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Kluge F, Hannink J, Pasluosta C, Klucken J, Gaßner H, Gelse K, Eskofier BM, Krinner S. Pre-operative sensor-based gait parameters predict functional outcome after total knee arthroplasty. Gait Posture 2018; 66:194-200. [PMID: 30199778 DOI: 10.1016/j.gaitpost.2018.08.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 08/20/2018] [Accepted: 08/22/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the general success of total knee arthroplasty (TKA) regarding patient-reported outcome measures, studies investigating gait function have shown diverse functional outcomes. Mobile sensor-based systems have recently been employed for accurate clinical gait assessments, as they allow a better integration of gait analysis into clinical routines as compared to laboratory based systems. RESEARCH QUESTION In this study, we sought to examine whether an accurate assessment of gait function of knee osteoarthritis patients with respect to surgery outcome evaluation after TKA using a mobile sensor-based gait analysis system is possible. METHODS A foot-worn sensor-based system was used to assess spatio-temporal gait parameters of 24 knee osteoarthritis patients one day before and one year after TKA, and in comparison to matched control participants. Patients were clustered into positive and negative responder groups using a heuristic approach regarding improvements in gait function. Machine learning was used to predict surgery outcome based on pre-operative gait parameters. RESULTS Gait function differed significantly between controls and patients. Patient-reported outcome measures improved significantly after surgery, but no significant global gait parameter difference was observed between pre- and post-operative status. However, the responder groups could be correctly predicted with an accuracy of up to 89% using pre-operative gait parameters. Patients exhibiting high pre-operative gait function were more likely to experience a functional decrease after surgery. Important gait parameters for the discrimination were stride time and stride length. SIGNIFICANCE The early identification of post-surgical functional outcomes of patients is of great importance to better inform patients pre-operatively regarding surgery success and to improve post-surgical management.
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Affiliation(s)
- Felix Kluge
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Carl-Thiersch-Str. 2b, 91052 Erlangen, Germany.
| | - Julius Hannink
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Carl-Thiersch-Str. 2b, 91052 Erlangen, Germany.
| | - Cristian Pasluosta
- Laboratory for Biomedical Microtechnology, Department of Microsystems Engineering, University of Freiburg, 79110 Freiburg, Germany.
| | - Jochen Klucken
- Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Heiko Gaßner
- Molecular Neurology, University Hospital Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Kolja Gelse
- Department of Trauma Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany.
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Carl-Thiersch-Str. 2b, 91052 Erlangen, Germany.
| | - Sebastian Krinner
- Department of Trauma Surgery, University Hospital Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany.
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Bączkowicz D, Skiba G, Czerner M, Majorczyk E. Gait and functional status analysis before and after total knee arthroplasty. Knee 2018; 25:888-896. [PMID: 29941283 DOI: 10.1016/j.knee.2018.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/12/2018] [Accepted: 06/04/2018] [Indexed: 02/02/2023]
Abstract
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. METHODS Walking speed, step length and single support time were analysed by GAITRite system in 60 healthy controls and 21 TKA patients analysed at four time points: one day before and five days after surgery and before and after a three-week rehabilitation (12 and 15 weeks after surgery). Functional status was assessed using the Western Ontario and McMaster Osteoarthritis Index (WOMAC). RESULTS At all time points, the TKA subjects walked significantly slower than the controls, but walking speed continuously increased after surgery. Gait asymmetries were observed in single support time (before surgery) and step length (after surgery). Partial restoration of gait function was observed 12 weeks after surgery and completion of the rehabilitation programme. An indirect correlation between gait velocity and function WOMAC subscores was found. CONCLUSIONS Patients after TKA were characterised by significant improvements in self-reported functionality and progressive reduction of gait abnormalities, probably related to pain reduction. However, at 15 weeks after surgery, patients exhibited step length asymmetry, which could be considered as an effect of habits of three-point crutch gait in the early postoperative period.
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Affiliation(s)
- Dawid Bączkowicz
- Institute of Physiotherapy, Faculty of Physical Education and Physiotherapy, Opole University of Technology, 76 Prószkowska Street, 45-758 Opole, Poland
| | - Grzegorz Skiba
- Opole Rehabilitation Centre, 26 Wyzwolenia Street, 48-317 Korfantów, Poland
| | - Marek Czerner
- Opole Rehabilitation Centre, 26 Wyzwolenia Street, 48-317 Korfantów, Poland
| | - Edyta Majorczyk
- Institute of Physiotherapy, Faculty of Physical Education and Physiotherapy, Opole University of Technology, 76 Prószkowska Street, 45-758 Opole, Poland; Laboratory of Immunogenetics and Tissue Immunology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 12 Rudolfa Weigla Street, 53-114 Wrocław, Poland.
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Friesenbichler B, Item-Glatthorn JF, Wellauer V, von Knoch F, Casartelli NC, Maffiuletti NA. Short-term functional advantages after medial unicompartmental versus total knee arthroplasty. Knee 2018; 25:638-643. [PMID: 29748141 DOI: 10.1016/j.knee.2018.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 03/28/2018] [Accepted: 04/22/2018] [Indexed: 02/02/2023]
Abstract
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. METHODS This study assessed isometric quadriceps strength, spatio-temporal gait parameters (walking speed, step length, single-limb support phase) and self-reported outcomes (pain, function, stiffness) in 18 TKA and 18 UKA patients six months after surgery, as well as in 18 healthy controls. RESULTS Quadriceps strength of TKA, but not of UKA patients, was lower than that of controls (P < 0.05). UKA patients demonstrated better gait function in terms of a longer single-limb support phase than TKA patients (P < 0.01), which agreed with better self-reported pain (P < 0.05), function (P < 0.01) and stiffness (P < 0.05) scores compared to TKA patients. CONCLUSIONS Six months after surgery, UKA patients showed better short-term quadriceps strength and gait function compared to TKA patients, together with less self-reported knee pain and stiffness. Patients eligible for UKA may experience less functional impairments compared to those who require TKA.
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Affiliation(s)
| | | | - Vanessa Wellauer
- Department of Performance Diagnostics, Schulthess Clinic, Zurich, Switzerland
| | | | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland; Laboratory of Exercise and Health, Department of Health Sciences and Technology ETH Zurich, Zurich, Switzerland
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Liu D, Li Y, Cai G, Jia D, Mao J, Meng X, Wang G, He C. [Short-term effectiveness of total knee arthroplasty assisted by three-dimensional printing osteotomy navigation template]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:899-905. [PMID: 30129315 DOI: 10.7507/1002-1892.201802013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the short-term effectiveness of total knee arthroplasty (TKA) assisted by three-dimensional (3D) printing osteotomy navigation template. Methods A retrospective study was performed on 60 patients with osteoarthritis bewteen January 2016 and June 2017. Thirty cases underwent TKA assisted by 3D printing osteotomy navigation template (3D printing group) and 30 cases underwent the conventional TKA (conventional TKA group). There was no significant difference in gender, age, body mass index, surgical side, and disease duration between 2 groups ( P>0.05). The operation time, the pre- and post-operative hemoglobin values, the amount of drainage, the Hospital for Special Surgery (HSS) score and Knee Society Score (KSS) of knee joint before operation and at 3 months after operation were observed. And 6 freedom degrees of knee (the varus and valgus angle, the internal and external rotation angle, the antero-posterior displacement, the proximal-distal displacement, the flexion and extension angle, and the internal and external displacement) before operation and at 3 months after operation were recorded by Opti-Knee (the knee 3D motion analysis system). The values of 2 groups were compared with 30 healthy adults (<60 years). Results The operation time was shorter in 3D printing group than that in conventional TKA group ( t=5.833, P=0.000). The hemoglobin values at 1 and 3 days after operation were higher in 3D printing group than those in conventional TKA group ( P<0.05). The amount of drainage was less in 3D printing group than that in conventional TKA group ( t=5.468, P=0.000). All patients were followed up 6-9 months (mean, 7.3 months). There was no significant difference in pre- and post-operative HSS score and KSS clinical score between 2 groups ( P>0.05). There was no significant difference in preoperative KSS function score between 2 groups ( P>0.05), but the KSS function score of 3D printing group at 3 months after operation was higher than that of conventional TKA group ( P<0.05). Before operation, the varus and valgus angle, the internal and external rotation angle, the antero-posterior displacement, the proximal-distal displacement of 3D printing group and conventional TKA group were larger than that of the healthy adults ( P<0.05); there was no significant difference in the flexion and extension angle and the internal and external displacement between 2 groups and healthy adults ( P>0.05). At 3 months after operation, compared with healthy adults, the varus and valgus angle of conventional TKA group was increased, the flexion and extension angle of conventional TKA group was decreased ( P<0.05); the proximal-distal displacement and the internal and external displacement of 2 groups were decreased ( P<0.05); there was no significant difference in other freedom degrees between groups ( P>0.05). No sign of prosthesis loosening was observed by X-ray examination. Conclusion Compared with the traditional TKA, TKA assisted by the 3D printing osteotomy navigation template had such advantages as shorter operation time, less postoperative blood loss, and well postoperative recovery.
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Affiliation(s)
- Dejian Liu
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Yanlin Li
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032,
| | - Guofeng Cai
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Di Jia
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Jianyu Mao
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Xuhan Meng
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Guoliang Wang
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
| | - Chuan He
- Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P.R.China
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Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1629-1635. [PMID: 29204861 DOI: 10.1007/s00167-017-4788-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Knee adduction moment (KAM) has been recognized as a good clinical surrogate for medial tibiofemoral joint loading and is associated with implant durability after total knee arthroplasty (TKA). This study aimed to examine the effects of joint line obliquity in kinematically aligned TKA (KA-TKA) on KAM during gait. METHODS The study enrolled 21 knees from 18 patients who underwent cylindrical axis reference KA-TKA and a matched group of 21 knees from 18 patients who underwent mechanically aligned (MA)-TKA as controls. Gait analyses were performed the day before TKA and at an overall mean of 2.6 years postoperatively. First peak KAM and variables associated with frontal knee kinetics were determined and compared between groups. RESULTS In KA-TKA, the proximal tibia was resected with 3.4° ± 1.5° of varus in relation to the mechanical axis, and the final femorotibial shaft axis was 176.7° ± 3.8° with KA-TKA and 174.4° ± 3.0° with MA-TKA. KAM was significantly smaller with KA-TKA than with MA-TKA (p < 0.032). Regarding variables affecting KAM, significant differences were evident between the two TKAs for knee adduction angle (p = 0.0021), lever arm (p = 0.028), and Δlever arm (p = 0.0001). CONCLUSIONS In KA-TKA, joint line obliquity reduced peak KAM during gait, despite slight varus limb alignment, and this reduced KAM in KA-TKA can tolerate constitutional varus alignment. In clinical settings, KA-TKA thus represents a promising technical option for patients with large coronal bowing of the shaft carrying a risk of increased KAM after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yasuo Niki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Katsuya Nagai
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Miller S, Agarwal A, Haddon WB, Johnston L, Arnold G, Wang W, Abboud RJ. Comparison of gait kinetics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl 2018; 100:267-274. [PMID: 29484928 PMCID: PMC5958845 DOI: 10.1308/rcsann.2017.0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to compare kinetical data from gait analysis of patients who have undergone total and uni-condylar knee replacement. Materials and methods Thirteen patients with unilateral total knee arthroplasty (TKA) and 13 unicondylar knee arthroplasty (UKA), were included, all performed by the same surgeon more than one year prior. The Vicon gait analysis system was used. Statistical power was calculated using SPSS. Results No significant difference was found in the spatiotemporal parameters of gait and survival years of the knee prosthesis between the two groups. The UKA group was found to have significantly larger moments than the TKA group in knee adduction on the operated side and knee flexion moment on the unoperated side during the loading phase. The maximum and minimum sagittal plane moments of the operated sides in the TKA group were significantly lower than the unoperated side. The difference was most significant at pre-swing. The maximum and minimum moments on the operated sides in the UKA group were significantly lower for the knee flexion and adduction moments when compared with the unoperated side and were most prevalent during the loading phase. Conclusions These results are relevant in terms of prosthesis wear. The TKA knees had smaller magnitude moments than the UKA knees in the sagittal and coronal planes. This could explain the higher revision rates for UKA. In both groups, the non-operated knees had significantly larger moments than the operated knees, which implies that after unilateral knee replacement of either type, the non-operated knee is being put under greater stress.
