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Harvey A, Kohli S, Al-Nasser S, Noroozi S. Gait analysis of a kinematic retaining implant for Total knee replacements during walking and running. J Orthop 2024; 56:1-5. [PMID: 38707966 PMCID: PMC11067358 DOI: 10.1016/j.jor.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/19/2024] [Indexed: 05/07/2024] Open
Abstract
Background The analysis of gait is an important tool for evaluating postoperative outcomes of a Total Knee Replacement (TKR). There are few studies which have evaluated the gait parameters of a Kinematic retaining (Kr) prosthesis. This study therefore aims to investigate the kinetic and kinematic differences of running and walking, in the ankle, knee and hip joints in patients who underwent a Kr TKR. Methods This study assessed the gait of 12 patients with physica lima Kr TKRs at 1 year follow up and 8 healthy controls using 3D video analysis. Data was collected on the kinetics and kinematics of walking and running at the ankle, knee and hip. Comparison was made between the operated and non-operated limbs of the patients, and between the operated and control limbs. Results Gait analysis showed no statistically significant difference in the hip, ankle and knee angles or moments between the non-operated and operated legs during walking and running. However, there was a statistically significant difference between the knee angles of initial contact, maximum flexion during stance and swing in the TKR knees vs controls in walking and running. Similarly, there was also a statistically significantly higher max knee flexion moment between operated knees and controls in both walking and running. Conclusion This study has shown that a quadriceps avoidance gait persists in patients after TKR, and that there was symmetry and reciprocated gait parameters in non-operated limbs. These findings suggest that Kr TKRs could be capable of replicating normal knee kinematics when running and walking.
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Affiliation(s)
- Adrian Harvey
- University Hospital Dorset, Castle Ln E, Bournemouth, BH7 7DW, United Kingdom
| | - Suraj Kohli
- University Hospital Dorset, Castle Ln E, Bournemouth, BH7 7DW, United Kingdom
| | - Samira Al-Nasser
- Department of Design and Engineering, Faculty of Science and Technology, Bournemouth University, United Kingdom
| | - Siamak Noroozi
- Department of Design and Engineering, Faculty of Science and Technology, Bournemouth University, United Kingdom
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Oku K, Yabuki M, Kishimoto T, Shinonaga A, Kimura D, Ito T, Sugioka T, Kobayashi Y, Satake H, Nagamoto H, Kawaguchi Y, Kumai T. Clinical reasoning of ultrasound imaging-guided manual passive manipulation for adhesion prevention in a patient with total knee arthroplasty: a case report. Physiother Theory Pract 2024; 40:1064-1071. [PMID: 36346357 DOI: 10.1080/09593985.2022.2143737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Patients with total knee arthroplasty occasionally develop postoperative abnormalities such as posttraumatic knee stiffness and arthrofibrosis, which may affect activities of daily living. However, there are no clear assessment methods or interventions for knee stiffness. Musculoskeletal ultrasound imaging enables real-time evaluation of mobility and flexibility of tissues. The purpose of this case report was to describe the use of musculoskeletal ultrasound imaging for evaluating the optimal location and methods of passive manipulation. CASE DESCRIPTION The patient was an 82-year-old woman who had undergone total knee arthroplasty. She was unable to climb stairs due to limited knee flexion. Based on the results of musculoskeletal ultrasound imaging assessment, we hypothesized that the knee flexion limitation was caused by decreased sliding movement of the suprapatellar pouch. Hence, we performed passive manipulation on the tissue with decreased sliding under musculoskeletal ultrasound guidance. OUTCOMES The patient's knee flexion angle increased from 90° to 110° within 1 week of intervention, and her gait speed improved from 16.48 to 13.2 s per 10 m. Furthermore, after the intervention, she was able to climb 10 steps using a handrail. DISCUSSION Ultrasound imaging is important because it allows the examination of tissues with mobility changes such as in arthrofibrosis. Our work highlights the use of musculoskeletal ultrasound imaging for identifying the target region for therapy and for providing guidance during passive manipulation.
