test preoperatively and 8, 14 and 26 weeks postoperatively. RESULTS: While the CR + BT group showed significant improvement for the right extremity eyes closed SLST score (p < 0.05), there was no significant difference for other assessment parameters between the CR and CR + BT groups (p > 0.05). There were significant improvements in both groups until 26 weeks following THA (p < 0.05). CONCLUSION: The results of our study indicate that there were similar improvements in the balance and functional parameters in the CR and CR + BT groups. There was no additional benefit after 26 weeks of controlled balance exercises following THA.

Investigation of the validity and reliability of the short physical performance battery in patients undergoing total knee arthroplasty.

BACKGROUND: Practical, applicable, valid, and reliable tools are needed to assess physical performance in patients with Total Knee Arthroplasty (TKA) in a variety of settings, including routine clinical assessment, research studies, and community-based programs. OBJECTIVE: The aim of this study is to evaluate the validity and reliability of the Short Physical Performance Battery (SPPB) among patients with TKA. METHODS: We included 45 patients who underwent TKA surgery (mean age 68.89 ± 9.26). The SPPB, Timed up and go (TUG) test and, Hospital for Special Surgery (HSS) Knee Score were administered to the patients. SPPB was performed twice on the same day with 1 h rest. RESULTS: The ICC(2,1) coefficient, MDC95 and SEM values were 0.97, 1.02 and 0.37 respectively. The Pearson correlation coefficient of the SPPB with the TUG and HSS was -.78, and 0.74 respectively. CONCLUSION: SPPB has excellent reliability, and strong validity in assessing physical performance in patients with TKA. SPPB can identify even minimal detectable difference in physical performance and can be reliably used to monitor patient outcomes in the postoperative period for a comprehensive assessment of TKA in many physical performance domains, including balance, walking speed, and lower extremity strength. CLINICAL TRIAL NUMBER: NCT06201637.

Balance assessment under dual task conditions in patients with total knee arthroplasty: a test-retest reliability and concurrent validity study.

BACKGROUND: Under dual-task (DT), functional mobility and balance testing can detect balance and mobility problems in activities of daily living, especially in situations that cannot be identified under single-task conditions. OBJECTIVE: Determine the test-retest reliability and concurrent validity of the Four Square Step Test (FSST) under DT conditions for people with total knee arthroplasty (TKA). METHOD: A total of 30 patients with TKA participated in this research, and patients were tested with the FSST under DT conditions. In addition, concurrent validity of the dual-task FSST was calculated using Timed Up and Go (TUG) under the single-task condition and Hospital for Special Surgery (HSS) Knee Score. Patients performed two FSST trials on the same day under DT conditions. RESULTS: The intraclass correlation coefficients (ICC2,1) two-way random effects model, and minimal detectable changes with 95% confidence intervals (MDC95) values of the FSST under DT conditions were .97 and 3.43, respectively. The Pearson's correlation coefficient of the FSST with the TUG and HSS was .65 and -.40, respectively. CONCLUSION: The FSST has been found to be a reliable and valid clinical assessment tool for dynamic balance under DT conditions in patients with TKA. For identify balance disorders in daily life at early points, clinicians and researchers can use the FSST under DT conditions in TKA. CLINICAL TRIAL REGISTRATION NUMBER: NCT06108466.

The Intrarater and Interrater Reliability and Validity of Universal Goniometer, Digital Inclinometer, and Smartphone Application Measuring Range of Motion in Patients with Total Knee Arthroplasty.

Objectives: The aim of this study was to investigate the intrarater and interrater reliability and validity of range of motion measurements obtained with a universal goniometer, digital inclinometer, and smartphone application in patients with total knee arthroplasty. Methods: Range of motion of the knee joint was measured by two examiners with a universal goniometer, digital inclinometer, and a smartphone application. Data were obtained from 51 knees of 27 patients at postoperative 6 months. Two measurements made by the first examiner were compared to assess interrater reliability, and measurements from both examiners were compared to assess intrarater reliability. Statistical analysis was performed using intraclass correlation coefficient (ICC) and Spearman's rho values. Results: With all three methods, active and passive knee flexion range of motion measurements showed high intrarater and interrater reliability (ICC = 0.749-0.949). Concurrent validity analysis also demonstrated statistically significant, moderate to strong correlation among the three methods (r = 0.775-0.941). Conclusion: The universal goniometer, digital inclinometer, and smartphone application were all found to be reliable and valid assessment tools in clinical practice for patients with total knee arthroplasty.

