Comparison of Biomechanical Gait Parameters and Patient-Reported Outcome in Patients After Total Knee Arthroplasty With the Use of Fixed-Bearing Medial Pivot and Multi-radius Design Implants—Retrospective Matched-Cohort Study

Abstract

Background Total knee arthroplasty (TKA) is considered to be highly successful in treatment of end-stage osteoarthritis. There are multiple implant designs available on the market, and it is difficult to point which one is the best. The aim of this study was to compare the clinical and functional outcomes and gait pattern after TKA with the use of fixed-bearing medial pivot (K-Mod) vs multi-radius design (NexGen) implants and to compare them to norms for healthy patients with no osteoarthritis or arthroplasty procedure in anamnesis. Methods A group of 30 patients who received the medial pivot (MP) TKA and 33 patients who received the posterior-stabilized (PS) TKA between May and August of 2018 were included. All surgeries were performed in the level III academic hospital by a single surgeon. Every patient was asked to fulfill the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire preoperatively and 2 years postoperatively. Standard X-ray, biomechanical gait analysis using a motion capture system, and statistical analysis were performed at 2 years postoperatively. Results A total of 28 patients from either MP cohort (93%) or PS (85%) matched-control cohort completed the whole assessment at the final follow-up. There were statistically significant differences in a few gait parameters such as shorter mean step length both in operated and healthy limb, lower mean gait velocity, and lower mean walking cadence than the norm in both MP and PS groups. As to the WOMAC score, there was statistically significant improvement in both groups comparing preoperative and postoperative outcomes. Nevertheless, in the MP group, there was a significantly higher score, indicating worse outcomes, in the stiffness part of the WOMAC score than in the PS group. No significant differences were found between groups during radiological evaluation. Conclusions There were satisfying and promising clinical, radiographic, and patient-reported outcomes in both MP and PS groups with very little difference in relation to norm values. However, both implants failed in fully restoring gait patterns similar to the healthy limb of the same patient.

Comparison between gaits after a medial pivot and posterior stabilized primary total knee arthroplasty: a systematic review of the literature

“…After title and abstract analysis, the full text of 17 potentially included studies was assessed for eligibility against inclusion and exclusion criteria. Nine studies that directly compared the results of gait analysis of MP vs. PS TKA were included in the final analysis [27][28][29][30][31][32][33][34][35]. Supplementary relevant articles were searched through the reference list of included studies.…”

“…Gait analysis was performed in 197 MP TKA (average age, 69.4 ± 3.9 years) and in 192 PS TKA patients (average age, 68.6 ± 4.4). Three studies [23,26,27] performed gait analysis also in a control group involving 40 healthy knees (average age, 36.1 ± 5.7). The average study quality based on MINORS criteria was 14.6 ± 2.6.…”

“…Six studies reported gait spatial-temporal parameters (Table 5) [27,28,30,[32][33][34]. Five studies [28,30,[32][33][34] reported the walking speed.…”

“…Five studies [28,30,[32][33][34] reported the walking speed. Three studies [27,30,34] reported the cadence. Three studies [27,30,34] reported the step length.…”

“…Three studies [27,30,34] reported the cadence. Three studies [27,30,34] reported the step length. One study reported the stride length [32].…”