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Affiliation(s)
- Kosuke Oku
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
- Department of Rehabilitation Center, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Mayumi Yabuki
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Tomoya Kishimoto
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Atsushi Shinonaga
- Department of Rehabilitation Center, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Daisuke Kimura
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Tomotaka Ito
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Tatsuya Sugioka
- Division of Rehabilitation, Hanna Central Hospital, Ikoma, Japan
| | - Yusuke Kobayashi
- Division of Rehabilitation, Hanna Central Hospital, Ikoma, Japan
| | - Hayato Satake
- Division of Rehabilitation, Hanna Central Hospital, Ikoma, Japan
| | - Hideaki Nagamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Japan
| | | | - Tsukasa Kumai
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
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Apostolopoulos V, Boháč P, Marcián P, Nachtnebl L, Mahdal M, Pazourek L, Tomáš T. Biomechanical comparison of all-polyethylene total knee replacement and its metal-backed equivalent on periprosthetic tibia using the finite element method. J Orthop Surg Res 2024; 19:153. [PMID: 38396020 PMCID: PMC10893603 DOI: 10.1186/s13018-024-04631-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) with all-polyethylene tibial (APT) components has shown comparable survivorship and clinical outcomes to that with metal-backed tibial (MBT). Although MBT is more frequently implanted, APT equivalents are considered a low-cost variant for elderly patients. A biomechanical analysis was assumed to be suitable to compare the response of the periprosthetic tibia after implantation of TKA NexGen APT and MBT equivalent. METHODS A standardised load model was used representing the highest load achieved during level walking. The geometry and material models were created using computed tomography data. In the analysis, a material model was created that represents a patient with osteopenia. RESULTS The equivalent strain distribution in the models of cancellous bone with an APT component showed values above 1000 με in the area below the medial tibial section, with MBT component were primarily localised in the stem tip area. For APT variants, the microstrain values in more than 80% of the volume were in the range from 300 to 1500 με, MBT only in less than 64% of the volume. CONCLUSION The effect of APT implantation on the periprosthetic tibia was shown as equal or even superior to that of MBT despite maximum strain values occurring in different locations. On the basis of the strain distribution, the state of the bone tissue was analysed to determine whether bone tissue remodelling or remodelling would occur. Following clinical validation, outcomes could eventually modify the implant selection criteria and lead to more frequent implantation of APT components.
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Affiliation(s)
- Vasileios Apostolopoulos
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Boháč
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Petr Marcián
- Institute of Solid Mechanics, Mechatronics and Biomechanics, Faculty of Mechanical Engineering, University of Technology, Brno, Czech Republic
| | - Luboš Nachtnebl
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Mahdal
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lukáš Pazourek
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Tomáš
- First Department of Orthopaedic Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Winnock de Grave P, Van Criekinge T, Luyckx T, Moreels R, Gunst P, Claeys K. Restoration of the native tibial joint line obliquity in total knee arthroplasty with inverse kinematic alignment does not increase knee adduction moments. Knee Surg Sports Traumatol Arthrosc 2023; 31:4692-4704. [PMID: 37311955 DOI: 10.1007/s00167-023-07464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/20/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Patient-specific alignment in total knee arthroplasty (TKA) has shown promising patient-reported outcome measures; however, the clinical and biomechanical effects of restoring the native knee anatomy remain