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Affiliation(s)
- S Miller
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - A Agarwal
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - WB Haddon
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - L Johnston
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - G Arnold
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - W Wang
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - RJ Abboud
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
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Ro DH, Han HS, Kim SH, Kwak YH, Park JY, Lee MC. Baseline varus deformity is associated with increased joint loading and pain of non-operated knee two years after unilateral total knee arthroplasty. Knee 2018; 25:249-255. [PMID: 29548817 DOI: 10.1016/j.knee.2018.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/01/2018] [Accepted: 01/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The goals of this study were (1) to document the gait pattern of patients with unilateral knee osteoarthritis (OA), (2) to determine the knee adduction moment (KAM) changes in the non-operated knee, and (3) to identify the predictors of change in KAM in the non-operated knee. METHODS The study recruited 23 patients with advanced unilateral knee OA. The preoperative Kellgren-Lawrence (KL) grade of the non-operated knee was one or two; non-operated knee pain, rated using a numeric rating scale (NRS), was less than three out of 10 points. We used a commercial gait analysis system to evaluate kinetics and kinematics. Radiological and gait measurements at the two-year follow-up were compared with baseline data. RESULTS The preoperative asymmetrical gait cycle characterized by elongation of the stance phase of the non-operated knee became symmetrical after TKA. The average KAM of the non-operated knee increased (P=0.010) and it was best predicted by the baseline mechanical axis of the non-operated knee. If the baseline mechanical axis was varus four degrees or above (varus group), the average KAM increased by 0.64 (% body weight×height, P=0.015), while for varus less than four degrees (non-varus group), KAM was unchanged. The KL grade was increased in the varus group (P=0.020) but it was unchanged in the non-varus group. Average pain NRS score was also higher (P=0.044) in the varus group. CONCLUSIONS Close follow-up is necessary for patients with a baseline varus deformity of the non-operated knee because of the higher possibility of developing pain, subsequent arthritis and increased joint loading of the non-operated knee. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Du Hyun Ro
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea
| | - Hyuk-Soo Han
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea
| | | | - Yoon-Ho Kwak
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea
| | - Jae-Young Park
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea
| | - Myung Chul Lee
- Seoul National University Hospital, Chongnogu, Seoul, Republic of Korea.
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Benjamin B, Pietrzak JRT, Tahmassebi J, Haddad FS. A functional comparison of medial pivot and condylar knee designs based on patient outcomes and parameters of gait. Bone Joint J 2018; 100-B:76-82. [PMID: 29292344 PMCID: PMC6424433 DOI: 10.1302/0301-620x.100b1.bjj-2017-0605.r1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 07/07/2017] [Indexed: 02/05/2023]
Abstract
Aims The outcome of total knee arthroplasty (TKA) is not always satisfactory.
The purpose of this study was to identify satisfaction and biomechanical
features characterising the gait of patients who had undergone TKA
with either an anatomical single radius design or a medial pivot
design. We hypothesised that the latter would provide superior function. Patients and Methods This is a study of a subset of patients recruited into a prospective
randomised study of a single radius design versus a
medial pivot design, with a minimum follow-up of one year. Outcome
measurements included clinical scores (Knee Society Score (KSS)
and Oxford Knee Score (OKS)) and gait analysis using an instrumented
treadmill. Results There was no statistically significant difference between the
two groups for both the KSS and OKS. There was also no statistical
significance in cadence, walking speed, stride length and stance
time, peak stride, mid support and push-off forces. Conclusion This study corroborates a previous study by the same authors
that showed equally good results in clinical outcome and gait between
the conventional single radius and medial pivot designs under stringent
testing conditions. Cite this article: Bone Joint J 2018;(1 Supple
A)100-B:76–82.
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Affiliation(s)
- B Benjamin
- University College London Hospitals, 235 Euston Road, NW1 2BU, London, UK
| | - J R T Pietrzak
- University College London Hospitals, 235 Euston Road, NW1 2BU, London, UK
| | - J Tahmassebi
- University College London Hospitals, 235 Euston Road, NW1 2BU, London, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK and NIHR University College London Hospitals Biomedical Research Centre, UK
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Bennour S, Ulrich B, Legrand T, Jolles BM, Favre J. A gait retraining system using augmented-reality to modify footprint parameters: Effects on lower-limb sagittal-plane kinematics. J Biomech 2018; 66:26-35. [DOI: 10.1016/j.jbiomech.2017.10.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/31/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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Queen R. Directing clinical care using lower extremity biomechanics in patients with ankle osteoarthritis and ankle arthroplasty. J Orthop Res 2017; 35:2345-2355. [PMID: 28543369 DOI: 10.1002/jor.23609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/12/2017] [Indexed: 02/04/2023]
Abstract
Ankle osteoarthritis is a debilitating disease with approximately 50,000 new cases per year leading to skeletal deformity, severe and recurrent pain, cartilage breakdown, and gait dysfunction limiting patient mobility and well-being. Although many treatments (total ankle arthroplasty [TAA], ankle fusion [arthrodesis], and ankle distraction arthroplasty) relieve pain, it is not clear that these procedures significantly improve patient mobility. The goal of the research presented here is to summarize what is presently known about lower extremity gait mechanics and outcomes and to quantify the impact of ankle osteoarthritis and TAA have on these measures using an explicitly holistic and mechanistic approach. Our recent studies have explored physical performance and energy recovery and revealed unexpected patterns and sequelae to treatment including incomplete restoration of gait function. These studies demonstrated for the first time the extreme levels and range of gait and balance dysfunction present in ankle osteoarthritis patients as well as quantifying the ways in which the affected joint alters movement and loading patterns not just in the painful joint, but throughout both the ipsilateral and contralateral lower extremity. Through this work, we determined that relieving pain alone through TAA is not enough to restore normal walking mechanics and balance due to underlying causes including limited ankle range of motion and balance deficits leading to long-term disability despite treatment. The results indicate the need to consider additional therapeutic interventions aimed at restoring balance, ankle range of motion, and movement symmetry in order to improve long-term health and function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2345-2355, 2017.
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Affiliation(s)
- Robin Queen
- Kevin Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, 230 Norris Hall, Blacksburg, Virginia, 24061
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Method for Estimating Three-Dimensional Knee Rotations Using Two Inertial Measurement Units: Validation with a Coordinate Measurement Machine. SENSORS 2017; 17:s17091970. [PMID: 28846613 PMCID: PMC5620966 DOI: 10.3390/s17091970] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 11/16/2022]
Abstract
Three-dimensional rotations across the human knee serve as important markers of knee health and performance in multiple contexts including human mobility, worker safety and health, athletic performance, and warfighter performance. While knee rotations can be estimated using optical motion capture, that method is largely limited to the laboratory and small capture volumes. These limitations may be overcome by deploying wearable inertial measurement units (IMUs). The objective of this study is to present a new IMU-based method for estimating 3D knee rotations and to benchmark the accuracy of the results using an instrumented mechanical linkage. The method employs data from shank- and thigh-mounted IMUs and a vector constraint for the medial-lateral axis of the knee during periods when the knee joint functions predominantly as a hinge. The method is carefully validated using data from high precision optical encoders in a mechanism that replicates 3D knee rotations spanning (1) pure flexion/extension, (2) pure internal/external rotation, (3) pure abduction/adduction, and (4) combinations of all three rotations. Regardless of the movement type, the IMU-derived estimates of 3D knee rotations replicate the truth data with high confidence (RMS error < 4 ° and correlation coefficient r ≥ 0.94 ).
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van de Bunt F, Emanuel KS, Wijffels T, Kooren PN, Kingma I, Smit TH. A novel physiological testing device to study knee biomechanics in vitro. Knee 2017; 24:718-725. [PMID: 28462799 DOI: 10.1016/j.knee.2017.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/23/2017] [Accepted: 04/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND To properly study knee kinetics, kinematics and the effects of injury and surgical treatment in vitro, the knee should be constrained as little as possible, while imposing physiological loads. A novel dynamic biomechanical knee system (BKS) is presented here. The aim of this study was to test the feasibility and reproducibility of the system and demonstrate its features with an Anterior Cruciate Ligament (ACL) lesion model. METHODS Six goat knees were used in the current study. Flexion and extension simulating gait was imposed by a servo-motor, while normal joint load was applied by two artificial muscles. Intra-class correlation coefficients (ICCs) were assessed for inter-test measures, while paired t-tests were performed for comparison between intact knees and knees with ACL-lesion. RESULTS The ICC's for inter-test measures based on all six goat knees were excellent: varus/valgus: ICC=0.93; rotation: ICC=0.94 (all p<0.01), and translation in frontal (x)-, side (y)- and upward (z)-direction (ICC=0.90, 0.88 & 0.94) (all p<0.01). A significant increase in joint center movement was found in knees after creating an ACL-lesion (p=0.018): translation increased more than two-fold in frontal (p=0.016), side (p=0.004) and upward (p=0.018) direction. CONCLUSIONS Five degrees of motion were reproducibly assessed in the intact joint, suggesting that the goat knee may find its natural pathway when loaded in the BKS. The novel five-degrees-of-freedom knee system allows a detailed study of the effect of a diversity of defects and surgical treatments on knee biomechanics under physiological loading conditions.
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Affiliation(s)
- Fabian van de Bunt
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - Kaj S Emanuel
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.
| | - Thomas Wijffels
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Peter N Kooren
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Idsart Kingma
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.
| | - Theodoor H Smit
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands; Department of Medical Biology, Academic Medical Center, University of Amsterdam, Netherlands.
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Rivière C, Ollivier M, Girerd D, Argenson JN, Parratte S. Does standing limb alignment after total knee arthroplasty predict dynamic alignment and knee loading during gait? Knee 2017; 24:627-633. [PMID: 28347597 DOI: 10.1016/j.knee.2017.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/03/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND A principle of TKA is to achieve a neutral standing coronal alignment of the limb (HKA angle) to reduce risks of implant loosening, reduce polyethylene wear, and optimize patellar tracking. Several long-term studies have questioned this because the relationship between alignment and implant survivorship is weaker than previously reported. We hypothesize that standing HKA poorly predicts implant failure because it does not predict dynamic HKA, dynamic adduction moment, and loading of the knee during gait. Therefore, the aim of our study is to assess the relationship between the standing and the dynamic (gait activity) HKAs. METHODS A prospective study on a cohort of 35 patients treated with a posterior-stabilized TKA for primary osteoarthritis. Three months after surgery each patient had a long-leg radiograph and the limb was classified as neutrally aligned (17 patients), varus aligned (nine patients), or valgus aligned (four patients). Patients then performed a gait analysis for level walking. RESULTS Standing HKA has a moderate correlation with the peak dynamic varus (r=0.318, p=0.001) and the mean and peak adduction moments (r=0.31 and r=-0.352 respectively). No significant correlation between standing HKA and the mean dynamic coronal alignment (r=0.14, p=0.449). No differences were found for dynamic frontal parameters (dynamic HKA and adduction moment) between patients defined as neutrally or varus aligned. CONCLUSIONS The standing HKA after TKA was of little value to predict dynamic behaviour of the limb during gait, this may explain why standing coronal alignment after TKA may have limited influence on long-term implant fixation and wear.