Non-drainage Offers Faster Proprioceptive and Functional Recovery, and More Clinical Benefits for Patients following Primary Total Knee Arthroplasty Compared to Drainage.

BACKGROUND: Although a non-drainage procedure following total knee arthroplasty (TKA) is becoming more acceptable in enhanced recovery after surgery, postoperative drainage is still commonly used in TKA surgeries. This study aimed to compare the non-drainage to the drainage during the early postoperative stage regarding proprioceptive and functional recovery, and postoperative outcomes of TKA patients. MATERIAL AND METHODS: A prospective, single-blind, randomized, controlled trial was carried out on 91 TKA patients, who were randomly allocated into the non-drainage group (NDG) or the drainage group (DG). Patients were evaluated regarding knee proprioception, functional outcomes, pain intensity, range of motion, knee circumference, and anesthetic consumption. Outcomes were assessed at the time of charge, at postoperative 7th day, and at postoperative 3rd month. RESULTS: There were no differences between groups at baseline (p > 0.05). During the inpatient period, the NDG experienced superior pain relief (p < 0.05), had a higher Hospital for Special Surgery knee score (p = 0.001), demanded lower assistance from a sitting position to a standing position (p = 0.001) and walking for 4.5 m (p = 0.034), and performed the Timed Up and Go test in a shorter duration (p = 0.016) compared to the DG. The NDG gained the actively straight leg raise earlier (p = 0.009), needed lower anesthetic consumption (p < 0.05), and showed improved proprioception (p < 0.05) compared to the DG during the inpatient period. CONCLUSIONS: Our findings support that a non-drainage procedure would be a better option to provide a faster proprioceptive and functional recovery, and beneficial results for patients following TKA. Therefore, the non-drainage procedure should be the first choice in TKA surgery rather than drainage.

Fear of movement and other associated factors in older patients with total knee arthroplasty.

BACKGROUND: Kinesiophobia is an important risk factor for functional activities of patients in the early stage following total knee arthroplasty (TKA). AIMS: This study aimed to investigate the relationship between fear of movement and associated factors in older patients in the late stage after TKA. METHODS: The study included 45 older patients (mean age:70.11 ± 0.90 years) with knee osteoarthritis who underwent TKA. Kinesiophobia was assessed with the Tampa Scale of Kinesiophobia (TSK). Pain and strength in the quadriceps femoris (QF) muscle were assessed by the Visual Analog Scale and hand-held dynamometer, respectively. Functional level was determined using the 30-s sit-to-stand test (STS) and 10-m walking test. RESULTS: There were correlations between TSK and QF muscle strength (r = -0.538, p < 0.001), activity pain level (r = 0.489, p = 0.001), and 30-s STS (r = -0.306, p = 0.041). There were no correlations between TSK and age (r = 0.207, p = 0.172) and 10-m walking test (r = 0.112, p = 0.465). CONCLUSIONS: Increased pain and decreased QF muscle strength and functional level on STS were related with fear of movement in TKA patients. It was concluded that kinesiophobia of older patients with TKA must be considered during the assessment and rehabilitation program in the late stage after TKA.

The Reliability and Validity of the Lie-to-Sit-to-Stand-to-Walk Transfer (LSSWT) Test in Knee Osteoarthritis.

Background: Several neuromuscular impairments may be observed in older patients with knee osteoarthritis (OA), increasing the risk of falling, which is common during transfer activities. The Lie-to-Sit-to- Stand-to-Walk Transfer (LSSWT) test was developed to evaluate complex transfer abilities. The study aims to investigate the reliability and validity of LSSWT in patients with knee OA. Methods: Twenty-nine patients with knee OA were included in this study. The LSSWT, Timed up and go test (TUG), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were administered to the patients. Patients rested for at least an hour between the trials to avoid fatigue. Results: The LSSWT has excellent reliability and high validity in patients with knee OA. The relative (ICC coefficient) and absolute (SEM and SRD95) reliability values are 0.96 (95% CI: 0.91-0.98), 1.00, and 2,75, respectively. The Pearson correlation coefficient of the LSSWT with the TUG is 0.73 (p < 0.01), and the Spearmen correlation coefficient of the LSSWT with the WOMAC is 0.54 (p < 0.05). Conclusions: The LSSWT is highly reliable and valid in knee OA and is recommended for routine dynamic balance establishment. Having a low minimal clinically important difference shows the LSSWT's sensitivity. The LSSWT can easily identify dynamic balance deficits in knee OA patients and help prevent fall incidents.