debated. The purpose of this study was to compare the gait pattern between a mechanically aligned TKA cohort (adjusted mechanical alignment-aMA) and a patient-specific alignment TKA cohort (inverse kinematic alignment-iKA). METHODS At two years postoperatively, the aMA and iKA groups, each with 15 patients, were analyzed in a retrospective case-control study. All patients underwent TKA with robotic assistance (Mako, Stryker) through an identical perioperative protocol. The patients' demographics were identical. The control group comprised 15 healthy participants matched for age and gender. Gait analysis was performed with a 3D motion capture system (VICON). Data collection was conducted by a blinded investigator. The primary outcomes were knee flexion during walking, knee adduction moment during walking and spatiotemporal parameters (STPs). The secondary outcomes were the Oxford Knee Score (OKS) and Forgotten Joint Score (FJS). RESULTS During walking, the maximum knee flexion did not differ between the iKA group (53.0°) and the control group (55.1°), whereas the aMA group showed lower amplitudes of sagittal motion (47.4°). In addition, the native limb alignment in the iKA group was better restored, and although more in varus, the knee adduction moments in the iKA group were not increased (225 N mm/kg) compared to aMA group (276 N mm/kg). No significant differences in STPs were observed between patients receiving iKA and healthy controls. Six of 7 STPs differed significantly between patients receiving aMA and healthy controls. The OKS was significantly better in patients receiving iKA than aMA: 45.4 vs. 40.9; p = 0.05. The FJS was significantly better in patients receiving iKA than aMA: 84.8 vs. 55.5; p = 0.002. CONCLUSION At two years postoperatively, the gait pattern showed greater resemblance to that in healthy controls in patients receiving iKA rather than aMA. The restoration of the native coronal limb alignment does not lead to increased knee adduction moments due to the restoration of the native tibial joint line obliquity. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Philip Winnock de Grave
- Department Rehabilitation Sciences, KU Leuven, Brugge, Belgium.
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium.
| | | | - Thomas Luyckx
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Leuven, Louvain, Belgium
| | - Robin Moreels
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
- Department Orthopaedic Surgery, UZ Gent, Ghent, Belgium
| | - Paul Gunst
- Department Orthopaedic Surgery, AZ Delta Roeselare, Brugsesteenweg 90, 8800, Roeselare, Belgium
| | - Kurt Claeys
- Department Rehabilitation Sciences, KU Leuven, Brugge, Belgium
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Goreham JA, Landry SC, Kozey JW, Smith B, Ladouceur M. Using principal component analysis to investigate pacing strategies in elite international canoe kayak sprint races. Sports Biomech 2023; 22:1444-1459. [PMID: 32844729 DOI: 10.1080/14763141.2020.1806348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
The aim of this research was to use principal component analysis (PCA) to investigate the current pacing strategies of elite canoe kayak sprint athletes and to determine if there are differences in pacing patterns between medallists and non-medallists at major international competitions. Velocity data collected using global positioning systems (GPS) from all a-finals of major international competitions in 2016-2017 (including canoe and kayak, single and crew boat, and male and female) were downloaded from the International Canoe Federation's website. Data were normalised by the average velocity within each race and organised by race distance. In total 10, 14 and 16 races were analysed, and they followed all-out, positive, and 'seahorse-shaped' pacing strategies for the 200 m, 500 m, and 1000 m events, respectively. Normalised velocity PC1 (p = 0.039, ES = -0.44) and PC2 scores (p < 0.001, ES = -0.73) for 1000 m races were significantly different between medallists and non-medallists; however, significant differences between PCs were not found between groups in shorter race distances (i.e. 200 m and 500 m). Data collected using GPS provide information that can be used to better prepare athletes for canoe kayak sprint races lasting between 30 s and 240 s in duration.
