Faster knee for better walking

Osaka Metropolitan University scientists delved into the relationship between gait function and knee extension velocity after total knee arthroplasty and compared the effects of various factors on walking. The results reveal that knee extension velocity, measured while seated, on the operated side was the most important determinant of gait function. These findings are expected to contribute to the development of new rehabilitation programs for efficient gait function improvement.

Scientists measured gait function, knee extension velocity while seated, quadriceps strength, knee range of motion, and knee pain in 186 total knee arthroplasty patients to identify the most important determinant of postoperative gait function.

Osaka, Japan – “Speed or strength, which is more important?” may be a critical question for not only athletes but also knee surgery patients. Osaka Metropolitan University scientists have revealed that knee extension velocity while seated is a stronger predictor of walking performance than muscle strength in elderly patients after their total knee arthroplasty (TKA) surgery.

TKA is the most common surgical intervention for knee osteoarthritis, a musculoskeletal disorder that mainly progresses with age. This surgery has been shown to be effective in relieving pain and restoring joint range of motion; however, TKA-enabled improvement in gait function may not be sufficient. Although the strength of the quadriceps—a muscle used to extend the knee—has been deemed to have a significant effect on postoperative gait function in TKA patients, there are many cases in which gait function does not improve even after quadriceps strength is restored. This raises a need to identify other factors influencing gait function.

A research team led by Professor Akira Iwata, from the Graduate School of Rehabilitation Science at Osaka Metropolitan University, hypothesized that the movement velocity of knee extension (i.e., knee extension velocity) is a strong determinant of gait function in TKA patients, and tested this hypothesis on 186 elderly patients who underwent TKA. Measurements were taken before and at 2 and 3 weeks after surgery and included gait function (gait speed and Timed Up and Go test), knee extension velocity, quadriceps strength, knee range of motion, and knee pain. Multiple regression analysis was performed to analyze the relationship between gait function and other variables.

The results show that the knee extension velocity on the operated side was the most important predictor of gait function in the participating patients. The findings were published in PLOS ONE.

“Thus far, rehabilitation programs aimed at recovering gait function after TKA surgery have focused on training to improve quadriceps strength,” explained Professor Iwata. “However, this study’s results suggest that training to enhance knee extension velocity on the operated side could be effective. We will continue to examine the effects of rehabilitation that concentrates on movement velocity.”


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Osaka Metropolitan University is a new public university established by a merger between Osaka City University and Osaka Prefecture University in April 2022. For more science news, see, and follow @OsakaMetUniv_en, or search #OMUScience.

Published: 12 Jan 2023

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Rina Matsuki

3-3-138 Sugimoto, Sumiyoshi-ku,
Osaka 558-8585 JAPAN

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Title: Maximum knee extension velocity without external load is a stronger determinant of gait
function than quadriceps strength in the early postoperative period following total knee
DOI: 10.1371/journal.pone.0276219
Author: Akira Iwata, Yuki Sano, Hideyuki Wanaka, Shingo Kobayashi, Kensuke Okamoto, Jun
Yamahara, Masaki Inaba, Yuya Konishi, Junji Inoue, Atsuki Kanayama, Saki Yamamoto,
Hiroshi Iwata
Publication date: November 22, 2022

Funding information:

This work was supported by Japan Society for the Promotion of Science KAKENHI Grant Numbers 20K11162. The funders had no role in study design, data collection, and analysis, decision to publish or preparation of the manuscript.