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Lisa M. Koralewicz, MPH, and Gerard A. Engh, MD

Abstract Background:
Proprioception - one's ability to sense joint position and joint motion - is affected by factors such as age, muscle fatigue, and osteoarthritis. Most proprioception studies have focused on young active subjects or on recipients of total knee replacements. Few have reported on a population with arthritic knees prior to total knee replacement or on persons similar in age to patients with advanced knee arthritis necessitating total knee arthroplasty. The purpose of the present study was to determine: 1) if proprioception in arthritic knees differs from proprioception in non-arthritic, age-matched, normal knees; 2) if when proprioception is reduced in one knee by the presence of advanced gonarthrosis, it also is reduced in the opposite knee irrespective of the presence of arthritis; and 3) if a person's grade of arthritis linearly correlates with his or her level of proprioception.

The customized test apparatus initiated motion at degree per second and recorded angular displacement when the test subject perceived motion or change in position of the knee. The test subject then identified the direction of movement.
Testing proprioception - one's ability to sense joint position and joint motion.

This study compared the proprioception levels of a group of 117 patients who were scheduled for total knee arthroplasty due to severe arthritis (mean age, 67.9 years) to a control group of forty patients who were recruited from a hospital-based cardiac rehabilitation program and did not have knee arthritis (mean age, 68.3 years). We used a customized Biodex System 2 Multi-Joint Testing and Rehabilitation System to compare proprioception (the threshold to detection of passive motion) between the two groups.

1) Middle-aged and elderly persons with advanced knee arthritis were significantly less sensitive to the detection of passive motion of the knee than middle-aged and elderly persons without knee arthritis. 2) The ability to detect passive motion was reduced in both knees when arthritis was present in only one knee. 3) No significant correlation existed between the radiographic se

Knee proprioception is reduced in middle-aged and elderly persons with advanced knee arthritis. When a knee with arthritis has reduced proprioception, its contralateral knee also has reduced proprioception independent of the presence or severity of degenerative arthritis. The results raise the question whether the loss of proprioception is a precursor and possibly a contributor to the development of gonarthrosis. The study also showed that when evaluating changes in proprioception occurring after knee arthroplasty, the best post-surgical method is to compare the operated knee to the patient's unoperated knee, rather than to age-matched controls.

Clinical Relevance:
Persons with advanced degenerative knee arthritis have reduced proprioception in comparison to middle-aged and older persons without arthritis. Such loss of proprioception is independent of the severity of knee arthritis, and may foretell the development of arthritis.



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