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Affiliation(s)
- Charles Rivière
- The MSK Lab, Charing Cross Hospital, Imperial College London, Fulham Palace Rd W6 8RF, London, United Kingdom.
| | - Matthieu Ollivier
- Service de Chirurgie Orthopédique, Hôpital Sainte Marguerite, Université Aix-Marseille, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France Marseille, France.
| | - Damien Girerd
- Service de Chirurgie Orthopédique, Hôpital Sainte Marguerite, Université Aix-Marseille, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France Marseille, France.
| | - Jean Noël Argenson
- Service de Chirurgie Orthopédique, Hôpital Sainte Marguerite, Université Aix-Marseille, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France Marseille, France.
| | - Sébastien Parratte
- Service de Chirurgie Orthopédique, Hôpital Sainte Marguerite, Université Aix-Marseille, 270 Boulevard de Sainte Marguerite, 13009 Marseille, France Marseille, France.
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Wang W, Ackland DC, McClelland JA, Webster KE, Halgamuge S. Assessment of Gait Characteristics in Total Knee Arthroplasty Patients Using a Hierarchical Partial Least Squares Method. IEEE J Biomed Health Inform 2017; 22:205-214. [PMID: 28371786 DOI: 10.1109/jbhi.2017.2689070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Quantitative gait analysis is an important tool in objective assessment and management of total knee arthroplasty (TKA) patients. Studies evaluating gait patterns in TKA patients have tended to focus on discrete data such as spatiotemporal information, joint range of motion and peak values of kinematics and kinetics, or consider selected principal components of gait waveforms for analysis. These strategies may not have the capacity to capture small variations in gait patterns associated with each joint across an entire gait cycle, and may ultimately limit the accuracy of gait classification. The aim of this study was to develop an automatic feature extraction method to analyse patterns from high-dimensional autocorrelated gait waveforms. A general linear feature extraction framework was proposed and a hierarchical partial least squares method derived for discriminant analysis of multiple gait waveforms. The effectiveness of this strategy was verified using a dataset of joint angle and ground reaction force waveforms from 43 patients after TKA surgery and 31 healthy control subjects. Compared with principal component analysis and partial least squares methods, the hierarchical partial least squares method achieved generally better classification performance on all possible combinations of waveforms, with the highest classification accuracy . The novel hierarchical partial least squares method proposed is capable of capturing virtually all significant differences between TKA patients and the controls, and provides new insights into data visualization. The proposed framework presents a foundation for more rigorous classification of gait, and may ultimately be used to evaluate the effects of interventions such as surgery and rehabilitation.
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Bytyqi D, Shabani B, Cheze L, Neyret P, Lustig S. Does a third condyle TKA restore normal gait kinematics in varus knees? In vivo knee kinematic analysis. Arch Orthop Trauma Surg 2017; 137:409-416. [PMID: 28160060 DOI: 10.1007/s00402-017-2629-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Patients with knee osteoarthritis tend to modify spatial and temporal parameters during walking to reduce the pain. Total knee arthroplasty (TKA) is considered the gold standard treatment for end-stage knee osteoarthritis. However, reduced physical function of the knee is partly, but apparently not fully, remedied by surgery. The purpose of this study was to investigate the in vivo, three dimensional knee kinematics during gait at the patients with knee osteoarthritis and the influence of "third condyle" psoterior stabilized (PS) total knee arthroplasty on restoration of normal kinematics. MATERIALS AND METHODS Twenty patients with medial knee osteoarthritis and a control group with age-matched subjects were prospectively collected for this study. The same group of 20 patients were re-assessed 10 months after total knee arthroplasty with "third condyle" PS prosthesis. All subjects were assessed with a 3D, optoelectric knee assessement device, while walking on a treadmill at a self-selected speed. For each participant, knee flexion-extension, abduction-adduction, internal-external rotation and anterior-posterior displacement, were calculated. RESULTS The range of flexion/extension was improved significantly (39.9° ± 5.5° vs 44.8° ± 5.1°, p < 0.05) after TKA but it still remained lower than control group (6.9° ± 5.5° vs 2.2° ± 3.9°, p < 0.05). The range of motion in internal-external rotation did not change pre- and post-arthroplasty, but remained lower than the matched control group (6.7° ± 2.4° vs 9.3° ± 2.4, p < 0.05). The maximum posterior displacement during swing phase was significantly higher at post-arthroplasty group comparing with control group (-9.5 ± 2.2 vs -5.7 ± 3 mm, p < 0.05). CONCLUSION Following "third condyle" PS-TKA, patients had better clinical, spatiotemporal and kinematic parameters. Despite improvements, the knee kinematics during gait in TKA group differed from healthy control group. TKA group had a lower extension lower range of axial rotation and an increased tibial posterior displacement.
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Affiliation(s)
- Dafina Bytyqi
- Laboratoire de Biomécanique et Mécanique des Chocs, University Claude Bernard Lyon 1, Lyon, France.,Albert Trillat Center, Lyon, France.,University of Prishtina, Prishtina, Kosovo
| | - Bujar Shabani
- Laboratoire de Biomécanique et Mécanique des Chocs, University Claude Bernard Lyon 1, Lyon, France.,Albert Trillat Center, Lyon, France.,University of Prishtina, Prishtina, Kosovo
| | - Laurence Cheze
- Laboratoire de Biomécanique et Mécanique des Chocs, University Claude Bernard Lyon 1, Lyon, France
| | - Philippe Neyret
- Laboratoire de Biomécanique et Mécanique des Chocs, University Claude Bernard Lyon 1, Lyon, France.,Albert Trillat Center, Lyon, France
| | - Sebastien Lustig
- Laboratoire de Biomécanique et Mécanique des Chocs, University Claude Bernard Lyon 1, Lyon, France. .,Albert Trillat Center, Lyon, France.
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Nagura T, Niki Y, Harato K, Mochizuki T, Kiriyama Y. Analysis of the factors that correlate with increased knee adduction moment during gait in the early postoperative period following total knee arthroplasty. Knee 2017; 24:250-257. [PMID: 28173989 DOI: 10.1016/j.knee.2016.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/15/2016] [Accepted: 11/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Analysis of dynamic knee loading during gait is essential to prevent mechanical failures following total knee arthroplasty. External knee adduction moment during gait is the primary factor producing medial joint reaction force, and an increase in the moment is directly related to an increase in the medial compartment load on the knee. METHODS Knee adduction moment during gait in 39 knees of 32 female patients following a posterior stabilized knee replacement with a single surgeon was evaluated at 1.3months following surgery. A cut-off moment was determined as mean+1 standard deviation (SD) of the moment from 10 healthy subjects, and patients' knees were divided into high- and normal-moment groups. Significant differences in clinical assessments and gait parameters between the two groups were assessed. RESULTS Based on the cut-off moment, 23 knees were grouped into normal knees and 16 knees were grouped into high-moment knees. High-moment knees showed identical femorotibial angles and knee society scores but had greater toe-out angles and medially directed ground reaction forces compared to normal-moment knees. High-moment knees showed strong correlations between peak moment and knee adduction angle, and frontal plain moment arm. CONCLUSIONS The clinical significance of a high knee adduction moment following total knee arthroplasty remains unclear, but dynamic frontal alignment during gait is one of the key factors for residual high-moment knees following surgery.
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Affiliation(s)
- Takeo Nagura
- Department of Clinical Biomechanics, Keio University, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan.
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | | | - Yoshimori Kiriyama
- Department of Mechanical Systems Engineering, Kogakuin University, Tokyo, Japan
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Clouthier AL, Bohm ER, Rudan JF, Shay BL, Rainbow MJ, Deluzio KJ. Correcting waveform bias using principal component analysis: Applications in multicentre motion analysis studies. Gait Posture 2017; 51:153-158. [PMID: 27770680 DOI: 10.1016/j.gaitpost.2016.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 09/06/2016] [Accepted: 10/11/2016] [Indexed: 02/02/2023]
Abstract
Multicentre studies are rare in three dimensional motion analyses due to challenges associated with combining waveform data from different centres. Principal component analysis (PCA) is a statistical technique that can be used to quantify variability in waveform data and identify group differences. A correction technique based on PCA is proposed that can be used in post processing to remove nuisance variation introduced by the differences between centres. Using this technique, the waveform bias that exists between the two datasets is corrected such that the means agree. No information is lost in the individual datasets, but the overall variability in the combined data is reduced. The correction is demonstrated on gait kinematics with synthesized crosstalk and on gait data from knee arthroplasty patients collected in two centres. The induced crosstalk was successfully removed from the knee joint angle data. In the second example, the removal of the nuisance variation due to the multicentre data collection allowed significant differences in implant type to be identified. This PCA-based technique can be used to correct for differences between waveform datasets in post processing and has the potential to enable multicentre motion analysis studies.
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Affiliation(s)
- Allison L Clouthier
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., Kingston, ON, Canada.
| | - Eric R Bohm
- Department of Surgery, University of Manitoba, 820 Sherbrook St., Winnipeg, Manitoba, Canada.
| | - John F Rudan
- Department of Surgery, Queen's University, 76 Stuart St., Kingston, ON, Canada.
| | - Barbara L Shay
- Department of Physical Therapy, University of Manitoba, 771 McDermot Ave., Winnipeg, Manitoba, Canada.
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., Kingston, ON, Canada.
| | - Kevin J Deluzio
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., Kingston, ON, Canada.
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Evaluation of the relationship of tibiofemoral kinematics before and after total knee replacement in an in vitro model of cranial cruciate deficiency in the dog. Vet Comp Orthop Traumatol 2016; 29:484-490. [PMID: 27739555 DOI: 10.3415/vcot-15-09-0158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 07/22/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the relationship between tibiofemoral kinematics before and after total knee replacement (TKR) in vitro. ANIMALS Eight canine hemipelves. METHODS A modified Oxford Knee Rig was used to place cadaveric limbs through a range of passive motion allowing the kinematics of the stifle to be evaluated. Four measurements were performed: a control stage, followed by a cranial cruciate transection stage, then following TKR with the musculature intact stage, and finally TKR with removal of limb musculature stage. Joint angles and translations of the femur relative to the tibia, including flexion-extension versus adduction-abduction, flexion-extension versus internal-external rotation, as well as flexion-extension versus each translation (cranial-caudal and lateral-medial) were calculated. RESULTS Significant differences were identified in kinematic data from limbs following TKR implantation as compared to the unaltered stifle. The TKR resulted in significant decreases in external rotation of the stifle during flexion-extension compared to the limb prior to any intervention, as well as increasing the abduction. The TKR significantly increased the caudal translation of the femur relative to the tibia compared to the unaltered limb. When compared with the cranial cruciate ligament-transection stage, TKR significantly decreased the ratio of the external rotation to flexion. DISCUSSION All three test periods showed significant differences from the unaltered stifle. The TKR did not completely restore the normal kinematics of the stifle.
