Correlation between objective gait parameters and subjective score measurements before and after total knee arthroplasty

The absence of uniformity, the use of different terminologies, and the diversity of methods used to translate numerical data into clinical outcomes have been described as potential problems when dealing with clinical knee scores for total knee arthroplasty (TKA). Gait analysis is believed to provide more objective parameters. The aim of the present study was to obtain information about the correlation between the outcome in terms of locomotion and the clinical knee score after TKA. Thirty consecutive patients awaiting TKA were involved in the study. One day prior to surgery and 3 months postoperatively, data pertaining to the Hospital for Special Surgery Score (HSS) and the Knee Society Score (KSS) (subgroups 'pain', 'knee', 'function' and 'total sum') were analyzed for correlations with kinematic and temporospatial parameters of gait analysis. At a significance-level of p相似文献   

全膝关节置换术后早期步态与预后功能的相关性分析

目的探讨全膝关节置换(total knee arthroplasty, TKA)术后14 d步态参数与术后3个月膝关节功能和生活质量的相关性。方法采用三维步态系统分析18名患者TKA术后14 d患侧步行特征,运用WOMAC和SF-36评价量表评估患者TKA术后3个月的膝关节功能指数及生活质量并分析其相关性。结果 TKA术后14 d,术侧单支撑时间和摆动期膝关节屈角峰值均显著小于健侧,术侧站立中期膝关节屈角和膝外翻角均显著大于健侧;步行过程中,术侧的时空参数指标与WOMAC评分存在中度负相关,膝屈角峰值、站立中期膝屈角及外翻角与WOMAC评分存在高度相关性;除步长、步速外,其余步态参数指标均与SF-36生活质量评分具有显著相关性。其中,单支撑时间和膝关节屈角峰值具有高度正相关,站立中期膝屈角及外翻角具有中度负相关。结论术后早期(14 d)步态分析结果中术侧单支撑时间、站立中期膝关节屈角、膝外翻角及摆动期膝关节屈角峰值可以作为判断TKA手术预后膝关节功能及生活质量康复疗效的有效指标。     

Clinical and objective gait outcomes remained stable seven years after total knee arthroplasty: A prospective longitudinal study of 28 patients

BackgroundThere is a paucity of data on mid to long-term gait outcomes after total knee arthroplasty. The aims of this longitudinal study were: to assess the evolution of both clinical and gait outcomes before and up to seven years after primary total knee arthroplasty (TKA) in a cohort of patients with knee osteoarthritis.MethodsThis study included 28 patients evaluated before and up to seven years after primary TKA with both gait analysis and patient reported outcomes; of these, 20 patients were evaluated one year after surgery as well. Kinematic outcomes during gait (gait velocity, dimensionless gait veolicity, maximal knee flexion and knee range of motion), pain relief, Western Ontario and MacMaster Osteoarthritis Index (WOMAC), quality of life and patient satisfaction were assessed and compared at each visit with the paired Wilcoxon signed rank test (p < 0.05).ResultsThe significant improvement achieved at one year after TKA was stable up to seven years after surgery, with all clinical and kinematic outcomes unchanged, except for gait velocity, with a significant decrease over time (1.3 (1.1–1.4) m/s one year after TKA versus 1.0 (0.9–1.1) m/s, p < 0.05 up to seven years after).ConclusionPatients with knee osteoarthritis significantly improve their clinical and kinematic outcomes at one year postoperatively and maintain the gain up to seven years after primary TKA, except for gait velocity which decreases over time, most likely along with ageing.     

Relationships between early postoperative gait biomechanical factors and patient-reported outcome measures 6 months after total knee arthroplasty

BackgroundThis study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated.MethodsTwenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined.ResultsThe maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores.ConclusionThe early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.     

