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 Adult Knee Reconstruction Test 5: Knee Arthroplasty
CME 1: January, February, March 2004
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The Journal of Bone and Joint Surgery (American) 86:328-334 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Proprioception, Kinesthesia, and Balance After Total Knee Arthroplasty with Cruciate-Retaining and Posterior Stabilized Prostheses

C. Buz Swanik, PhD, ATC1, Scott M. Lephart, PhD, ATC2 and Harry E. Rubash, MD3

1 Department of Kinesiology, Temple University, 18 Pearson Hall, Philadelphia, PA 19122. E-mail address: cswanik{at}temple.edu
2 Neuromuscular Research Laboratory, Department of Sports Medicine and Nutrition, University of Pittsburgh, Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA 15203
3 Department of Orthopaedic Surgery, Massachusetts General Hospital, Gray Building, 55 Fruit Street, White 601, Boston, MA 02114

Investigation performed at the Neuromuscular Research Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The effect of total knee arthroplasty on proprioception, kinesthesia, and postural control remains controversial. It is argued that retaining the posterior cruciate ligament may help to preserve these sensorimotor functions and improve the longevity of the prosthesis and the functional outcome. We performed a prospective, randomized study to assess proprioception, kinesthesia, and balance following total knee arthroplasty with cruciate-retaining and posterior stabilized prostheses.

Methods: Twenty patients scheduled to undergo total knee arthroplasty were randomly assigned to receive either a cruciate-retaining or a posterior stabilized prosthesis. Joint-position sense, the threshold to detect joint motion, and the subject's ability to balance on an unstable platform were assessed prior to and at least six months after the operation. Paired two-tailed t tests (with a level of significance of p < 0.05) were used to assess the effect of the arthroplasty on the preoperative measures for all subjects. Analysis of covariance was performed to identify the effects of prosthetic design.

Results: Following total knee arthroplasty, patients detected motion significantly faster and reproduced joint position with less error. The balance index also improved significantly from the preoperative to the postoperative evaluation. The group treated with the posterior stabilized prosthesis more accurately reproduced joint position when the knee was extended from a flexed position.

Conclusions: Total knee arthroplasty results in mild improvements in proprioception, kinesthesia, and balance. These changes may result from the retensioned capsuloligamentous structures and reduced pain and inflammation. Retention of the posterior cruciate ligament does not appear to significantly improve proprioception and balance compared with those functions in patients with a posterior stabilized total knee design.

Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.


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