Gait, Balance Recovery and Balance Confidence after Total Knee Replacement: Differences between Younger and Older Patients

Total knee replacement (TKR) is the gold standard treatment for improving mobility and relieving pain associated with end-stage knee osteoarthritis (OA) when other modalities have failed. Patients demonstrate significant improvements compared to pre-TKR levels, however deficiencies in function and mobility remain when compared to healthy controls. Recent national joint replacement registries have reported a substantial increase in the number of TKR procedures performed on younger patients. Over the last decade in Canada, the largest relative percent increase (≈300%) in TKRs has occurred to patients who were between 45-54 years of age. Although this younger patient group (<55 years old) is rapidly growing, the vast majority of the literature investigating TKR outcomes has been based upon the ‘typical’, older TKR patient (≥ 65 years old). This has created a therapeutic dilemma for clinicians, having little empirical data to formulate explicit statements or recommendations regarding how TKR will affect this younger population, and a concern with prosthesis failure and revision surgery, there is a hesitation to perform TKR on the younger knee OA patient. Age-related deterioration in sensory information acquisition and musculoskeletal function has been observed between younger and older adults in the absence of knee OA and TKR, and has been linked to an increase in fall risk and falls. These age-related deficits observed in healthy adults may also distinguish younger and older TKR patients, which would have important implications to the surgical and rehabilitation practice. Currently, there are a limited number of published reports examining age-related differences in TKR patients and this gap in the literature warrants investigation. Therefore, the goal of this thesis is primarily to investigate the younger TKR patient and to compare their observations to that of the older, ‘typical’ patient and to their healthy age-matched controls.