RR-PL-1872

Monday 09:30, Palau de Congressos, Hall 2, Room A

TOTAL KNEE ARTHROPLASTY: PRE-OPERATIVE GAIT, BALANCE AND KNEE SOCIETY IMPAIRMENTS.  Kauffman T, Mauriello A, Palsgrove B, Gamber W, Laughlin M; Kauffman Gamber Physical Therapy.  Lancaster, Pennsylvania 17602.  USA. PURPOSE: Pain and functional declines eventually lead to orthopedic consideration of total knee arthroplasty.  X-rays are usually taken, but it remains unclear when one becomes a candidate for total joint surgery.  This pilot study describes the functional declines in a pre-operative sample in order to establish a range of impairments in persons choosing to undergo total knee arthroplasty.  RELEVANCE: In patients with osteoarthritis of the knee(s), physical therapy is often used to delay, to prepare or possibly to avoid total knee arthroplasty.  It is also used to palliate patients with degenerative joint changes who are unable to undergo or refuse total knee arthroplasty.  Physical therapists should assess functional abilities in patients and communicate those findings with the patient and surgeon to allow for a more informed decision about total knee arthroplasty.  These same assessment tools should be used post-operatively to validate the results of knee arthroplasty and may become prognosticators of long-term outcomes.  SUBJECTS: This sample consists of 3 males and 5 females, age range 49 to 84, mean 67 years.  All subjects were referred by 1 orthopedist for pre-operative assessment.  METHODS: The American Knee Society score is a clinical test divided into the knee rating and the functional rating.  Each category has a maximum or best score of 100 points.  The knee rating is based upon pain, range of motion, stability and alignment.  The functional score is based upon walking distance, stairs and assistive device needed.  A gait abnormality rating score was also used to determine risk for falling and overall gait characteristics.  The gait velocity over a 10-meter course was recorded.  Subjects were evaluated on the Balance Master (NeuroCom™) for static stance with eyes open and eyes closed.  ANALYSES: All statistical data are presented descriptively.  Due to the small number of subjects, no tests of statistical significance were used.  RESULTS: The knee rating component of the American Knee Society scores ranged between 38 – 70, mean 57.  The functional rating had a range of 30 – 90, mean 48.  The gait abnormality rating score ranged between 0 – 13, mean 4.9.  A score over 8 indicates a higher risk for falling, with 0 the best possible and 21 the worst possible scores.  The 10-meter gait path was traversed in a range of 7.5 – 14.9 seconds, mean 11.6.  A gait speed of less than 1 meter per second is suggestive of impairment.  On the Balance Master™, 4 of 8 subjects had abnormal static balance when compared to norms.  With the eyes closed, 5 of 8 had abnormal sway.  One of the 8 subjects chose not to have total knee arthroplasty because he had normal balance, the best knee and function ratings score and his gait speed was 7.5 seconds.  CONCLUSION: These functional assessments have been useful in confirming the need for total knee arthroplasty.