Achieving normative quadriceps strength after total knee arthroplasty : associations with satisfaction, function, and
Yoshinori Hiyama1, Ryuichi Sawa1, Moeka Yokoyama1
1Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan.
The Bone & Joint Journal
|March 31, 2026
Summary
Achieving normative quadriceps strength after total knee arthroplasty (TKA) is linked to better patient satisfaction and function. Preoperative and contralateral leg strength significantly influence outcomes, aiding personalized rehabilitation goals.
Area of Science:
- Orthopaedic Surgery
- Rehabilitation Medicine
- Biomedical Engineering
Background:
- Total knee arthroplasty (TKA) aims to restore function, but quadriceps strength deficits are common post-surgery.
- Contralateral limb strength may play a role in achieving functional recovery benchmarks after TKA.
- Individualized goal setting is crucial for optimizing rehabilitation outcomes.
Purpose of the Study:
- To quantify the contribution of contralateral quadriceps strength to achieving a normative strength benchmark one year after TKA.
- To evaluate the association between achieving this benchmark and patient satisfaction and function.
- To develop a nomogram for individualized quadriceps strength goal setting post-TKA.
Main Methods:
- Retrospective cohort study of 1,341 patients (1,475 knees) undergoing primary TKA and 240 knees from a control group.
- Quadriceps strength measured preoperatively and one year postoperatively using a handheld dynamometer, normalized to body weight.
- Generalized estimating equations and nomogram development used to analyze associations and predict strength achievement.
Main Results:
- 45.0% of TKA patients achieved the normative quadriceps strength threshold at one year.
- Achieving this threshold correlated with significantly higher patient satisfaction and functional activity scores.
- Preoperative surgical-side strength and postoperative contralateral strength were key predictors of achieving the benchmark.
Conclusions:
- Quadriceps strength within the range of healthy older adults post-TKA is associated with improved satisfaction and function.
- Contralateral limb strength is a significant factor in post-TKA recovery.
- A validated nomogram offers a practical tool for personalized rehabilitation goal setting after TKA.
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