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Trinler UK, Baty F, Mündermann A, Fenner V, Behrend H, Jost B, Wegener R. Stair dimension affects knee kinematics and kinetics in patients with good outcome after TKA similarly as in healthy subjects. J Orthop Res 2016; 34:1753-1761. [PMID: 26844935 DOI: 10.1002/jor.23181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 01/28/2016] [Indexed: 02/04/2023]
Abstract
Joint biomechanics during stair walking may contain important information on functional deficits in patients with orthopaedic conditions but depend on the stair dimension. The goal of this study was to compare knee kinematics and kinetics between patients with good outcome 2 years after total knee arthroplasty (TKA) and age-matched controls during stair ascent and descent at two different stair heights. Principal component analysis was used to detect differences in gait mechanics between 15 patients and 15 controls at different stair conditions. Linear mixed models showed differences in knee kinematic and kinetic patterns (in flexion/extension and abduction/adduction) between stair heights. The knee adduction angle was more affected by stair heights in stair ascending whereas knee adduction moment and knee power were more affected during stair descent. Some stair by height and subject effects were small but not significant. Overall, good outcome after TKA is reflected in close-to-normal knee biomechanics during stair walking. Specific stair configuration must be considered when comparing joint biomechanics between subject groups and studies. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1753-1761, 2016.
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Affiliation(s)
- Ursula K Trinler
- School of Health Science, University of Salford, Manchester, United Kingdom
| | - Florent Baty
- Division of Pulmonary Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Annegret Mündermann
- Clinic of Traumatology and Orthopaedics, University Hospital Basel, Basel, Switzerland
| | - Verena Fenner
- Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Henrik Behrend
- Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Bernhard Jost
- Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Regina Wegener
- Department of Orthopedics and Traumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. .,Department of Paediatric Orthopaedics, Laboratory for Motion Analysis, Children's Hospital of Eastern Switzerland, Claudiusstr. 6, St. Gallen, 9006, Switzerland.
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Rodriguez JA, Bas MA, Orishimo KF, Robinson J, Nicholas SJ. Differential Effect of Total Knee Arthroplasty on Valgus and Varus Knee Biomechanics During Gait. J Arthroplasty 2016; 31:248-53. [PMID: 27460296 DOI: 10.1016/j.arth.2016.06.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/08/2016] [Accepted: 06/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty and its relation to gait abduction or adduction moment has not been fully described. METHODS Gait analysis was performed on 25 patients (27 knees) preoperatively, 6 months and 1 year after total knee arthroplasty. Reflective markers were placed on the lower extremity, and motion data were collected at 60 Hz using 6 infrared cameras. Ground reaction forces were recorded at 960 Hz with a force plate. Stance phase was divided into braking and propulsive phases. Coronal knee angles and moments were calculated. Repeated-measures analysis of variance was used to compare frontal plane knee impulse over time and between the braking and propulsive phases of stance. RESULTS In varus knees, static alignment was corrected from 2.2° varus to 3.3° valgus and in valgus knees from 15.2° valgus to 2.7° valgus (P < .010). Braking phase adduction impulse decreased from 0.145 to 0.111 at 6 months but increased to 0.126 Nm/kg s (P > .05) at 1 year. Propulsive phase impulse changed from 0.129 to 0.085 and persisted at 1 year. Impulse changed from 0.01 (abduction) to 0.11 Nm/kg s (adduction) at 6 months and persisted (P = .01). CONCLUSION Restoration of anatomic alignment and soft tissue balancing changes the lateral loading conditions of valgus knees. Both cases, between 6 months and 1 year, increased peak moment.
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Affiliation(s)
- Jose A Rodriguez
- Department of Orthopaedic Surgery, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York
| | - Marcel A Bas
- Department of Orthopaedic Surgery, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York
| | - Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma, Department of Orthopaedic Surgery, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York
| | - Jonathan Robinson
- Department of Orthopaedic Surgery, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York
| | - Stephen J Nicholas
- Department of Orthopaedic Surgery, Lenox Hill Hospital, North Shore-LIJ Health System, New York, New York
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Abstract
OBJECTIVES This study aimed to evaluate functional biomechanics in patients who undergo total knee arthroplasty (TKA). METHODS Lower limb joint kinematics and kinetics were evaluated in 25 TKA patients at 3 months following TKA and 25 age-matched controls after 12 months following TKA. Participants were evaluated in a gait laboratory, with self-selected gait speed. RESULTS Experimental group walked significantly slower (p < 0.01), using a shorter stride length (p < 0.01), compared to those for the controls. The experimental group exhibited significantly greater knee motion, lower knee extension moment (p < 0.01), and lower peak power generation (p < 0.01) compared to those for the control group. Additionally, the TKA group showed significantly smaller peak ankle motion (p < 0.01), lower ankle dorsiflexion moments (p < 0.05), and ankle power generation (p < 0.01) compared to those for the control group. DISCUSSION These biomechanical properties of gait in the experimental group may be a compensatory response to lesser recovered knee function to allow sufficient power generation for propulsion. Therefore, rehabilitative strategies at 3 months following TKA are needed to improve not only knee function but also hip and ankle function after TKA.
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Papagiannis GI, Roumpelakis IM, Triantafyllou AI, Makris IN, Babis GC. No Differences Identified in Transverse Plane Biomechanics Between Medial Pivot and Rotating Platform Total Knee Implant Designs. J Arthroplasty 2016; 31:1814-20. [PMID: 26923498 DOI: 10.1016/j.arth.2016.01.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 12/20/2015] [Accepted: 01/25/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasties (TKAs) using well-designed, fixed bearing prostheses, such as medial pivot (MP), have produced good long-term results. Rotating-platform, posterior-stabilized (RP-PS) mobile bearing implants were designed to decrease polyethylene wear. Sagittal and coronal plane TKA biomechanics are well examined and correlated to polyethylene wear. However, limited research findings describe this relationship in transverse plane. We assumed that although axial plane biomechanics might not be the most destructive parameters on polyethylene wear, it is important to clarify their role because both joint kinematics and kinetics in all 3 planes are important input parameters for TKA wear testing (International Organization for Standardization 14243-1 and 14343-3). Our hypothesis was that transverse plane overall range of motion (ROM) and/or peak moment show differences that reflect on wear advantages when compared RP-PS implants to MP designs. METHODS Two groups (MPs = 24 and RP-PSs = 22 subjects) were examined by using 3D gait analysis. The variables were total internal-external rotation (IER) ROM and peak IER moments. RESULTS No statistically significant difference was demonstrated between the 2 groups in kinetics (P = .389) or kinematics (P = .275). CONCLUSION In the present study, no wear advantages were found between 2 TKAs. Both designs showed identical kinetics at the transverse plane in level-ground walking. Kinematic analysis could not illustrate any statistically significant difference in terms of overall IER ROM. Nevertheless, kinematic gait pattern differences observed possibly reflect different patterns of joint surface motion or abnormal gait patterns. Thus, wear testing with various input waveforms combined with functional data analysis will be necessary to identify the actual effects of gait variability on polyethylene wear.
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Affiliation(s)
- Georgios I Papagiannis
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", "Attikon" University Hospital, 1st Department of Orthopaedics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias M Roumpelakis
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", "Attikon" University Hospital, 1st Department of Orthopaedics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios I Triantafyllou
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", "Attikon" University Hospital, 1st Department of Orthopaedics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis N Makris
- Biomechanics and Gait Analysis Laboratory "Sylvia Ioannou", Orthopaedic Research and Education Center "P.N.Soukakos", "Attikon" University Hospital, 1st Department of Orthopaedics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - George C Babis
- 2nd Department of Orthopaedics, Medical School, National and Kapodistrian University of Athens, Konstantopouleio General Hospital, Nea Ionia, Greece
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Knee Extensor Strength and Gait Characteristics After Minimally Invasive Unicondylar Knee Arthroplasty vs Minimally Invasive Total Knee Arthroplasty: A Nonrandomized Controlled Trial. J Arthroplasty 2016; 31:1711-6. [PMID: 26979765 DOI: 10.1016/j.arth.2016.01.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/04/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In light of the existing lack of evidence, it was the aim of this study to compare gait characteristics and knee extensor strength after medial unicondylar knee arthroplasty (MUKA) with those after total knee arthroplasty (TKA), given the same standardized minimally invasive surgery (MIS) approach in both groups. METHODS Patients scheduled for MIS-MUKA or MIS-TKA as part of clinical routine were invited to participate. A posterior cruciate ligament-retaining total knee design was used for all MIS-TKA. A 3-dimensional gait analysis was performed preoperatively with a VICON system and at 8 weeks postoperative to determine temporospatial parameters, ground reaction forces, joint angles, and joint moments. At the same 2 times, isokinetic tests were performed to obtain peak values of knee extensor torque. A multivariate analysis of variance was conducted and included the main effects time (before and after surgery) and surgical group and the group-by-time interaction effect. RESULTS Fifteen MIS-MUKA patients and 17 MIS-TKA patients were eligible for the final analysis. The groups showed no differences regarding age, body mass index, sex, side treated, or stage of osteoarthritis. We determined neither intergroup differences nor time × group interactions for peak knee extensor torque or any gait parameters (temporospatial, ground reaction forces, joint angles, and joint moments). CONCLUSION It is concluded that MUKA is not superior to TKA with regard to knee extensor strength or 3-dimensional gait characteristics at 8 weeks after operation. As gait characteristics and knee extensor strength are only 2 of the various potential outcome parameters (knee scores, activity scores…) and quadriceps strength might take a longer time to recover, our findings should be interpreted with caution.
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Grier AJ, Schmitt AC, Adams SB, Queen RM. The effect of tibiotalar alignment on coronal plane mechanics following total ankle replacement. Gait Posture 2016; 48:13-18. [PMID: 27477702 DOI: 10.1016/j.gaitpost.2016.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 04/06/2016] [Accepted: 04/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait mechanics following total ankle replacement (TAR) have reported improved ankle motion following surgery. However, no studies have addressed the impact of preoperative radiographic tibiotalar alignment on post-TAR gait mechanics. We therefore investigated whether preoperative tibiotalar alignment (varus, valgus, or neutral) resulted in significantly different coronal plane mechanics or ground reaction forces post-TAR. METHODS We conducted a non-randomized study of 93 consecutive end-stage ankle arthritis patients. Standard weight-bearing radiographs were obtained preoperatively to categorize patients as having neutral (±4°), varus (≥5° of varus), or valgus (≥5° of valgus) coronal plane tibiotalar alignment. All patients underwent a standard walking assessment including three-dimensional lower extremity kinetics and kinematics preoperatively, 12 and 24 months postoperatively. RESULTS A significant group by time interaction was observed for the propulsive vertical ground reaction force (vGRF), coronal plane hip range of motion (ROM) and the peak hip abduction moment. The valgus group demonstrated an increase in the peak knee adduction angle and knee adduction angle at heel strike when compared to the other groups. Coronal plane ankle ROM, knee and hip angles at heel strike, and the peak hip angle exhibited significant increases across time. Peak ankle inversion moment, peak knee abduction moment and the weight acceptance vGRF also exhibited significant increases across time. Neutral ankle alignment was achieved for all patients by 2 years following TAR. CONCLUSIONS Restoration of neutral ankle alignment at the time of TAR in patients with preoperative varus or valgus tibiotalar alignment resulted in biomechanics similar to those of patients with neutral preoperative tibiotalar alignment by 24-month follow-up.
