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Preoperative Predictors of Persistent Impairments During Stair Ascent and Descent After Total Knee Arthroplasty
Joseph A. Zeni, Jr., PT, PhD1; Lynn Snyder-Mackler, PT, ScD, FAPTA1
1 Department of Physical Therapy, University of Delaware, 301 McKinly Laboratory, Newark, DE 19716. E-mail address for J.A. Zeni Jr.: Joseph.Zeni@gmail.com
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institutes for Health (R01HD041055 and P20RR016458). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Physical Therapy, University of Delaware, Newark, Delaware

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 May 01;92(5):1130-1136. doi: 10.2106/JBJS.I.00299
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Although total knee arthroplasty improves functional mobility in persons with end-stage knee osteoarthritis, many subjects have reported continued difficulty with stair ascent and descent after surgery. The purpose of the present study was to determine preoperative predictors of handrail use during stair ascent and descent following primary unilateral total knee arthroplasty.


One hundred and five adults who were scheduled for unilateral total knee arthroplasty participated in the study. Postoperative handrail use during stair ascent or descent was predicted on the basis of preoperative functional measures. Preoperative age, body mass index, knee strength, knee flexion active range of motion, Knee Outcome Survey scores, time to complete a stair-climbing task, and previous handrail use were entered as covariates into a binary logistic regression. Forward logistic regression was performed to determine which preoperative factors best predicted handrail use at three months and two years after surgery. Handrail use in a control group was also evaluated at baseline and at the time of the two-year follow-up.


Prior to surgery, sixty-three of the 105 subjects required a handrail. Two years after surgery, sixty of the 105 subjects required a handrail. In the control group, nineteen of the sixty-four subjects required a handrail at baseline and ten of thirty-one required a handrail at the time of the two-year follow-up. At two years, the preoperative ability to ascend and descend stairs without a handrail was the best predictor of individuals who would not require a handrail after surgery, followed by younger age and greater quadriceps strength. Collectively, these variables correctly predicted the ability of ninety of 105 persons to negotiate stairs without a handrail at two years after surgery (p < 0.001).


Younger, stronger patients who do not use a handrail prior to unilateral total knee arthroplasty can expect the best outcomes in terms of ascending and descending stairs following surgery. This information may provide patients with more realistic expectations after surgery and allow them to make more appropriate discharge plans.

Level of Evidence: 

Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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