Relationship between leg extensor muscle strength and knee joint loading during gait before and after total knee arthroplasty

ObjectiveThe aim of the present study was to evaluate an isometric maximal voluntary contraction (MVC) force of the leg extensor muscles and its relationship with knee joint loading during gait prior and after total knee arthroplasty (TKA).MethodsCustom-made dynamometer was used to assess an isometric MVC force of the leg extensor muscles and 3-D motion analysis system was used to evaluate the knee joint loading during gait in 13 female patients (aged 49–68 years) with knee osteoarthritis. Patients were evaluated one day before, and three and six months following TKA in the operated and non-operated leg.ResultsSix months after TKA, MVC force of the leg extensor muscles for the operated leg did not differ significantly as compared to the preoperative level, whereas it remained significantly lower for the non-operated leg and controls. The knee flexion moment and the knee joint power during mid stance of gait was improved six months after TKA, remaining significantly lowered compared with controls. Negative moderate correlation between leg extensor muscles strength and knee joint loading for the operated leg during mid stance was noted three months after TKA.ConclusionsThe correlation analysis indicates that due to weak leg extensor muscles, an excessive load is applied to knee joint during mid stance of gait in patients, whereas in healthy subjects stronger knee-surrounding muscles provide stronger knee joint loading during gait.Level of Evidence: III (correlational study)     

Optimizing patellofemoral arthroplasty

Patellofemoral arthroplasty (PFA) has been an option for patients with symptomatic patellofemoral osteoarthritis since the 1950's. Many of the early failures resulted from a combination of implant design and surgeon technique. The goal of this overview is not to review the history of PFA, but rather to explore options for surgeons to optimize long-term outcomes and improve patient knee function, while highlighting the differing techniques required in PFA with those routinely adopted in total knee arthroplasty (TKA).     

Gait analysis: Comparative evaluation of conventional total knee replacement and modular distal femoral megaprosthesis

BackgroundGait alterations have been studied with computer-assisted gait analysis after megaprosthetic replacement for tumors around the knee. It has never been proven that megaprostheses affects gait more than total knee arthroplasty (TKA); this study aims to compare via gait analysis patients who underwent megaprosthesis with patients with TKA.MethodsWe analyzed 26 patients with a megaprosthetic replacement of the distal femur and 21 patients with a standard TKA. For each subject computerized gait analysis was performed. Range of motion (ROM) of the knee was recorded, Quality of Life and functional evaluation in the oncologic group were assessed with the Musculoskeletal Tumor Society (MSTS) questionnaire, while Short Form-36 (SF-36) scores were calculated for both groups.ResultsAll patients walked slower than healthy people (P < 0.05). Gait analysis showed a lower cadence than in the healthy population but no significant difference between the two groups. A longer swing and a shorter stance phase were detected in the megaprosthetic sample. The osteoarthritis group showed greater flexion during the phase of loading response, even if this was lower than the contralateral limb or healthy population. There was a statically significant difference between the healthy limb and the operated one in both groups regarding ROM, but no significant difference was registered between the two implants. MSTS score and most of SF-36 parameters showed no significant differences compared with literature data.ConclusionsGait analysis shows little discrepancy between the two groups; gait pattern abnormalities do not affect patients with a megaprosthetic replacement more significantly than patients undergoing TKA.     

Gait and functional status analysis before and after total knee arthroplasty

Background

Among the procedures for severe gonarthrosis, total knee arthroplasty (TKA) is considered a successful method patient satisfaction and functional improvement; however, TKA is commonly associated with incompletely recovered gait function. The aim of this study was to evaluate the influence of TKA and physiotherapy programmes on gait features and patient-reported functional status and the relationship between them, leading to broader knowledge of the origins of long-term gait disturbances.

骨水泥型与非骨水泥型全膝关节置换后的步态差异

背景：全膝关节置换已经被证明是一种有效治疗膝骨性关节炎的方法,但是不同类型的全膝关节置换假体固定方式术后所产生的膝关节下肢生物力学差异至今仍不明确。 目的：通过三维步态分析骨水泥固定和非骨水泥固定两种不同的全膝关节置换术后患者的膝关节生物力学差异。 方法：分别选取骨水泥型全膝关节置换以及非骨水泥型全膝关节置换患者各16例,通过测力台以及三维步态分析系统比较2组患者术前以及术后3个月的膝关节生物力学变化并进行对比。 结果与结论：与手术前相比两组患者术后步速及步长均明显增加,支撑相在整个步态周期中的百分比明显减小, 膝关节屈在支撑相及摆动相中最大屈曲角度均明显增加,膝关节外翻角度增加。两种患者术后膝关节内翻角度以及膝关节内收力矩均明显减小。提示,骨水泥型与非骨水泥型全膝关节置换术均能有效改善膝骨性关节炎患者的步行能力以及下肢关节功能,两者间未见明显生物力学差异。     