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Affiliation(s)
- A Jordan Grier
- Michael W. Krzyzewski Human Performance Lab, Duke University, United States; Department of Orthopaedic Surgery, Duke University, United States.
| | - Abigail C Schmitt
- Michael W. Krzyzewski Human Performance Lab, Duke University, United States; Department of Orthopaedic Surgery, Duke University, United States.
| | - Samuel B Adams
- Department of Orthopaedic Surgery, Duke University, United States.
| | - Robin M Queen
- Kevin Granata Biomechanics Lab, Virginia Tech, United States; Department of Biomedical Engineering and Mechanics, Virginia Tech, United States.
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75
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Ardestani MM, Moazen M. How human gait responds to muscle impairment in total knee arthroplasty patients: Muscular compensations and articular perturbations. J Biomech 2016; 49:1620-1633. [DOI: 10.1016/j.jbiomech.2016.03.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 10/22/2022]
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76
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Calliess T, Ettinger M, Schado S, Becher C, Hurschler C, Ostermeier S. Patella tracking and patella contact pressure in modular patellofemoral arthroplasty: a biomechanical in vitro analysis. Arch Orthop Trauma Surg 2016; 136:849-55. [PMID: 27052369 DOI: 10.1007/s00402-016-2451-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In the recent years modular partial knee prosthesis with the opportunity to combine unicompartmental tibiofemoral (UKA) and patellofemoral prosthesis (PFJ) were introduced to the clinics. To date, little is known about the biomechanics of these bi-cruciate retaining prosthetic designs. Aim of this study was to evaluate the influence of a PFJ in bicompartmental arthroplasty (UKA + PFJ) on patella tracking and retropatella pressure distribution. METHODS A dynamic in vitro knee kinemator simulating an isokinetic extension cycle of the knee was used on eight knee specimen. Patella tracking and patellofemoral contact pressure were evaluated using pressure sensitive films after implantation of a medial UNI and after subsequent implantation of a PFJ. RESULTS Whereas the area contact pressure remained the same after PFJ implantation, the contact area was reduced significantly and significantly elevated peak pressures were determined in deep flexion and close to extension. The patella tracking was not significantly altered, however, effects of edge loading could be shown. CONCLUSION When using PFJ prosthesis, one must be aware of altered pressure introduction on the retropatella surface compared to the physiological situation. The elevated peak pressures and reduced contact area may be an argument for patella resurfacing and the problems of edge loading indicate that care must be taken on the correct implantation of the device with no implant overhang.
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Affiliation(s)
- Tilman Calliess
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625, Hannover, Germany.
| | - Max Ettinger
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625, Hannover, Germany
| | - Ssuheib Schado
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625, Hannover, Germany
| | - Christoph Becher
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625, Hannover, Germany
| | - Christof Hurschler
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625, Hannover, Germany
| | - Sven Ostermeier
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625, Hannover, Germany.,Orthopädische Praxis und Gelenk-Klinik, Alte Bundesstrasse 58, 79194, Gundelfingen, Germany
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77
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Wahid F, Begg R, McClelland JA, Webster KE, Halgamuge S, Ackland DC. A multiple regression normalization approach to evaluation of gait in total knee arthroplasty patients. Clin Biomech (Bristol, Avon) 2016; 32:92-101. [PMID: 26874198 DOI: 10.1016/j.clinbiomech.2015.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 12/09/2015] [Accepted: 12/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait features characteristic of a cohort may be difficult to evaluate due to differences in subjects' demographic factors and walking speed. The aim of this study was to employ a multiple regression normalization method that accounts for subject age, height, body mass, gender, and self-selected walking speed in the evaluation of gait in unilateral total knee arthroplasty patients. METHODS Three-dimensional gait analysis was performed on 45 total knee arthroplasty patients and 31 aged-matched controls walking at their self-selected speed. Gait data peaks including joint angles, ground reaction forces, net joint moments, and net joint powers were normalized using subject body mass, standard dimensionless equations, and a multiple regression approach that modeled subject age, height, body mass, gender, and self-selected walking speed. FINDINGS Normalizing gait data using subject body mass, dimensionless equations, and multiple regression approach resulted in a significantly lower knee adduction moment and knee extensor power in total knee arthroplasty patients compared to controls (p<0.05). In contrast to normalization using body mass and dimensionless equations, multiple regression normalization greatly reduced variance in gait data by minimizing correlations with subject demographic factors and walking speed, resulting in significantly higher peak hip extension angles and peak hip flexion powers in total knee arthroplasty patients (p<0.05). INTERPRETATION Total knee arthroplasty patients generate greater hip extension angles and hip flexor power and have a lower knee adduction moment than healthy controls. This gait pattern may be a strategy to reduce muscle and joint loading at the knee.
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Affiliation(s)
- Ferdous Wahid
- Department of Mechanical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Rezaul Begg
- College of Sport and Exercise Science, VIC University, Melbourne, VIC, Australia
| | | | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Saman Halgamuge
- Department of Mechanical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - David C Ackland
- Department of Mechanical Engineering, University of Melbourne, Melbourne, VIC, Australia.
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78
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Hatfield GL, Stanish WD, Hubley-Kozey CL. Relationship between knee adduction moment patterns extracted using principal component analysis and discrete measures with different amplitude normalizations: Implications for knee osteoarthritis progression studies. Clin Biomech (Bristol, Avon) 2015; 30:1146-52. [PMID: 26363732 DOI: 10.1016/j.clinbiomech.2015.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee adduction moment discrete features (peaks and impulses) are commonly reported in knee osteoarthritis gait studies, but they do not necessarily capture loading patterns. Principal component analysis extracts dynamic patterns, but can be difficult to interpret. This methodological study determined relationships between external knee adduction moment discrete measures and principal component analysis features, and examined whether amplitude-normalization methods influenced differences in those with knee osteoarthritis who progressed to surgery versus those that did not. METHODS 54 knee osteoarthritis patients had three-dimensional biomechanical measures assessed during walking. Knee adduction moments were calculated and non-normalized and amplitude-normalized waveforms using two common methods were calculated. Patterns were extracted using principal component analysis. Knee adduction moment peak and impulse were calculated. Correlation coefficients were determined between two knee adduction moment patterns extracted and peak and impulse. T-tests evaluated between-group differences. FINDINGS An overall magnitude pattern was correlated with peak (r=0.88-0.90, p<0.05) and impulse (r=0.93, p<0.05). A pattern capturing a difference between early and mid/late -stance knee adduction moment was significantly correlated with peak (r=0.27-0.40, p<0.05), but explained minimal variance. Between-group peak differences were only affected by amplitude-normalization method. INTERPRETATION Findings suggest that the overall magnitude knee adduction moment principal pattern does not provide unique information from peak and impulse measures. However, low correlations and minimal variance explained between the pattern capturing ability to unload the joint during mid-stance and the two discrete measures, suggests that this pattern captured a unique waveform feature.
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Affiliation(s)
- Gillian L Hatfield
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - William D Stanish
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
| | - Cheryl L Hubley-Kozey
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada; School of Physiotherapy, Dalhousie University, Halifax, NS, Canada.
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79
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Debbi EM, Bernfeld B, Herman A, Laufer Y, Greental A, Sigal A, Zaulan Y, Salai M, Haim A, Wolf A. Frontal plane biomechanics of the operated and non-operated knees before and after unilateral total knee arthroplasty. Clin Biomech (Bristol, Avon) 2015; 30:889-94. [PMID: 26330122 DOI: 10.1016/j.clinbiomech.2015.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 07/30/2015] [Accepted: 07/31/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND After unilateral total knee arthroplasty, frontal plane loading patterns on the operated knee remain pathological in the long term, but it is unclear how they change in the early postoperative period. Additionally, researchers have suggested that the non-operated knee bears greater frontal plane loads postoperatively, but this effect is unclear. The objective of the present study was to compare the preoperative and early postoperative frontal plane loading patterns of both knees after unilateral total knee arthroplasty. METHODS Fifty patients with end-stage knee osteoarthritis were examined prior to and six weeks after surgery. Patients underwent a three-dimensional gait analysis that determined the frontal plane loading patterns of knee varus angle and knee adduction moment during gait, and completed self-evaluative questionnaires and functional tests. FINDINGS There were no significant loading differences between limbs preoperatively. The operated knee showed large reductions in varus angle and adduction moment after surgery (all p<0.001). The non-operated knee showed no increases in varus angle or adduction moment, but did show a small reduction in the adduction moment (p<0.001). Both knees showed reduction in pain after surgery (p<0.001) and the operated Knee Society Score improved after surgery (p=0.01). INTERPRETATION Total knee arthroplasty reduces frontal plane loading in the operated knee and does not worsen frontal plane loading in the non-operated knee. Therapy after surgery should focus on retaining the reduction in knee adduction moment in the operated knee and preventing further worsening loading patterns in the non-operated knee.
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Affiliation(s)
- Eytan M Debbi
- Biorobotics and Biomechanics Lab, Faculty of Mechanical Engineering, Technion Israel Institute of Technology, Haifa, Israel.
| | - Benjamin Bernfeld
- Department of Orthopedic Surgery, Carmel Medical Center, Haifa, Israel
| | - Amir Herman
- Department of Orthopedics and Talpiot Medical Leadership program, Sheba Medical Center, Tel Aviv, Israel
| | - Yocheved Laufer
- Department of Physical Therapy, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
| | - Arnan Greental
- Department of Orthopedics, Rambam Health Care Campus, Haifa, Israel
| | - Amit Sigal
- Department of Orthopedics, Rambam Health Care Campus, Haifa, Israel
| | - Yaron Zaulan
- Department of Orthopedic Surgery, Carmel Medical Center, Haifa, Israel
| | - Moshe Salai
- Division of Orthopedics, Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Haim
- Biorobotics and Biomechanics Lab, Faculty of Mechanical Engineering, Technion Israel Institute of Technology, Haifa, Israel
| | - Alon Wolf
- Biorobotics and Biomechanics Lab, Faculty of Mechanical Engineering, Technion Israel Institute of Technology, Haifa, Israel
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Effects of Weight-Bearing Biofeedback Training on Functional Movement Patterns Following Total Knee Arthroplasty: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2015; 45. [PMID: 26207975 PMCID: PMC4558346 DOI: 10.2519/jospt.2015.5593] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVES To examine the effects of weight-bearing biofeedback training on weight-bearing symmetry and functional joint moments following unilateral total knee arthroplasty. BACKGROUND Individuals after unilateral total knee arthroplasty place more weight on the nonsurgical limb compared to the surgical limb during function. It is unknown whether targeted intervention can improve function in the surgical limb and resolve altered movement patterns. METHODS Twenty-six patients were randomly assigned to 2 groups (reload or control). The reload group had a standard-of-care rehabilitation augmented with weight-bearing biofeedback training, and the control group had a dose-matched standard-of-care rehabilitation. Lower-limb weight-bearing ratios were measured preoperatively and 6 and 26 weeks after total knee arthroplasty during a 5-time sit-to-stand test (FTSST) and walking. Secondary outcomes were FTSST time, walking speed, and lower-limb joint moments during the FTSST and walking. RESULTS No between-group differences were found in weight-bearing ratios. Five-time sit-to-stand test time improved in the reload group compared to the control group at 6 (P = .021) and 26 weeks (P = .021). There were no between-group differences in knee extension moment during the FTSST. Surgical-limb knee extension moments during walking increased from baseline to 26 weeks in the reload group and decreased in the control group (P = .008). CONCLUSION Weight-bearing biofeedback training had no effect on functional weight-bearing symmetry or knee extension moments during the FTSST. However, the biofeedback training resulted in increases of knee extension moments during gait and improved FTSST times. Trial registered at ClinicalTrials.gov (NCT01333189). Level of Evidence Therapy, level 2b.