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Affiliation(s)
| | - Scott C Landry
- Kinesiology, Acadia University, Wolfville, Nova Scotia, Canada
| | - John W Kozey
- Kinesiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bruce Smith
- Mathematics and Statistics, Dalhousie University, Halifax, Nova Scotia, Canada
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Feng Y, Liu Y, Fang Y, Chang J, Deng F, Liu J, Xiong Y. Advances in the application of wearable sensors for gait analysis after total knee arthroplasty: a systematic review. ARTHROPLASTY 2023; 5:49. [PMID: 37779198 PMCID: PMC10544450 DOI: 10.1186/s42836-023-00204-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/31/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Wearable sensors have become a complementary means for evaluation of body function and gait in lower limb osteoarthritis. This study aimed to review the applications of wearable sensors for gait analysis after total knee arthroplasty (TKA). METHODS Five databases, including Web of Science Core Collection, Embase, Cochrane, Medline, and PubMed, were searched for articles published between January 2010 and March 2023, using predetermined search terms that focused on wearable sensors, TKA, and gait analysis as broad areas of interest. RESULTS A total of 25 articles were identified, involving 823 TKA patients. Methodologies varied widely across the articles, with inconsistencies found in reported patient characteristics, sensor data and experimental protocols. Patient-reported outcome measures (PROMs) and gait variables showed various recovery times from 1 week postoperatively to 5 years postoperatively. Gait analysis using wearable sensors and PROMs showed differences in controlled environments, daily life, and when comparing different surgeries. CONCLUSION Wearable sensors offered the potential to remotely monitor the gait function post-TKA in both controlled environments and patients' daily life, and covered more aspects than PROMs. More cohort longitudinal studies are warranted to further confirm the benefits of this remote technology in clinical practice.
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Affiliation(s)
- Yuguo Feng
- College of Art and Design, Xihua University, Chengdu, 610039, China
| | - Yu Liu
- Chongqing Brace Technology Co., Ltd., Chongqing, 401120, China
| | - Yuan Fang
- Chongqing Brace Technology Co., Ltd., Chongqing, 401120, China
| | - Jin Chang
- Chongqing Brace Technology Co., Ltd., Chongqing, 401120, China
| | - Fei Deng
- Chongqing Brace Technology Co., Ltd., Chongqing, 401120, China
| | - Jin Liu
- Affiliated Experimental School of Sichuan Normal University, Chengdu, 610000, China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Kurihara Y, Ohsugi H, Tosaka T, Matsuda T, Tsuneizumi Y, Tsukeoka T. Verification of biomechanical factors of gait related to medial knee loading in patients 6 Months after total knee arthroplasty. J Clin Orthop Trauma 2023; 39:102150. [PMID: 37101901 PMCID: PMC10123370 DOI: 10.1016/j.jcot.2023.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/31/2023] [Indexed: 04/28/2023] Open
Abstract
Background The knee adduction moment (KAM) is considered an index for estimating the knee mechanical load, and increased KAM peak and KAM impulse are related to increased medial knee load and progression of knee joint degeneration. We aimed to verify the biomechanical factors of gait related to medial knee loading in patients 6 months after TKA. Methods Thirty-nine women who underwent TKA were enrolled. A three-dimensional gait analysis was performed 6 months postoperatively to generate data on the lower limb joint angle, moment, and power at the backward component (braking phase) and forward component (propulsion phase) peaks of the ground reaction force. Medial knee loading was evaluated using the time-integrated value of KAM during the stance period (KAM impulse). The higher the value of the KAM impulse, the higher the medial knee joint load. The relationships between the KAM impulse and the data for biomechanical factors were evaluated using partial correlation analysis with gait speed as a control factor. Results In the braking phase, the KAM impulse positively correlated with the knee adduction angle (r = 0.377) and negatively correlated with the toe-out angle (r = -0.355). The KAM impulse positively correlated with the knee adduction angle (r = 0.402), the hip flexion moment (r = 0.335), and the hip adduction moment (r = 0.565) and negatively correlated with the toe-out angle (r = -0.357) in the propulsive phase. Conclusion The KAM impulse 6 months after TKA was related to the knee adduction angle, hip flexion moment, hip adduction moment, and toe-out angle. These findings may provide fundamental data for controlling variable medial knee joint load after TKA and implementing patient management strategies to ensure implant durability.