Short-term functional advantages after medial unicompartmental versus total knee arthroplasty

Background

There are many uncertainties about the advantages and disadvantages of using unicompartmental (UKA) versus total knee arthroplasty (TKA) to treat patients with knee osteoarthritis. It is important to have sufficient early postoperative quadriceps strength for long-term, self-reported and gait-related outcomes after knee arthroplasty, but very limited comparative data exist regarding UKA and TKA patients.

Which is more important after total knee arthroplasty: Local inflammatory response or systemic inflammatory response?

We aimed to determine the relationship between functional recovery after knee arthroplasty and systemic and local inflammatory responses. A prospective, clinical study of thirty patients who had osteoarthritis was conducted. After the total knee arthroplasty (TKA), intraarticular IL-6 levels, serum IL-6 levels and serum CRP levels were measured. The primary outcome measures for functional recovery after TKA were the the Knee Society Score (KSS) and Western Ontario and McMaster Universities Index (WOMAC). All patients were examined preoperatively and at 4, 8 and 24 weeks postoperatively. The mean postoperative intraarticular IL-6 level was 218355.1 pg/ml, the mean postoperative serum CRP level was 109.9 mg/L and the mean postoperative serum IL-6 level was 219.0 pg/ml. Preoperative and 4-, 8- and 24-week postoperative KSS and WOMAC scores were evaluated. Significant correlations were found between intraarticular IL-6 concentrations and KSS and WOMAC scores at the first month according to the Pearson correlation test, but no correlations were found between serum IL-6 and CRP levels and KSS and WOMAC scores. The local inflammatory response is more important than the systemic response for early postoperative functional recovery. After TKA, control of local inflammation is much more important than control of systemic inflammation.     

髌周去神经化预防全膝关节置换术后膝前疼痛

目的　依据髌周解剖学特点，探讨全膝关节置换术（total knee arthroplasty，TKA）中应用髌周电灼去神经化的临床效果。 方法　纳入82名诊断为骨性关节炎的患者（91膝），予行双侧或单侧不置换髌骨的TKA，按随机对照原则将病人分为两组，共有41名实验组患者（45膝）在TKA中接受了髌周去神经化处理，41名对照组患者（46膝）未做该处理。手术主刀为同一骨科医师，均使用相同的膝关节假体系统。主要评价项目包括膝关节KSS评分、Western Ontario and McMaster Universities（WOMAC）、Feller髌骨评分及VAS评分。 结果　82名患者术后均获随访，平均随访时间为12个月，两组病人的膝关节KSS评分、WOMAC、Feller髌骨评分及VAS评分均无显著统计学差异（P>0.05）。 结论　在TKA中行髌周电灼去神经化，不能显著改善病人的预后。     

Usefulness of gait parameters obtained from inertial sensors attached to the lower trunk and foot for assessment of gait performance in the early postoperative period after total knee arthroplasty

BackgroundThis study was performed to (i) compare gait parameters obtained from inertial sensors attached to the lower trunk and foot between patients in the early postoperative period after total knee arthroplasty (TKA) and healthy age- and sex-matched controls and (ii) elucidate the association between the gait parameters and patient-reported outcome measures (PROMs).MethodThe gait performance of 19 patients who had undergone TKA was assessed using inertial sensors and PROMs obtained from the Knee Injury and Osteoarthritis Outcome Score (KOOS) 1 week before hospital discharge. The patients walked along a 15-m walkway and we calculated the following gait parameters: walking speed, coefficient of variation (CV) of stride time, unbiased autocorrelation coefficient (AC), harmonic ratio (HR), and symmetry index (SI). The same gait parameter data from 19 age- and sex-matched healthy adults (controls) were obtained from our past study.ResultsThe TKA group demonstrated slower walking speed, larger CV of stride time, lower HR in all three directions, lower AC in the vertical direction, and higher SI in the vertical direction than the healthy control group (all p < 0.05). Correlation analysis revealed that the SI in the anteroposterior direction was significantly correlated with the KOOS symptoms subscore and ADL subscore (p < 0.05).ConclusionsPatients in the early postoperative period after TKA exhibited worse gait performance as assessed by inertial sensors compared with healthy controls. Gait symmetry was correlated with PROMs. These results indicate the usefulness of assessing gait parameters after TKA.     