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81
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In vitro kinematics of fixed versus mobile bearing in unicondylar knee arthroplasty. Arch Orthop Trauma Surg 2015; 135:871-7. [PMID: 25877013 DOI: 10.1007/s00402-015-2214-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Indexed: 02/09/2023]
Abstract
PURPOSE When performing unicondylar knee arthroplasty (UKA), the surgeon can choose between two fundamentally different designs: a mobile-bearing (MB) inlay with high conformity, or a low-conformity, fixed bearing (FB) inlay. There is an ongoing debate in the orthopaedic community about which design is superior. To date, there have been no comparative biomechanical studies regarding each system's effects on the quadriceps force and the medial contact pressure. The purpose of this study was to investigate these alterations in vitro before and after UKA with two prosthesis systems, representing the MB and FB designs. METHODS FB and MB unicondylar knee prosthesis designs were tested in sequence under isokinetic extension in an in vitro simulator. In each case, the required quadriceps extension force was determined before and after implantation of a medial UKA. Furthermore, the tibiofemoral contact pressures were evaluated for both prosthesis designs. RESULTS The quadriceps force maximum was achieved at 106° and 104° of flexion with the FB and MB designs, respectively. Implantation of the FB UKA resulted in a significant increase in the necessary maximum quadriceps force (p = 0.006). In addition, implantation of the MB UKA resulted in a significantly higher extension force (p = 0.03). The difference between the two groups was statistically significant in deep flexion (p = 0.03), with higher forces in MB UKA. CONCLUSION The MB design showed significantly increased quadriceps extension force compared with the FB inlay in deep flexion. Although the FB design showed higher maximum peak pressures concentrated on a smaller area, the pressure introduction in deep flexion was lower, compared to MB inserts.
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Worsley PR, Whatling G, Barrett D, Holt C, Stokes M, Taylor M. Assessing changes in subjective and objective function from pre- to post-knee arthroplasty using the Cardiff Dempster-Shafer theory classifier. Comput Methods Biomech Biomed Engin 2015; 19:418-27. [PMID: 25898862 DOI: 10.1080/10255842.2015.1034115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study is to assess changes in subjective and objective function from pre- to post-knee arthroplasty (KA) using a combined classifier technique. Twenty healthy adults (50-80 years) and 31 KA patients (39-81 years) were studied (4 weeks pre- and 6 months post-KA). Questionnaire measures of subjective pain, joint stability, activity and function were collected. Objective functional assessment included goniometry, ultrasound imaging and 3-D motion analysis/inverse modelling of gait and sit-stand. An optimal set of variables were used to classify function using the Cardiff Dempster-Shafer theory (DST) method. Out of sample accuracy of the classifiers ranged between 90% and 94% for segregating healthy individuals and pre-KA patients. Post-KA subjective function improved with 74% classified as healthy. However, there was minimal improvement in objective measures (23% classified as healthy). The novel use of Cardiff DST segregated KA patients from healthy individuals and estimated changes in function from pre- to post-surgery. KA patients had improved pain and function post-operation but objective knee joint measures remained different to healthy individuals.
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Affiliation(s)
- Peter R Worsley
- a Bioengineering Science Research Group, School of Engineering Sciences, University of Southampton , Southampton , UK.,b Faculty of Health Sciences, University of Southampton , Southampton , UK
| | - Gemma Whatling
- c Cardiff School of Engineering, Cardiff University , Cardiff , UK.,d Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University , Cardiff , UK
| | - David Barrett
- a Bioengineering Science Research Group, School of Engineering Sciences, University of Southampton , Southampton , UK
| | - Cathy Holt
- c Cardiff School of Engineering, Cardiff University , Cardiff , UK.,d Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University , Cardiff , UK
| | - Maria Stokes
- b Faculty of Health Sciences, University of Southampton , Southampton , UK.,e Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis , Southampton , UK
| | - Mark Taylor
- a Bioengineering Science Research Group, School of Engineering Sciences, University of Southampton , Southampton , UK.,f Medical Device Research Institute, Flinders University , Adelaide , Australia
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Rahman J, Tang Q, Monda M, Miles J, McCarthy I. Gait assessment as a functional outcome measure in total knee arthroplasty: a cross-sectional study. BMC Musculoskelet Disord 2015; 16:66. [PMID: 25886558 PMCID: PMC4374376 DOI: 10.1186/s12891-015-0525-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/10/2015] [Indexed: 11/26/2022] Open
Abstract
Background The aim of the study was to assess gait in total knee arthroplasty (TKA) patients, using a technique that can to be used on a routine basis in a busy orthopaedic clinic. Methods A total of 103 subjects were recruited: 29 pre-op TKA patients; 17 TKA patients at 8 weeks post-op; 28 TKA patients at 52 weeks post-op; and 29 age-matched controls. Inertial measurement units (IMUs) were used to assess gait. Limb segment angles, knee angle and temporal parameters of gait were calculated. Specific gait parameters were quantified, and data analysed using MANOVA and discriminant analysis. Results The gait of TKA patients as a group was only slightly improved at 12 months when compared with the pre-operative group, and both groups were significantly different to controls in several variables. Knee flexion range in stance was the most important variable in discriminating between patients and controls; knee flexion range in swing was the only variable that showed a significant difference between pre- and post-operative patients. When considered individually, only 1/29 patient was within the normal range for this variable pre-operatively, but 9/28 patients were within the normal range 12 months post-operatively. Conclusions Even after 12 months after surgery, many TKA patients have not improved their gait relative to pre-operative patients. Routine gait assessment may be used to guide post-operative rehabilitation, and to develop strategies to improve mobility of these patients.
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Affiliation(s)
- Jeeshan Rahman
- UCL Institute of Orthopaedics and Musculoskeletal Science, London, UK. .,Royal National Orthopaedic Hospital, London, UK.
| | - Quen Tang
- Royal National Orthopaedic Hospital, London, UK.
| | - Maureen Monda
- UCL Institute of Orthopaedics and Musculoskeletal Science, London, UK.
| | | | - Ian McCarthy
- Biomedical Instrumentation Group, Pedestrian Accessibility and Movement Environment Laboratory, UCL, London, UK.
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Motion analysis of patients after knee arthroplasty during activities of daily living--a systematic review. Gait Posture 2015; 41:370-7. [PMID: 25680471 DOI: 10.1016/j.gaitpost.2015.01.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/02/2014] [Accepted: 01/18/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Motion analysis with optoelectronic systems is a frequently used method to analyze the patient's gait as well as further relevant activities of daily living before and after knee arthroplasty. The aim of this systematic review was to identify the investigated activities of daily living and to show an extensive presentation of gait analysis studies with patients after knee arthroplasty surgery. METHODS The articles were searched in electronic databases: MEDPILOT, EMBASE. To identify articles that potentially met the inclusion criteria the titles and abstracts were screened. The level of evidence was analyzed for the included articles. RESULTS Overall 3989 abstracts were reviewed and 87 full text articles were included. Ten activities of daily living were identified. Level walking was the most frequently investigated activity (78.2%). In 94.6% the sagittal plane kinematics were analyzed and 5.3% presented the results in all three planes. Knee adduction moments were determined in 33.3% of the included articles. At least two joints were investigated in 40.2%, including the impaired knee and further body parts (ankle, hip, pelvis, trunk). Unicondylar knee arthroplasty was addressed in 14.1%. CONCLUSIONS Besides level walking, it is necessary to examine physical more demanding activities of daily living to detect potential kinematic and kinetic abnormalities. Further research should imply the evaluation of sagittal, frontal and transverse plane joint and muscle function based on accurate inverse-dynamic techniques. More motion analysis studies are necessary that address unicondylar knee arthroplasty in comparison to total knee arthroplasty and healthy controls.
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Tang ACW, Tang SFT, Hong WH, Chen HC. Kinetics features changes before and after intra-articular hyaluronic acid injections in patients with knee osteoarthritis. Clin Neurol Neurosurg 2015; 129 Suppl 1:S21-6. [DOI: 10.1016/s0303-8467(15)30007-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Astephen Wilson JL, Dunbar MJ, Hubley-Kozey CL. Knee joint biomechanics and neuromuscular control during gait before and after total knee arthroplasty are sex-specific. J Arthroplasty 2015; 30:118-25. [PMID: 25123606 DOI: 10.1016/j.arth.2014.07.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/11/2014] [Accepted: 07/21/2014] [Indexed: 02/01/2023] Open
Abstract
The future of total knee arthroplasty (TKA) surgery will involve planning that incorporates more patient-specific characteristics. Despite known biological, morphological, and functional differences between men and women, there has been little investigation into knee joint biomechanical and neuromuscular differences between men and women with osteoarthritis, and none that have examined sex-specific biomechanical and neuromuscular responses to TKA surgery. The objective of this study was to examine sex-associated differences in knee kinematics, kinetics and neuromuscular patterns during gait before and after TKA. Fifty-two patients with end-stage knee OA (28 women, 24 men) underwent gait and neuromuscular analysis within the week prior to and one year after surgery. A number of sex-specific differences were identified which suggest a different manifestation of end-stage knee OA between the sexes.
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Affiliation(s)
| | - Michael J Dunbar
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada; Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Canada
| | - Cheryl L Hubley-Kozey
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada; School of Physiotherapy, Dalhousie University, Halifax, Canada
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87
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Baker KM, Foutz TL, Johnsen KJ, Budsberg SC. Effects of tibial plateau angle and spacer thickness applied during in vitro canine total knee replacement on three-dimensional kinematics and collateral ligament strain. Am J Vet Res 2014; 75:792-9. [DOI: 10.2460/ajvr.75.9.792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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88
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Jung MC, Chung JY, Son KH, Wang H, Hwang J, Kim JJ, Kim JH, Min BH. Difference in knee rotation between total and unicompartmental knee arthroplasties during stair climbing. Knee Surg Sports Traumatol Arthrosc 2014; 22:1879-86. [PMID: 24859731 DOI: 10.1007/s00167-014-3064-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 05/02/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare knee kinematics during stair walking in patients with simultaneous total knee arthroplasty (TKA) and unicompartmental knee arthroplasties (UKA). It was hypothesized that UKA would reproduce more normalized knee kinematics than TKA during stair ascent and descent. METHODS Six patients who received UKA in one knee and TKA in the other knee were included in the study. For this study, a four-step staircase was assembled with two force platforms being positioned at the centre of the second and third steps. Each patient was attached with 16 reflective markers at both lower extremities and was asked to perform five roundtrip trials of stair climbing. Kinematic parameters including stance duration, knee angle, vertical ground reaction force (GRF), joint reaction force, and moments were obtained and analysed using a10-camera motion system (VICON, Oxford, UK). Nonparametric Friedman test was used to compare the results between two arthroplasty methods and between stair ascent and descent. RESULTS Compared to TKA, UKA knees exhibited significantly greater degree of rotation in transverse planes (5.0 degrees during ascent and 6.0 degrees during descent on average), but showed no difference in terms of the other parameters. When comparing the results during stair ascent with descent, overall greater knee angle, vertical GRF, joint reaction force, and moment were observed during stair descent. CONCLUSIONS Both UKA and TKA knees have shown overall similar knee kinematics, though UKA knee may allow greater degree of rotation freedom, which resembles normal knee kinematics during stair walking.