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Affiliation(s)
- Yasushi Kurihara
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture, 283-8555, Japan
| | - Hironori Ohsugi
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture, 283-8555, Japan
| | - Tomonari Tosaka
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 2-1-1 Hongou Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoshikazu Tsuneizumi
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tadashi Tsukeoka
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
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He R, Xiong R, Sun ML, Yang JJ, Chen H, Yang PF, Yang L. Study on the correlation between early three-dimensional gait analysis and clinical efficacy after robot-assisted total knee arthroplasty. Chin J Traumatol 2023; 26:83-93. [PMID: 35798637 PMCID: PMC10071330 DOI: 10.1016/j.cjtee.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/23/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Robot-assisted technology is a forefront of surgical innovation that improves the accuracy of total knee arthroplasty (TKA). But whether the accuracy of surgery can improve the clinical efficacy still needs further research. The purpose of this study is to perform three-dimensional (3D) analysis in the early postoperative period of patients who received robot-assisted total knee arthroplasty (RATKA), and to study the trend of changes in gait parameters after RATKA and the correlation with the early clinical efficacy. METHODS Patients who received RATKA in the Center of Joint Surgery, the First Hospital Affiliated to Army Military Medical University from October 2020 to January 2021 were included. The imaging parameters, i.e., hip-knee-ankle angle, lateral distal femoral angle, medial proximal tibial angle, posterior condylar angle were measured 3 months post-TKA. The 3D gait analysis and clinical efficacy by Western Ontario Mac Master University Index (WOMAC) score were performed pre-TKA, 3 and 6 months post-TKA. The differences in spatiotemporal parameters of gait, kinetic parameters, and kinematic parameters of the operated limb and the contralateral limb were compared. The correlation between gait parameters and WOMAC scores was analyzed. Paired sample t-test and Wilcoxon rank-sum test were used to analyze the difference between groups, and Spearman correlation coefficient was used to analyze the correlation. RESULTS There were 31 patients included in this study, and the imaging indexes showed that all of them returned to normal post-TKA. The WOMAC score at 3 months post-TKA was significantly lower than that pre-TKA, and there was no significant difference between at 3 and 6 months. The 3D gait analysis results showed that the double support time of the operated limb reduced at 3 and 6 months (all p < 0.05), the maximum extension and maximum external rotation of the knee joint increased at stance phase, and the maximum flexion angle, the range of motion and the maximum external rotation increased at swing phase. Compared with the preoperative data, there were significant improvements (all p < 0.05). Compared with the contralateral knee joint, the maximum external rotation of the knee joint at swing phase was smaller than that of the contralateral side, and the maximum flexion and extension moment was greater than that of the contralateral knee. The maximum external rotation moment of the joint was greater than that of the contralateral knee joint (p < 0.05). There was a negative correlation between the single support time pre-TKA and the WOMAC score at 3 months (p = 0.017), and the single support time at 3 months was negatively correlated with the WOMAC score at 6 months (p = 0.043). The cadence at 6 months was negatively correlated with the WOMAC score at 6 months (p = 0.031). The maximum knee extension at stance phase at 6 months was negatively correlated with the WOMAC score at 6 month (p = 0.048). The maximum external rotation at stance phase at 6 months was negatively correlated with the WOMAC score at 6 months (p = 0.024). CONCLUSION The 3D gait analysis of RATKA patients is more sensitive than WOMAC score in evaluating the clinical efficacy. Trend of changes in gait parameters shows that the knee joint support, flexion and extension function, range of motion, external rotation and varus deformity moment of the patient were significantly improved at 3 months after surgery, and continued to 6 months after surgery. Compared with the contralateral knee, the gait parameters of the operated limb still has significant gaps in functionality, such as the external rotation and flexion and extension. The single support time, cadence, knee extension, and knee external rotation of the operated limb have a greater correlation with the postoperative WOMAC score. Postoperative rehabilitation exercises should be emphasized, which is of great value for improving the early efficacy of RATKA.