Stress fracture of the first metatarsal after total knee arthroplasty: Two case reports using gait analysis

Stress fractures after total knee arthroplasty (TKA) occur mainly in patients with considerable deformity of the knee. In addition, the majority of these fractures after TKA involve the hip joint. We present two cases of stress fractures of the first metatarsal after TKA in patients with severe varus deformity. Correction of leg alignment and pain reduction obtained by TKA lead to stress fracture of the bone. Gait analysis was carried out for both cases in order to clarify the gait characteristics of the stress fracture. As a result, side-to-side differences of the distance between first metatarsal and foot center of pressure in the coronal plane were observed using gait analysis in these patients. Fortunately, conservative treatment was successful for these patients. Stress fractures should be considered when a patient who had a considerable severe deformity of the knee preoperatively complains of foot pain on the affected side. Contrary to stress fractures at the hip joint, patients with the fracture of the first metatarsal can be treated without surgery.     

全膝关节置换治疗氟骨症所致的膝关节损害*

背景：地方性氟骨症膝关节损害是一个复杂的慢性全身性疾病,可造成膝关节骨周,骨质的损害。 目的：观察人工全膝关节置换治疗地方性氟骨症所致的膝关节损害的临床疗效。 方法：纳入2010-03/2011-10依据地方性流行病学、氟斑牙、临床表现及影像学检查确诊由氟骨症所致的膝关节损害患者9例,均行双侧人工全膝关节置换,于置换前及本次随访时根据美国特种外科医院膝关节评分系统进行临床疗效评估。 结果与结论：膝关节置换后,美国特种外科医院膝关节评分结果显示优5例,良3例,可1例。患者治疗后在疼痛、功能以及关节活动度等方面均明显改善。说明人工全膝关节置换是治疗地方性氟骨症所致的膝关节损害的有效方法。 关键词：氟骨症;膝关节损害;膝关节置换;疗效;植入体 doi:10.3969/j.issn.1673-8225.2012.09.009     

全膝关节置换术后疗效评分系统的研究进展

全膝关节置换术是当前治疗各种严重膝关节疾病最有效的方法,能有效缓解膝关节疼痛,改善膝关节功能,提高患者满意度。临床医生常通过以医生为主的评分量表和病人报告的评分量表来评价膝关节置换术的疗效。本文旨在综合临床上运用最多及最新的评分量表,对膝关节置换术后的疗效评分系统进展进行综述。     

Preoperative proprioceptive training in patients with total knee arthroplasty

Proprioceptive deficiencies due to osteoarthritis and arthroplasty have been repeatedly reported. Proprioceptive training, which leads to an economisation of movements and supports energy-saving movement patterns, has become popular in athletes, but not in rehabilitation yet. The aim of this randomised phase IIb study was to evaluate whether preoperative proprioceptive training would influence postoperative balance and function in activities of daily life in patients undergoing total knee arthroplasty. Subjects with severe osteoarthritis of the knee scheduled for TKA were randomised to either a control group (CG) or a training group (TG). All patients were examined 6 weeks before and 6 weeks after TKA, patients of the TG also one day before surgery, i.e. after six weeks of preoperative proprioceptive training, in order to evaluate the influence of training without TKA. Evaluation included balance assessment using the Biodex Stability System, as well as measurements of gait speed and clinical outcome using the WOMAC and Knee Society Score. As opposed to the CG, stance stability improved significantly in the TG (Biodex OSI (p = 0.045), APSI (p = 0.029)) 6 weeks after TKA. There was a significant improvement in KSS, WOMAC pain and stiffness in both groups after TKA. Preoperative proprioceptive training in patients undergoing TKA resulted in improved standing balance, but no difference in clinical outcome was observed between the two groups.     