The effectiveness of cruciate-retaining versus posterior-stabilized designs on extensor mechanism function and knee function in patients after simultaneous bilateral total knee arthroplasty: A two-year retrospective follow-up study.

INTRODUCTION: The importance of the posterior-cruciate ligament in knee functionality is known; however, the effect of preserving the posterior-cruciate ligament in total knee arthroplasty (TKA) on extensor mechanism function and knee function is not clear. We aimed to compare extensor mechanism function and knee function between patients operated with the cruciate-retaining and posterior-stabilized designs for simultaneous bilateral TKA. HYPOTHESIS: Patients operated with the cruciate-retaining design would produce better outcomes than those operated with the posterior-stabilized design. MATERIALS AND METHODS: A total of 104 patients were divided into two groups as the cruciate-retaining (n=52) and posterior-stabilized (n=52) groups. The groups were compared for extensor mechanism function (chair-rise test) and knee function (Hospital for Special Surgery [HSS] knee score). The follow-up points were six weeks, three months, six months, one year and two years. RESULTS: No statistically significant effect on chair-rise performance of the group-by-time interaction (χ2 [5, n=104]=5.32, p=.37) or of group (χ2 [1, n=104]=1.69, p=.19). In the HSS knee score, the group-by-time interaction was statistically significant (F [5.510]=6.24, p<.001). A statistically significant difference of 7.4 points in favor of the posterior-stabilized group was found at six weeks (p=.002). No statistically significant differences were found between the groups at the other follow-up points. DISCUSSION: The cruciate-retaining and posterior-stabilized designs have similar outcomes with regard to extensor mechanism function and knee function in the long-term period in patients who underwent simultaneous bilateral TKA. In the short-term period, the posterior-stabilized design shows better knee function than the cruciate-retaining design. LEVEL OF EVIDENCE: III; a retrospective study.

Validity and reliability of performance tests as balance measures in patients with total knee arthroplasty.

PURPOSE: This study aimed to investigate validity and reliability of the Timed Up and Go Test (TUG), 10 Meter Walk Test (10MWT), Single Leg Stance Test (SLST), 2 Minute Walk Test (2MWT), and Five Times Sit-to-Stand Test (5xSST) for evaluating balance in patients with total knee arthroplasty (TKA). MATERIALS AND METHODS: This cross-sectional study included 41 participants who had undergone TKA 6 months before the study due to osteoarthritis. Participants performed the TUG, 10MWT, SLST, 5xSST, and 2MWT. Each of the tests was performed twice, with a 1-day interval between tests. Intraclass correlation coefficient (ICC) models were used to determine the test-retest reliability. The level of correlations between performance tests and Berg Balance Scale and Fall Efficacy Scale-International were used to establish concurrent and convergent validity of the performance tests, respectively. RESULTS: The mean age of the subjects was 64.07 ± 10.57 years. All tests showed excellent reliability (ICC > 0.94), excluding SLST that demonstrated good test-retest reliability (ICC = 0.72). All of the tests (SLST, 10MWT, 5xSST, 2MWT, TUG) were found to have good validity (rho > 0.704). CONCLUSIONS: According to these results, TUG, 10MWT, SLST, 5xSST, and 2MWT are reliable and valid outcome measures in patients with TKA, and could be used to assess balance after TKA surgery.

Reliability, concurrent validity and minimal detectable change of the L test in patients with total knee arthroplasty.

PURPOSE: The L test is a modified version of the timed up and go test (TUG), extending the walking distance from 6 to 20 meters and also requiring participants to make four turns in both (right/left) direction. It could be a useful measurement method in assessment of functional mobility for patients with Total Knee Arthroplasty (TKA). The aim of the study was to determine reliability, concurrent validity, and minimal detectable change (MDC) of L test in patients with TKA. MATERIALS AND METHODS: The study included 43 patients with TKA. The Intraclass Correlation Coefficient (ICC) was used to assess the intra-rater reliability of the L test. The correlations of the L test with TUG were assessed for concurrent validity. RESULTS: Intra-rater (ICC 0.97) reliability of the L test was determined to be excellent. The SEM and MDC95 values of intra-rater reliability were 1.03 and 2.84, respectively. A high correlation was found between the L test and TUG (r: 0.75). CONCLUSION: The L test is a valid and reliable method in the assessment of functional mobility in patients with TKA. The L test can be used to quantify changes in functional mobility level in patients with TKA.Implications for rehabilitationThe L test is a reliable and valid measurement tool that can be used to assess functional mobility in patients with TKA.Clinicians and researchers can use a greater change than 2.84 seconds for the L test as a meaningful change in patients with TKA.