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Affiliation(s)
- Myung-Chul Jung
- Department of Industrial Engineering, Ajou University College of Engineering, Suwon, South Korea
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Abdel MP, Parratte S, Blanc G, Ollivier M, Pomero V, Viehweger E, Argenson JNA. No benefit of patient-specific instrumentation in TKA on functional and gait outcomes: a randomized clinical trial. Clin Orthop Relat Res 2014; 472:2468-76. [PMID: 24604110 PMCID: PMC4079860 DOI: 10.1007/s11999-014-3544-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 02/20/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although some clinical reports suggest patient-specific instrumentation in TKA may improve alignment, reduce surgical time, and lower hospital costs, it is unknown whether it improves pain- and function-related outcomes and gait. QUESTIONS/PURPOSES We hypothesized that TKA performed with patient-specific instrumentation would improve patient-reported outcomes measured by validated scoring tools and level gait as ascertained with three-dimensional (3-D) analysis compared with conventional instrumentation 3 months after surgery. METHODS We randomized 40 patients into two groups using either patient-specific instrumentation or conventional instrumentation. Patients were evaluated preoperatively and 3 months after surgery. Assessment tools included subjective functional outcome and quality-of-life (QOL) scores using validated questionnaires (New Knee Society Score(©) [KSS], Knee Injury and Osteoarthritis Outcome Score [KOOS], and SF-12). In addition, gait analysis was evaluated with a 3-D system during level walking. The study was powered a priori at 90% to detect a difference in walking speed of 0.1 m/second, which was considered a clinically important difference, and in a post hoc analysis at 80% to detect a difference of 10 points in KSS. RESULTS There were improvements from preoperatively to 3 months postoperatively in functional scores, QOL, and knee kinematic and kinetic gait parameters during level walking. However, there was no difference between the patient-specific instrumentation and conventional instrumentation groups in KSS, KOOS, SF-12, or 3-D gait parameters. CONCLUSIONS Our observations suggest that patient-specific instrumentation does not confer a substantial advantage in early functional or gait outcomes after TKA. It is possible that differences may emerge, and this study does not allow one to predict any additional variances in the intermediate followup period from 6 months to 1 year postoperatively. However, the goals of the study were to investigate the recovery period as early pain and functional outcomes are becoming increasingly important to patients and surgeons. LEVEL OF EVIDENCE Level I, therapeutic study. See the Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Matthew P. Abdel
- />Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Sébastien Parratte
- />Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France , />Center of Motion and Gait Analysis, Department of Pediatric Orthopaedic Surgery, Timone Hospital, Marseille, France
| | - Guillaume Blanc
- />Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - Matthieu Ollivier
- />Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France
| | - Vincent Pomero
- />Center of Motion and Gait Analysis, Department of Pediatric Orthopaedic Surgery, Timone Hospital, Marseille, France
| | - Elke Viehweger
- />Center of Motion and Gait Analysis, Department of Pediatric Orthopaedic Surgery, Timone Hospital, Marseille, France
| | - Jean-Noël A. Argenson
- />Department of Orthopedic Surgery, Institute for Locomotion, Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France , />Center of Motion and Gait Analysis, Department of Pediatric Orthopaedic Surgery, Timone Hospital, Marseille, France
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90
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Smith JW, Christensen JC, Marcus RL, LaStayo PC. Muscle force and movement variability before and after total knee arthroplasty: A review. World J Orthop 2014; 5:69-79. [PMID: 24829868 PMCID: PMC4017309 DOI: 10.5312/wjo.v5.i2.69] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 02/26/2014] [Accepted: 03/11/2014] [Indexed: 02/06/2023] Open
Abstract
Variability in muscle force output and movement variability are important aspects of identifying individuals with mobility deficits, central nervous system impairments, and future risk of falling. This has been investigated in elderly healthy and impaired adults, as well as in adults with osteoarthritis (OA), but the question of whether the same correlations also apply to those who have undergone a surgical intervention such as total knee arthroplasty (TKA) is still being investigated. While there is a growing body of literature identifying potential rehabilitation targets for individuals who have undergone TKA, it is important to first understand the underlying post-operative impairments to more efficiently target functional deficits that may lead to improved long-term outcomes. The purpose of this article is to review the potential role of muscle force output and movement variability in TKA recipients. The narrative review relies on existing literature in elderly healthy and impaired individuals, as well as in those with OA before and following TKA. The variables that may predict long-term functional abilities and deficits are discussed in the context of existing literature in healthy older adults and older adults with OA and following TKA, as well as the role future research in this field may play in providing evidence-based data for improved rehabilitation targets.
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91
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Nüesch C, Valderrabano V, Huber C, Pagenstert G. Effects of supramalleolar osteotomies for ankle osteoarthritis on foot kinematics and lower leg muscle activation during walking. Clin Biomech (Bristol, Avon) 2014; 29:257-64. [PMID: 24445126 DOI: 10.1016/j.clinbiomech.2013.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 11/15/2013] [Accepted: 12/18/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early stages of asymmetric ankle osteoarthritis can be treated by joint preserving supramalleolar osteotomies that surgically realign the ankle and unload degenerated cartilage. While studies have already shown pain relief and functional improvements, the effects on gait biomechanics are largely unknown. This study investigated patients' gait pattern after supramalleolar osteotomies by focusing on foot kinematics and lower leg muscle activation. METHODS An instrumented three-dimensional gait analysis with simultaneous electromyography of gastrocnemius medialis and lateralis, soleus, peroneus longus, and tibialis anterior muscles was performed on 12 patients with ankle osteoarthritis, seven of which were followed up 12-18months postoperatively. Additionally, seven different long-term follow-up patients (8-9years postoperatively) and 15 healthy control subjects were measured. The waveforms of the foot kinematics and muscle activation were analyzed using principal component analysis. FINDINGS Compared to healthy controls, principal component scores that affected the sagittal range of motion of the hindfoot and hallux were lower in all patient groups, while scores that affected the timing of the peaks in the sagittal forefoot motion were mainly altered in short-term follow-up patients. Lower principal component scores in patients with ankle osteoarthritis and short-term follow-up patients resulted in a less pronounced peak activation of gastrocnemius medialis and soleus. INTERPRETATION Both postoperative patient groups showed similar adaptations in their gait pattern as those observed in patients with ankle osteoarthritis. These changes are probably related to the lower ankle mobility. However, the reduced mobility seems to affect the patients' well-being less than a painful joint.
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Affiliation(s)
- Corina Nüesch
- Orthopaedic Department, University Hospital, University of Basel, Switzerland; Osteoarthritis Research Center, University of Basel, Switzerland.
| | - Victor Valderrabano
- Orthopaedic Department, University Hospital, University of Basel, Switzerland; Osteoarthritis Research Center, University of Basel, Switzerland.
| | - Cora Huber
- Biomechanics & Calorimetry Center Basel, University of Basel, Switzerland; Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Germany
| | - Geert Pagenstert
- Orthopaedic Department, University Hospital, University of Basel, Switzerland; Osteoarthritis Research Center, University of Basel, Switzerland
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92
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Calliess T, Schado S, Richter BI, Becher C, Ezechieli M, Ostermeier S. Quadriceps force during knee extension in different replacement scenarios with a modular partial prosthesis. Clin Biomech (Bristol, Avon) 2014; 29:218-22. [PMID: 24342453 DOI: 10.1016/j.clinbiomech.2013.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous biomechanical studies have shown that bi-cruciate retaining knee replacement does not significantly alter normal knee kinematics, however, there are no data on the influence of a combined medial and patellofemoral bi-compartimental arthroplasty. The purpose of this in vitro study was to evaluate the effect of different replacement scenarios with a modular partial knee replacement system on the amount of quadriceps force required to extend the knee during an isokinetic extension cycle. METHODS Ten human knee specimens were tested in a kinematic knee simulator under (1) physiologic condition and after subsequent implantation of (2) a medial unicondylar and (3) a trochlear replacement. An isokinetic extension cycle of the knee with a constant extension moment of 31 Nm was simulated. The resulting quadriceps extension force was measured from 120° to full knee extension. FINDINGS The quadriceps force curve described a typically sinusoidal characteristic before and after each replacement scenario. The isolated medial replacement resulted in a slightly, but significantly higher maximum quadriceps force (1510 N vs. 1585 N, P = 0.006) as well as the subsequent trochlear replacement showed an additional increase (1801 N, P = 0.008). However, for both replacements no significant difference to the untreated condition could be detected in mid-flexion (10-50°). INTERPRETATION When considering a bi-compartimental replacement an increase of required maximum quadriceps force needed to extend the knee has to keep in mind. However, the close to physiological movement in mid-flexion suggests that patients with a bi-crutiate retaining arthroplasty might have an advantage in knee stability compared to total knee arthroplasty.
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Affiliation(s)
- Tilman Calliess
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany.
| | - Ssuheib Schado
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
| | - Berna I Richter
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
| | - Christoph Becher
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
| | - Marco Ezechieli
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
| | - Sven Ostermeier
- Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 3, 30625 Hannover, Germany
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93
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Murphy MT, Skinner TL, Cresswell AG, Crawford RW, Journeaux SF, Russell TG. The effect of knee flexion contracture following total knee arthroplasty on the energy cost of walking. J Arthroplasty 2014; 29:85-9. [PMID: 23725927 DOI: 10.1016/j.arth.2013.04.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 02/01/2023] Open
Abstract
This study evaluated the energy cost of walking (Cw) with knee flexion contractures (FC) simulated with a knee brace, in total knee arthroplasty (TKA) recipients (n=16) and normal controls (n=15), and compared it to baseline (no brace). There was no significant difference in Cw between the groups at baseline but TKA recipients walked slower (P=0.048) and with greater knee flexion in this condition (P=0.003). Simulated FC significantly increased Cw in both groups (TKA P=0.020, control P=0.002) and this occurred when FC exceeded 20° in the TKA group and 15° in the controls. Reported perceived exertion was only significantly increased by FC in the control group (control P<0.001, TKA P=0.058). Simulated knee FCs less than 20° do not increase Cw or perceived exertion in TKA recipients.
