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BACKGROUND: Some patients with end-stage osteoarthritis of the knee remain unsatisfied after total knee arthroplasty (TKA). We postulated that to increase satisfaction, self-efficacy (SE) for physical activity should receive more attention in rehabilitative intervention, alongside the management of patient expectations, pain, and function. OBJECTIVE: We examined the relative impact of Physical Activity SE on Health-Related Quality of Life (HRQOL) alongside other factors such as pain and physical function which are well-addressed by current interventions. METHODS: One hundred and six first-TKA recipients (15 Male/91 Female, age 73.6 ± 7.2) were evaluated at 3 and 6 months post-operatively using the Medical Outcomes Study 36-Item Health Survey (SF-36v2) for HRQOL, knee extension strength measurement, Timed Up and Go test (TUG), One Leg Standing time test (OLS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain and function, and an instrument for measuring Physical Activity SE among the frail elderly in Japan. RESULTS: Significant improvement over pre-operative values was found at 3 and 6 months in TUG, OLS, WOMAC Pain and Function, and the 8 subscales of the SF-36v2. Factors found to significantly impact SF-36v2 subscale scores at 6 months post-operatively were found to be knee pain, knee function, and SE for physical activity. CONCLUSION: These results support our postulation that interventions to improve SE for physical activity could have comparable impact alongside interventions for knee pain and knee function, on the advancement of HRQOL among TKA recipients.

[Purpose] The purpose of this study was to identify the factors influencing change in life-space mobility after total knee arthroplasty (TKA) in patients with severe knee osteoarthritis (knee OA). [Participants and Methods] Overall, 58 primary unilateral TKA recipients (9 males and 49 females; age ± SD 74.6 ± 6.5 years) were enrolled. We evaluated Life-Space Assessment (LSA) scores, knee extensor strength, Timed Up and Go test (TUG), one-leg standing time (OLS), Western Ontario and McMaster Universities osteoarthritis Index, and physical activity self-efficacy (SE) before surgery and at 3 months post-operation. [Results] Life space mobility significantly expanded 3 months after surgery compared with preoperative baseline. Preoperatively, walking SE and knee extensor muscle strength on the operative side were found to have strong correlation with LSA scores, while stairs SE and knee extensor muscle strength of the operative side were correlated at 3 months post-operation. [Conclusion] These findings suggest that to expand the life-space mobility of TKA recipients, it is important to enhance self-efficacy for general physical activity in addition to strengthening the quadriceps muscles.

Background Fusion surgeries for scoliosis patients are believed to deteriorate sports performance; in particular, forward roll should deteriorate, but no literature is available to substantiate this claim. Hypothesis The extent of postoperative deterioration can vary according to surgery type or curve type. Patients and methods Idiopathic scoliosis patients between 10 and 29 years of age who underwent correction and fusion surgeries at our hospital were included in this study. Forward roll was recorded on video preoperatively and 1-year postoperatively. Performances were evaluated twice on a 10-point scale by two blinded examiners. Preoperative and 1-year postoperative upright spinal radiographs were analyzed for the Lenke classification, number of fused vertebrae, upper and lower instrumented vertebrae, major curve Cobb angle, thoracic kyphosis, lumbar lordosis, and surgical procedures. Results The average age was 16 years. Curve types according to the Lenke classification were: 15, type 1; 5, type 2; 14, type 5; 2, type 6. The mean number of fused vertebrae was 6.9 (3.2 for anterior surgeries and 9.3 for posterior surgeries). The mean preoperative assessment of forward roll was 9.6 points, and the 1-year postoperative assessment was lower at 8.8 points. Cluster analysis classified patients into 3 groups: long fusion with marked performance deterioration (C1), long fusion with minimal deterioration (C2), and short fusion with minimal deterioration (C3). The upper and lower instrumented vertebrae in C1 were more distal than those in C2. Conclusion Patients with thoracic curves were classified into two groups, and patients who underwent surgeries with more distal upper and lower instrumented vertebra levels exhibited lower postoperative performance. However, patients with Lenke 5 curves who underwent anterior surgery showed better preoperative performance than other patients who underwent posterior surgery, showing minimal postoperative deterioration. Level of evidence III; therapeutic study.

Background Fusion surgeries for scoliosis patients are believed to deteriorate sports performance; in particular, forward roll should deteriorate, but no literature is available to substantiate this claim. Hypothesis The extent of postoperative deterioration can vary according to surgery type or curve type. Patients and methods Idiopathic scoliosis patients between 10 and 29 years of age who underwent correction and fusion surgeries at our hospital were included in this study. Forward roll was recorded on video preoperatively and 1-year postoperatively. Performances were evaluated twice on a 10-point scale by two blinded examiners. Preoperative and 1-year postoperative upright spinal radiographs were analyzed for the Lenke classification, number of fused vertebrae, upper and lower instrumented vertebrae, major curve Cobb angle, thoracic kyphosis, lumbar lordosis, and surgical procedures. Results The average age was 16 years. Curve types according to the Lenke classification were: 15, type 1; 5, type 2; 14, type 5; 2, type 6. The mean number of fused vertebrae was 6.9 (3.2 for anterior surgeries and 9.3 for posterior surgeries). The mean preoperative assessment of forward roll was 9.6 points, and the 1-year postoperative assessment was lower at 8.8 points. Cluster analysis classified patients into 3 groups: long fusion with marked performance deterioration (C1), long fusion with minimal deterioration (C2), and short fusion with minimal deterioration (C3). The upper and lower instrumented vertebrae in C1 were more distal than those in C2. Conclusion Patients with thoracic curves were classified into two groups, and patients who underwent surgeries with more distal upper and lower instrumented vertebra levels exhibited lower postoperative performance. However, patients with Lenke 5 curves who underwent anterior surgery showed better preoperative performance than other patients who underwent posterior surgery, showing minimal postoperative deterioration. Level of evidence III;Therapeutic Study.

〔目的〕人工膝関節全置換術（TKA）による回復過程を検討するために，身体機能および健康関連QOL（HRQOL）を調査した．〔対象〕TKA術後リハを実施した変形性膝関節症患者40膝とした．〔方法〕身体機能評価にはTimed Up and Go test（TUG），膝伸展筋力，開眼片脚起立時間を測定し，HRQOL評価には準WOMACとSF-36を用いた．〔結果〕身体機能の全項目において術後3ヶ月で有意に改善した．準WOMACの痛みとSF-36の身体機能，体の痛み，全体的健康感，社会生活機能は術後1ヶ月で有意に改善し，さらに術後3ヶ月で準WOMACの機能も有意に改善した．開眼片脚起立時間を除く身体機能とHRQOLの全項目は，変化量と初期値との間に有意な負の相関を認めた．〔結語〕TKAによりHRQOLは術後1ヶ月で改善し，術後3ヶ月では身体機能が改善することが示唆された．