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Affiliation(s)
- Rui He
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Ran Xiong
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Mao-Lin Sun
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Jun-Jun Yang
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Hao Chen
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Peng-Fei Yang
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military University (Amy Medical University), Chongqing, 400038, China.
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9
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Young-Shand KL, Roy PC, Dunbar MJ, Abidi SSR, Astephen Wilson JL. Gait biomechanics phenotypes among total knee arthroplasty candidates by machine learning cluster analysis. J Orthop Res 2023; 41:335-344. [PMID: 35538599 DOI: 10.1002/jor.25363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/28/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
Knee osteoarthritis patient phenotyping is relevant to developing targeted treatments and assessing the treatment efficacy of total knee arthroplasty (TKA). This study aimed to identify clusters among TKA candidates based on demographic and knee mechanic features during gait, and compare gait changes between clusters postoperatively. TKA patients underwent 3D gait analysis 1-week pre (n = 134) and 1-year post-TKA (n = 105). Principal component analysis was applied to frontal and sagittal knee angle and moment waveforms, extracting major patterns of variability. Age, sex, body mass index, gait speed, and frontal and sagittal pre-TKA angle and moment PC scores previously identified as relevant to TKA outcomes were standardized (mean = 0, SD = 1, [134 × 15]). Multidimensional scaling and machine learning-based hierarchical clustering were applied. Final clusters were validated by examining intercluster differences pre-TKA and gait feature changes (PostPCscore - PrePCscore ) by k-way Χ2 and ANOVA tests. Four TKA candidate phenotypes yielded optimum clustering metrics, interpreted as higher and lower functioning clusters that were predominantly male and female. Higher functioning clusters pre-TKA (clusters 1 and 4) had more dynamic sagittal flexion moment (p < 0.001) and frontal plane adduction moment (p < 0.001) loading/un-loading patterns during stance. Post-TKA, higher functioning clusters demonstrated less knee mechanic improvements during gait (flexion angle p < 0.001; flexion moment p < 0.001). TKA candidates can be characterized by four clusters, predominately separated by sex and knee joint biomechanics. Post-TKA knee kinematics and kinetics improvements were cluster-specific; lower functioning clusters experienced more improvement. Cluster-based patient profiling may aid in triaging and developing OA management and surgical strategies meeting group-level function needs.
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Affiliation(s)
- Kathryn L Young-Shand
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrice C Roy
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Syed S R Abidi
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janie L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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10
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Lee PA, Wang TM, Chen YT, Wu KH, Liu HC, Lu TW. Mid-vastus total knee arthroplasty for medial osteoarthritis recovers gait balance control better than lateral parapatellar approach three months post-surgery. Front Bioeng Biotechnol 2023; 11:1133992. [PMID: 37034249 PMCID: PMC10073553 DOI: 10.3389/fbioe.2023.1133992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Total knee arthroplasty (TKA) approaches affect recovery outcomes, with different levels of residual loss of muscle strength and functional deficits. The current study compared the gait balance control in older individuals 3 months after TKA via the lateral parapatellar approach (LPPA) and mid-vastus approach (MVA) in terms of the inclination angle (IA) of the center of pressure (COP) to the body's center of mass (COM) vector, and the rate of change of IA (RCIA). In a gait laboratory, 12 patients with severe medial knee osteoarthritis who had undergone bilateral TKA via LPPA and 12 via MVA were evaluated and compared against 12 healthy controls for their balance control during gait 3 months after surgery. The participants' kinematic data and ground reaction forces were measured synchronously using an 8-camera motion capture system and three forceplates, respectively, from which the COM, COP, IA and RCIA were calculated using a 13-body-segment model. The LPPA group showed significantly greater sagittal IA during DLS (p < 0.01) but less sagittal and frontal RCIA throughout the gait cycle (p < 0.04) compared to controls. The MVA showed better recovery in the balance control with most IA and RCIA variables similar to those of the healthy controls throughout the gait cycle. The patients with LPPA walked with a compromised balance control throughout the gait cycle while the MVA group showed close-to-normal balance control with a slight decrease in sagittal RCIA during SLS. The current between-approach findings were likely related to the differences in the muscles involved during surgery, suggesting that MVA may be a better choice than LPPA when taking short-term gait balance control into consideration.