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Affiliation(s)
- Michael T Murphy
- Mater Research, Mater Health Services, South Brisbane, Australia
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94
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Robbins SM, Astephen Wilson JL, Rutherford DJ, Hubley-Kozey CL. Reliability of principal components and discrete parameters of knee angle and moment gait waveforms in individuals with moderate knee osteoarthritis. Gait Posture 2013; 38:421-7. [PMID: 23357757 DOI: 10.1016/j.gaitpost.2013.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/18/2012] [Accepted: 01/03/2013] [Indexed: 02/02/2023]
Abstract
Gait measures are used to evaluate change in patients with knee osteoarthritis (OA), but reliability has not been fully established in this population. This study examined test-retest reliability of knee angle and moment gait waveform characteristics captured using discrete parameters and principal component analysis (PCA) in individuals with moderate knee OA. Participants (n=20) underwent three-dimensional gait analysis on two occasions. Motion and force data were captured using two camera banks, infrared light emitting diodes and force plate during self-selected walking. Knee angle and moment waveforms were calculated and analyzed using discrete parameters and by identifying waveform characteristics using PCA. Intraclass correlation coefficients (ICC2,k) examined test-retest reliability of discrete parameters and PCA derived scores (PC-scores). ICC2,k values ranged from 0.57 to 0.93 for discrete parameters, 0.52-0.86 for knee angle PC-scores and 0.30-0.94 for the knee moment PC-scores. However, 10 of 13 discrete parameters, six of nine knee angle PC-scores and seven of nine knee moment PC-scores had ICC2,k values greater than or equal to 0.70. Discrete parameters and PC-scores from flexion angles and adduction moments had the highest ICC2,k values while adduction angles, rotation angles, and rotation moments had the lowest. Most knee angle and moment waveform characteristics demonstrated ICC2,k values that could be interpreted as acceptable. Caution should be used when examining adduction and rotation angle magnitudes and early/mid-stance rotation moment magnitudes due to lower ICC2,k values.
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Affiliation(s)
- Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Constance Lethbridge Rehabilitation, Montreal, QC, Canada.
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95
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McCarthy I, Hodgins D, Mor A, Elbaz A, Segal G. Analysis of knee flexion characteristics and how they alter with the onset of knee osteoarthritis: a case control study. BMC Musculoskelet Disord 2013; 14:169. [PMID: 23692671 PMCID: PMC3663779 DOI: 10.1186/1471-2474-14-169] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/14/2013] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study was to examine the differences in gait profile between patients with knee osteoarthritis (OA) and healthy control and to create motion characteristics that will differentiate between them. Methods Twenty three patients diagnosed with knee OA and 21 healthy matched controls underwent a gait test using a sensor system (gaitWALK). Gait parameters evaluated were: stride duration, knee flexion range of motion (ROM) in swing and stance. T-Test was used to evaluate significant differences between groups (P < 0.05). Results Patients with knee OA had significant lower knee flexion ROM (10.3° ± 4.0°) during stance than matched controls (18.0° ± 4.0°) (p < 0.001). Patients with knee OA had significant lower knee flexion ROM (54.8° ± 5.5°) during swing than matched controls (61.2° ± 6.1) (p = 0.003). Patients with knee OA also had longer stride duration (1.12 s ± 0.09 s) than matched controls (1.06 s ± 0.11 s), but this was not statistically significant (p = 0.073). Motion characteristics differentiate between a patient with knee OA and a healthy one with a sensitivity of 0.952 and a specificity of 0.783. Conclusions Significant differences were found in the gait profile of patients with knee OA compared to matched control and motion characteristics were identified. This test might help clinicians identify and evaluate a knee problem in a simple gait test.
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Affiliation(s)
- Ian McCarthy
- Royal National Orthopaedic Hospital, Stanmore, UK
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96
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Broström EW, Esbjörnsson AC, von Heideken J, Iversen MD. Gait deviations in individuals with inflammatory joint diseases and osteoarthritis and the usage of three-dimensional gait analysis. Best Pract Res Clin Rheumatol 2013; 26:409-22. [PMID: 22867935 DOI: 10.1016/j.berh.2012.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 02/08/2023]
Abstract
This chapter describes three-dimensional gait analysis and common gait deviations in adults with rheumatoid arthritis (RA) and osteoarthritis (OA). Furthermore, we describe changes in gait deviations following surgical and non-surgical interventions. Gait analysis is used to define gait deviations and to evaluate varying surgical approaches, types of surgeries and non-pharmacologic interventions. Most studies examine gait in adults with knee OA. Limitations of existing studies include small samples, poor selection of controls, sample heterogenecity, lack of baseline gait assessments and inconsistency in measurement. Across studies, time and distance parameters are generally used to provide a global measure of gait deviations. Individuals with RA and OA in the lower extremities exhibit reduced walking speed/cadence and decreased motion and moments in relation to healthy subjects. Future research should include larger sample sizes, the use of proper controls, pre- and post-assessments and identify gait abnormalities early in the disease process to minimise long-term consequences.
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Affiliation(s)
- Eva W Broström
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden.
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97
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Metcalfe A, Stewart C, Postans N, Barlow D, Dodds A, Holt C, Whatling G, Roberts A. Abnormal loading of the major joints in knee osteoarthritis and the response to knee replacement. Gait Posture 2013; 37:32-6. [PMID: 22841587 DOI: 10.1016/j.gaitpost.2012.04.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 04/19/2012] [Indexed: 02/02/2023]
Abstract
Knee osteoarthritis is common and patients frequently complain that they are 'overloading' the joints of the opposite leg when they walk. However, it is unknown whether moments or co-contractions are abnormal in the unaffected joints of patients with single joint knee osteoarthritis, or how they change following treatment of the affected knee. Twenty patients with single joint medial compartment knee osteoarthritis were compared to 20 asymptomatic control subjects. Gait analysis was performed for normal level gait and surface EMG recordings of the medial and lateral quadriceps and hamstrings were used to investigate co-contraction. Patients were followed up 12 months post-operatively and the analysis was repeated. Results are presented for the first 14 patients who have attended follow-up. Pre-operatively, adduction moment impulses were elevated at both knees and the contra-lateral hip compared to controls. Co-contraction of hamstrings and quadriceps was elevated bilaterally. Post-operatively, moment waveforms returned to near-normal levels at the affected knee and co-contraction fell in the majority of patients. However, abnormalities persisted in the contra-lateral limb with partial or no recovery of both moment waveforms and co-contraction in the majority. Patients with knee osteoarthritis do experience abnormal loads of their major weight bearing joints bilaterally, and abnormalities persist despite treatment of the affected limb. Further treatment may be required if we are to protect the other major joints following joint arthroplasty.
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98
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Wegrzyn J, Parratte S, Coleman-Wood K, Kaufman KR, Pagnano MW. The John Insall award: no benefit of minimally invasive TKA on gait and strength outcomes: a randomized controlled trial. Clin Orthop Relat Res 2013; 471:46-55. [PMID: 22806264 PMCID: PMC3528913 DOI: 10.1007/s11999-012-2486-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While some clinical reports suggest minimally invasive surgical (MIS) techniques improve recovery and reduce pain in the first months after TKA, it is unclear whether it improves gait and thigh muscle strength. QUESTIONS/PURPOSES We hypothesized TKA performed through a mini-subvastus approach would improve subjective and objective and subjective function compared to a standard medial parapatellar approach 2 months after surgery. METHODS We randomized 40 patients into two groups using either the mini-subvastus approach or standard medial parapatellar approach. Patients were evaluated preoperatively and 2 months after surgery. We assessed subjective functional outcome and quality of life (QOL) using routine questionnaires (SF-12, Knee Society Score [KSS], Knee Injury and Osteoarthritis Outcome Score [KOOS], UCLA activity, patient milestone diary of activities). We determined isometric strength of the thigh muscles and assessed gait with a three-dimensional (3-D) analysis during level walking and stair climbing. RESULTS We observed improvements from preoperatively to 2 months postoperatively in functional scores, QOL, and knee kinematic and kinetic gait parameters during level and stair walking. Isometric quadriceps strength increased in both groups, although remaining lower when compared to sound limbs. We found no differences between the groups in KSS, SF-12, KOOS, UCLA activity, patient milestone diary of activities, isometric quadriceps strength, or 3-D gait parameters, except a marginally higher speed of stair ascent in the MIS group. CONCLUSIONS Our observations suggest an MIS approach does not confer a substantial advantage in early function after TKA. LEVEL OF EVIDENCE Level I, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.
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Affiliation(s)
- Julien Wegrzyn
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA ,Biomechanics and Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Sebastien Parratte
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA ,Biomechanics and Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Krista Coleman-Wood
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA ,Biomechanics and Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Kenton R. Kaufman
- Biomechanics and Motion Analysis Laboratory, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Mark W. Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN USA
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Wilson DAJ, Hubley-Kozey CL, Astephen Wilson JL, Dunbar MJ. Pre-operative muscle activation patterns during walking are associated with TKA tibial implant migration. Clin Biomech (Bristol, Avon) 2012; 27:936-42. [PMID: 22858133 DOI: 10.1016/j.clinbiomech.2012.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gait biomechanical variables have been associated with total knee arthroplasty tibial implant migration measured with Radiostereometric Analysis (RSA), but no studies have examined the role of the periarticular musculature, which is responsible for a high proportion of the forces on the joint. The purpose of this study was to measure the pre-operative electromyography (EMG) patterns of the periarticular knee muscles during gait and determine the association of these patterns with the post-operative tibial implant migration measured with RSA. We hypothesized that pre-operative muscle activation patterns (specifically the activation patterns of the vastus and gastrocnemius muscle groups) measured with EMG are associated with migration at 6months. METHODS Electromyographic data were collected from 6 periarticular knee joint muscles on 37 patients pre-operatively during gait. Radiostereometric exams were performed immediately and at 6 months post-operatively. Relationships between the pre-operative patterns of muscle activation and micromotion of the implant were examined using Pearson correlation and regression models. FINDINGS Statistically significant correlations were found between the pattern of the quadriceps and gastrocnemius muscle activations during gait and implant translation in the posterior direction. Regression analysis illustrated that a substantial proportion of the variance in the post-operative tibial component posterior translation (R2=0.49) was explained by a prolonged activation of the vastus medialis muscle and higher activation of the lateral gastrocnemius muscle during early stance. INTERPRETATION The variability in migration explained by the muscle activation patterns supports the hypothesis that pre-operative functional characteristics can contribute to predicting implant migration following total knee arthroplasty surgery.
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Affiliation(s)
- David A J Wilson
- Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, Canada.
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100
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Kiss RM, Bejek Z, Szendrői M. Variability of gait parameters in patients with total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20:1252-60. [PMID: 22453309 DOI: 10.1007/s00167-012-1965-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 03/12/2012] [Indexed: 12/17/2022]
Abstract
PURPOSE Gait analysis has provided important information about the variability of gait for patients prior to and after total knee arthroplasty (TKA). The objective of this research was to clarify how the different surgical techniques influence gait variability. METHODS Gait analysis was performed at 0.8, 1.0, and 1.2 m/s in three groups of patients (operated on using the conventional technique, conventional technique combined with computer-assisted navigation, and the minimally invasive technique combined with computer-assisted navigation; n = 15 each) and a control group (n = 15; healthy, age, body mass, and body height matched). Gait analysis was performed preoperatively and 6 and 12 months after the surgery. Gait parameter variability was characterized by the coefficient of variance of spatio-temporal parameters and by the mean coefficient of variance of angular parameters. RESULTS One year after surgery, the variability of spatio-temporal parameters recovered to normal in patients operated on using the conventional technique; however, the variability of articular motion of the affected side decreased and the variability of articular motion of the non-affected side and pelvis increased compared to the control group. In patients operated on using the minimally invasive technique, the variability of spatio-temporal and angular parameters was similar to that of the control group. CONCLUSION The type of surgical technique significantly influences the variability and stability of gait. Difference in the variability of angular parameters predicts gait instability and increased risk of falling after TKA with the conventional surgical technique. The minimally invasive technique ensures a recovery of gait variability and stability. Thus, particular attention must be paid to improving gait stability during postoperative rehabilitation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rita M Kiss
- Department of Structures, Budapest University of Technology and Economics, Műegyetem rkp. 3, 1111, Budapest, Hungary.
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