Do Patients Achieve Normal Gait Patterns 3 Years After Total Knee Arthroplasty?

Abstract

STUDY DESIGN Longitudinal cross-sectional study. BACKGROUND In the early stages after total knee arthroplasty (TKA), quadriceps strength of the operated limb decreases and is substantially less than that of the nonoperated limb. This asymmetry in strength is related to asymmetrical movement patterns that increase reliance on the nonoperated limb. Over time, quadriceps strength in the operated limb increases but remains less than that in age-matched controls without knee pathology, whereas the quadriceps strength in the nonoperated limb gradually decreases. The purpose of this study was to investigate the changes in quadriceps strength and function of both limbs up to 3 years after TKA and to evaluate change in interlimb kinematic and kinetic parameters over time compared to that in age-matched individuals without knee pathology. METHODS Fourteen individuals after TKA and 14 healthy individuals matched for age, weight, height, and sex participated in the study. Outcome measures included kinematics, kinetics, quadriceps strength, and functional performance. RESULTS In participants who underwent TKA, quadriceps strength was significantly different between limbs at 3 months and 1 year after TKA, but not at 3 years after TKA. In this group, there was also a significant improvement in self-reported function between 3 months and 1 year after TKA, but a significant decrease between years 1 and 3 for the physical component summary score of the Medical Outcomes Study 36-Item Short-Form Health Survey. In the TKA group, there were few interlimb differences in joint kinematics and kinetics 3 years after TKA, which may be attributed to a combination of worsening in the nonoperated limb, as well as improvement in the operated limb. Differences between participants without knee pathology and those 3 years after TKA still existed for kinematic, kinetic, and spatiotemporal variables. CONCLUSION As interlimb differences in quadriceps strength decrease after TKA, there are concomitant symmetrical improvements in temporospatial and kinetic gait parameters. The symmetry 3 years after TKA in quadriceps strength is primarily the result of progressive weakness in the nonoperated limb.

Effects of Weight-Bearing Biofeedback Training on Functional Movement Patterns Following Total Knee Arthroplasty: A Randomized Controlled Trial

“…In contrast, it has been shown previously that individuals post-TKA have significantly less WB during gait on the surgical limb compared to the non-surgical limb (3 months after surgery) and that symmetry improves by 3 years after surgery. 31 With our study sample, the WBRs indicated a high amount of symmetry pre-op, creating a ceiling effect for the amount of change that could occur with intervention. It is evident from our data that although a sub-population of patients have significant WB asymmetry before and early after unilateral TKA, 4, 6, 8, 31 asymmetrical WBR does not characterize all patients.…”

“…31 With our study sample, the WBRs indicated a high amount of symmetry pre-op, creating a ceiling effect for the amount of change that could occur with intervention. It is evident from our data that although a sub-population of patients have significant WB asymmetry before and early after unilateral TKA, 4, 6, 8, 31 asymmetrical WBR does not characterize all patients. Other measures of movement pattern may be superior to WBR for capturing changes in movement quality before and after TKA.…”

“…4, 13, 22, 31 Such asymmetrical WB and lower limb joint mechanics following TKA are associated with poor physical function outcomes 3, 24, 30 and are linked to weakness in the quadriceps, which is a key muscle related to physical function following TKA. 22, 30 Decreased surgical limb WB during functional activity may also be linked to long-term problems following unilateral TKA, including functional limitations and contralateral knee and hip joint pain.…”

Magnitude of Deformity Correction May Influence Recovery of Quadriceps Strength After Total Knee Arthroplasty

“…[5–7] Failure to resolve limitations in quadriceps strength in the early post-operative period can result in residual deficits impacting physical function more than one year following the operative procedure. [5, 7, 8] Interestingly, the relationship between the magnitude of surgical deformity correction and quadriceps strength has yet to be fully elucidated. [9, 10] Previous studies, including those examining the use of computer assisted techniques, have been primarily limited to self-reported outcomes, and fail to capture meaningful declines in quadriceps strength likely to impact function during the early postoperative period.…”

Whole Body Gait Function during Stair Ascending and Level Walking in Patients Following Total Knee Arthroplasty

“…Hence, there are different possible gait adaptations to TKA which are likely not limited to the lower extremity but also include changes in upper body kinematics. However, most studies have focused on lower body kinematics and kinetics and frontal knee moments in people with knee osteoarthritis or patients after TKA [13][14][15]. To the best of our knowledge comprehensive information on ambulatory changes including joint kinetics and joint kinematics of the lower and upper body in patients with good physical function after TKA during walking and stair ascending is lacking.…”