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Affiliation(s)
- Pei-An Lee
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ting Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Kuan-Hsien Wu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Hwa-Chang Liu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopaedic Surgery, Taiwan Adventist Hospital National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Tung-Wu Lu, ; Hwa-Chang Liu,
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
- *Correspondence: Tung-Wu Lu, ; Hwa-Chang Liu,
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11
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Fukaya T, Mutsuzaki H, Mori K. Sway and Acceleration Changes of the Center of Mass during Walking Stance Phase before and after Total Knee Arthroplasty. Geriatrics (Basel) 2022; 8:geriatrics8010002. [PMID: 36648907 PMCID: PMC9844275 DOI: 10.3390/geriatrics8010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Elucidating the sway and changes in the acceleration of center of mass (COM) during walking is important for effective gait training and rehabilitation. The objective of this study was to verify the improvement in gait before and after total knee arthroplasty (TKA) from COM sway and the changes in the acceleration of COM during the stance phase of walking. This study included 13 patients (1 male and 12 females) with medial knee osteoarthritis who were hospitalized for TKA. The COM sway during the stance phase of walking was evaluated using root mean square (RMS) normalized by walking speed, and the changes in acceleration were further verified. Lateral and vertical RMS showed significant differences between preoperative and postoperative states and demonstrated low values after TKA. The lateral acceleration at the latter part of the early stance phase demonstrated a significant difference between preoperative and postoperative states. A significant difference was also observed in the lateral acceleration in the late stance phase between the two groups. Improvement in pain and alignment after TKA reduced the lateral sway of COM and the changes in acceleration during the gait stance phase, which is speculated to lead to improvement in gait and prevention of falls.
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Affiliation(s)
- Takashi Fukaya
- Department of Physical Therapy, Faculty of Health Sciences, Tsukuba International University, 6-8-33 Manabe, Tsuchiura 300-0051, Japan
- Correspondence:
| | - Hirotaka Mutsuzaki
- Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
| | - Koichi Mori
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
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12
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Carozzo S, Vatrano M, Coschignano F, Battaglia R, Calabrò RS, Pignolo L, Contrada M, Tonin P, Cerasa A, Demeco A. Efficacy of Visual Feedback Training for Motor Recovery in Post-Operative Subjects with Knee Replacement: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11247355. [PMID: 36555971 PMCID: PMC9783629 DOI: 10.3390/jcm11247355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/21/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
To evaluate the effects of visual feedback training on motor recovery in postoperative patients with a total knee replacement (TKR). The performance of 40 first-ever TKR patients (27 females; mean age: 70.5 (67.2−74.0) years) was evaluated in a single center, single-blind, randomized controlled study. The patients were randomly and equally distributed into two demographically/clinically matched groups undergoing experimental or traditional treatments. All patients have been treated in a 1 h session, 2/day for 5 days a week, for six consecutive weeks. The first group (“control”) underwent conventional physical therapy, whereas the experimental group received advanced knee training with visual feedback using the TecnoBody® device (Walker View 3.0 SCX, Dalmine (BG), Italy). The clinical scales and kinematic parameters coming from the gait analysis were evaluated to demonstrate the dynamic balance function in a standing position before and after each treatment. After the treatment, both experimental and control groups improved significantly and similarly, as measured by the clinical scales (Numeric Rating Scale for Pain and Barthel index). A significant boosting of the motor performance was detected in the experimental group with respect to the control group in the terms of symmetry index 84 (80.8−85.4) vs. 87.15 (84−92.8) p = 0.001 *; single stance support 34.9 (34.1−36.5) vs. 37.8 (36.6−38.9); p < 0.001; and obliquity parameters 58.65 (51.3−70.3) vs. 73 (62.3−82.1); p < 0.001. Applying visual feedback training in addition to traditional rehabilitation strategies improves the knee function and motor control in postoperative TKR patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Antonio Cerasa
- S’Anna Institute, 88900 Crotone, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
- Correspondence: (A.C.); (A.D.)
| | - Andrea Demeco
- S’Anna Institute, 88900 Crotone, Italy
- Correspondence: (A.C.); (A.D.)
