Slow gait speed after bilateral total knee arthroplasty is associated with suboptimal improvement of knee biomechanics

Ro, Du Hyun; Han, Hyuck; Lee, Dong Yeon; Kim, Seong Hwan; Kwak, Yoon Ho; Lee, Myung Chul

doi:10.1007/s00167-017-4682-8

Cited by 32 publications

(20 citation statements)

References 49 publications

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“…Similarly to the findings of other studies, the second PC of the knee flexion angle was a better discriminator of OA than PC1, despite accounting for only 24% of the total variance [17,23].…”

Section: Discussionsupporting

confidence: 85%

“…Longitudinal studies adopting 3DGA techniques have identified a number of abnormal biomechanical parameters which do not recover following TKR surgery [6,8,17,18,[9][10][11][12][13][14][15][16]. Of these studies, many do not include biomechanical parameters of the hip and ankle [6,[12][13][14][15][16], and/or exclude parameters within the frontal [6,[14][15][16][17] or transverse [6,8,17,[9][10][11][12][13][14][15][16] plane.…”

Section: Introductionmentioning

confidence: 99%

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Which osteoarthritic gait features recover following Total Knee Replacement surgery?

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Whatling

Wilson

et al. 2018

Preprint

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299]Background Gait analysis can be used to measure variations in joint function in patients with knee osteoarthritis (OA), and is useful when observing longitudinal biomechanical changes following Total Knee Replacement (TKR) surgery. The Cardiff Classifier is an objective classification tool applied previously to examine the extent of biomechanical recovery following TKR. In this study, it is further developed to reveal the salient features that contribute to recovery towards healthy function. MethodsGait analysis was performed on 30 patients before and after TKR surgery, and 30 healthy controls. Median TKR follow-up time was 13 months. The combined application of principal component analysis (PCA) and the Cardiff Classifier defined 18 biomechanical features that discriminated OA from healthy gait. Statistical analysis tested whether these features were affected by TKR surgery and, if so, whether they recovered to values found for the controls. ResultsThe Cardiff Classifier successfully discriminated between OA and healthy gait in all 60 cases.Of the 18 discriminatory features, only six (33%) were significantly affected by surgery, including features in all three planes of the ground reaction force (p<0.001), ankle dorsiflexion moment (p<0.001), hip adduction moment (p=0.003), and transverse hip angle (p=0.007). All but two (89%) of these features remained significantly different to those of the control group after surgery. ConclusionsThis approach was able to discriminate gait biomechanics associated with knee OA. The ground reaction force provided the strongest discriminatory features. Despite increased gait velocity and improvements in self-reported pain and function, which would normally be clinical indicators of recovery, the majority of features were not affected by TKR surgery. This TKR cohort retained pre-operative gait patterns; reduced sagittal hip and knee moments, decreased knee flexion, increased hip flexion, and reduced hip adduction. The changes that were associated with surgery were predominantly found at the ankle and hip, rather than at the knee.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Which osteoarthritic gait features recover following Total Knee Replacement surgery?

Biggs

Whatling

Wilson

et al. 2018

Preprint

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“…Knee OA patients have reduced range of motion (ROM) and increased ground reaction force [4, 5]. Stride length and walking speed are decreased in OA [6]. Patients attempt to reduce pain by minimizing the impact on their knees [4, 5].…”

Section: Introductionmentioning

confidence: 99%

Effects of Knee Osteoarthritis on Hip and Ankle Gait Mechanics

Lee

et al. 2019

Advances in Orthopedics

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Introduction. Knee osteoarthritis (OA) can affect the hip and ankle joints, as these three joints operate as a kinetic/kinematic chain while walking. Purpose. This study was performed to compare (1) hip and ankle joint gait mechanics between knee OA and control groups and (2) to investigate the effects of knee gait mechanics on the ipsilateral hip and ankle joint. Methods. The study group included 89 patients with end-stage knee OA and 42 age- and sex-matched controls without knee pain or OA. Kinetic and kinematic parameters were evaluated using a commercial optoelectric gait analysis system. Range of motion (ROM) during gait, coronal motion arc, and peak joint moment of hip, knee, and ankle joints were investigated. Results. Ankle varus moment was 50% higher in the OA group (p=0.005) and was associated with higher knee adduction moment (p<0.001). The ROM of the hip and ankle joints were significantly smaller in the OA group and were associated with limited ROM of the knee joint (both p<0.001). The coronal motion arc of the hip was smaller in the OA group and was also associated with limited motion arc of the knee (p<0.001). Conclusions. Knee OA has a negative effect on the ROM, coronal motion arc, and joint moment of the ankle joint and hip joint. As knee OA is associated with increased moment of the ankle joint, attention should be paid to the ankle joint when treating patients with knee OA.

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“…Compared with the results regarding knee function during the first days and weeks after surgery, the results regarding basic mobility over a longer period may be even more important. In one other study, it was reported that walking speed was impaired 2 years after TKA [22]. However, the issue of mobility has been investigated in few studies of tourniquet use and only indirectly by the use of self-report [11, 14, 17, 18, 23].…”

Section: Introductionmentioning

confidence: 99%

A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study

Alexandersson

Wang

Eriksson

2018

Knee Surg Sports Traumatol Arthrosc

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PurposeWhen a tourniquet is used during surgery on the extremities, the pressure applied to the muscles, nerves and blood vessels can cause neuromuscular damage that contributes to postoperative weakness. The hypothesis was that the rehabilitation-related results would be improved if total knee arthroplasty (TKA) is performed without the use of a tourniquet.Methods81 patients with osteoarthritis of the knee who underwent TKA surgery were randomized to surgery with or without tourniquet. Active flexion and extension of the knee, pain by visual analog scale (VAS), swelling by knee circumference, quadriceps function by straight leg raise, and timed up and go (TUG) test results were measured before and up to 3 months after surgery.ResultsANCOVA revealed no between-groups effect for flexion of the knee at day 3 postsurgery. Compared with the tourniquet group, the nontourniquet group experienced elevated pain at 24 h, with a mean difference of 16.6 mm, p = 0.005. The effect on mobility (TUG test) at 3 months was better in the nontourniquet group, with a mean difference of -1.1 s, p = 0.029.ConclusionsThe hypothesis that the rehabilitation-related results would be improved without a tourniquet is not supported by the results. When the results in this study for surgery performed with and without tourniquet are compared, no clear benefit for either procedure was observed, as the more pain exhibited by the nontourniquet group was only evident for a short period and the improved mobility in this group was not at a clinically relevant level.Level of evidenceInconsistent results, Level II.

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Slow gait speed after bilateral total knee arthroplasty is associated with suboptimal improvement of knee biomechanics

Abstract: Retrospective cohort study, Level III.

Cited by 32 publications

References 49 publications

Which osteoarthritic gait features recover following Total Knee Replacement surgery?

Which osteoarthritic gait features recover following Total Knee Replacement surgery?

Effects of Knee Osteoarthritis on Hip and Ankle Gait Mechanics

A small difference in recovery between total knee arthroplasty with and without tourniquet use the first 3 months after surgery: a randomized controlled study

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