Increased muscle activity to stabilise mobile bearing knees in patients with rheumatoid arthritis

The aim of this study was to assess the differences in muscle activity (surface EMG) between a posterior stabilised (PS) total knee design and a mobile bearing (MB) posterior cruciate ligament retaining design in rheumatoid arthritis (RA) patients during a step-up task. Four patients with a PS total knee prosthesis and three patients with a MB total knee prosthesis were selected based on pain score, knee function, range of motion and joint stability. Clinical scores and functional scores were comparable between the two groups pre-operatively and at the 1-year follow-up. Visual analysis of the EMG activity of the main flexor and extensor muscles showed that the activity of both extensor and flexor muscles of the MB group was on average higher compared to the PS group. When the maximum activities of the muscles were compared, the patients in the MB group showed a significant higher maximum peak activity (p<0.05) of the Vastus Medialis (VM), Vastus Lateralis (VL) and Semitendinosus (ST) during step-up than the patients in the PS group. Also the instance of activation of the Vastus Medialis and the Vastus Lateralis was significant earlier in the MB group compared to the PS group. Since the differences between the PS and the MB group did not only show an increase of muscle activity but also an earlier activation of the flexor muscles, this may express compensation by coordination. Rehabilitation programs for RA patients should include besides muscle strength training, elements of muscle-coordination training.