Automated detection & classification of knee arthroplasty using deep learning

BackgroundPreoperative identification of knee arthroplasty is important for planning revision surgery. However, up to 10% of implants are not identified prior to surgery. The purposes of this study were to develop and test the performance of a deep learning system (DLS) for the automated radiographic 1) identification of the presence or absence of a total knee arthroplasty (TKA); 2) classification of TKA vs. unicompartmental knee arthroplasty (UKA); and 3) differentiation between two different primary TKA models.MethodWe collected 237 anteroposterior (AP) knee radiographs with equal proportions of native knees, TKA, and UKA and 274 AP knee radiographs with equal proportions of two TKA models. Data augmentation was used to increase the number of images for deep convolutional neural network (DCNN) training. A DLS based on DCNNs was trained on these images. Receiver operating characteristic (ROC) curves with area under the curve (AUC) were generated. Heatmaps were created using class activation mapping (CAM) to identify image features most important for DCNN decision-making.ResultsDCNNs trained to detect TKA and distinguish between TKA and UKA both achieved AUC of 1. Heatmaps demonstrated appropriate emphasis of arthroplasty components in decision-making. The DCNN trained to distinguish between the two TKA models achieved AUC of 1. Heatmaps showed emphasis of specific unique features of the TKA model designs, such as the femoral component anterior flange shape.ConclusionsDCNNs can accurately identify presence of TKA and distinguish between specific arthroplasty designs. This proof-of-concept could be applied towards identifying other prosthesis models and prosthesis-related complications.     

Gait analysis comparison of cruciate retaining and substituting TKA following PCL sacrifice

The role of the posterior cruciate ligament (PCL) remains controversial in total knee arthroplasty (TKA), with some surgeons who believe in PCL sacrifice and substitution and others who believe in PCL preservation for stability. Manufacturers have developed both cruciate-substituting/posterior stabilized (PS) implants typically used when the ligament is sacrificed and cruciate retaining (CR) implants designed for ligament preservation. However, studies demonstrate excellent clinical results with CR implants despite PCL sacrifice. This study sought to determine functional stability differences between PS and CR TKAs following PCL sacrifice. Eighteen (9 matched pairs) subjects with either a PS or CR TKA and sacrificed PCL and a normal contralateral knee were subjected to physical exam and gait analysis (walking, stair ascent and descent) using a staircase model, passive reflective arrays and an optoelectric system. No differences were detected between the two groups among any of the measured parameters (knee flexion angle, knee flexion moment, knee power absorption, pelvic tilt). PCL sacrifice in a well-balanced cruciate retaining TKA did not result in instability during stair descent based on gait parameters. The decision to use a posterior stabilized design when faced with an incompetent PCL intraoperatively should be based on factors other than anticipated instability.     

Unicondylar knee arthroplasty in the UK National Health Service: An analysis of candidacy, outcome and cost efficacy

The viability of unicondylar knee arthroplasty (UKA) as a stand-alone or temporising option for the management of gonarthrosis is a topic of considerable contention. Despite recent advances in prosthesis design and surgical technique, as well as mounting evidence of long-term survivorship, UKA remains infrequently used, accounting for just 8–15% of all knee arthroplasties. Instead this group is more typically managed using total knee arthroplasty (TKA). For UKA to warrant increased usage the candidacy for UKA must be prevalent, the outcome must be equivalent or superior to that of TKA, and the costs should be comparatively low. Here we address three issues regarding UKA: 1) a prospective assessment of the proportion of knees needing arthroplasty that are candidates for UKA; 2) retrospective outcome measures comparing TKA, UKA and controls; and 3) an estimation of the difference in costs between TKA and UKA from a hospital perspective. We show in a series of 200 knees that candidacy for UKA is widespread; representing 47.6% of knees. Furthermore, we also show for the first time, that not only is UKA functionally superior to TKA (based on Total Knee Questionnaire (TKQ) scores), but scores in medial and lateral UKA knees do not differ significantly from normal, non-operative age- and sex-matched knees (t = 1.14 [38], p = 0.163; and t = 1.16 [38], p = 0.255 respectively). Finally, we report that UKA offers a substantial cost saving over TKA (£1761 per knee) indicating that UKA should be considered the primary treatment option for unicompartmental knee arthritis.