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13
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Lee PA, Liu HC, Chen TY, Wang TM, Lu TW. Recovery of balance control in bilateral medial knee osteoarthritis after total knee arthroplasty during level walking. J Orthop Res 2022; 40:1993-2003. [PMID: 34866219 DOI: 10.1002/jor.25234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/01/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Older adults are at higher risk of falling following total knee arthroplasty (TKA). However, it remains unclear how long a full recovery of the balance control during gait post-TKA will take. The current study aimed to bridge this knowledge gap via long-term follow-up gait analyses. Twelve older adults with severe bilateral medial knee osteoarthritis (OA) before, 3 and 12 months after TKA, and twelve healthy controls were evaluated for their balance control during level walking, in terms of the inclination angle (IA) of the center of pressure to center of mass vector, and the rate of change of IA (RCIA). The patients before TKA showed significantly increased sagittal IA but decreased RCIA throughout the gait cycle (p < 0.04) compared to controls, suggesting a compromised balance control. Three months post-TKA, deviations in IA remained, although those in RCIA were improved to normal. One-year post-TKA, no significant differences were found in any of the IA- and RCIA-related variables between patient and Control groups. The results show that TKA surgery was effective in reducing the deviations in the center of mass-center of pressure control in patients with severe bilateral knee OA, and full recovery of balance control can be expected 1 year after surgery.
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Affiliation(s)
- Pei-An Lee
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Hwa-Chang Liu
- Department of Orthopaedic Surgery, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Tsan-Yang Chen
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, National Taiwan University, Taipei, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, National Taiwan University, Taipei, Taiwan
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14
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Usami T, Nishida K, Iguchi H, Okumura T, Sakai H, Ida R, Horiba M, Kashima S, Sahashi K, Asai H, Nagaya Y, Murakami H, Ueki Y, Kuroyanagi G. Evaluation of lower extremity gait analysis using Kinect V2 ® tracking system. SICOT J 2022; 8:27. [PMID: 35748723 PMCID: PMC9231176 DOI: 10.1051/sicotj/2022027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Microsoft Kinect V2® (Kinect) is a peripheral device of Xbox® and acquires information such as depth, posture, and skeleton definition. In this study, we investigated whether Kinect can be used for human gait analysis. Methods: Ten healthy volunteers walked 20 trials, and each walk was recorded by a Kinect and infrared- and marker-based-motion capture system. Pearson’s correlation and overall agreement with a method of meta-analysis of Pearson’s correlation coefficient were used to assess the reliability of each parameter, including gait velocity, gait cycle time, step length, hip and knee joint angle, ground contact time of foot, and max ankle velocity. Hip and knee angles in one gait cycle were calculated in Kinect and motion capture groups. Results: The coefficients of correlation for gait velocity (r = 0.92), step length (r = 0.81) were regarded as strong reliability. Gait cycle time (r = 0.65), minimum flexion angle of hip joint (r = 0.68) were regarded as moderate reliability. The maximum flexion angle of the hip joint (r = 0.43) and maximum flexion angle of the knee joint (r = 0.54) were regarded as fair reliability. Minimum flexion angle of knee joint (r = 0.23), ground contact time of foot (r = 0.23), and maximum ankle velocity (r = 0.22) were regarded as poor reliability. The method of meta-analysis revealed that participants with small hip and knee flexion angles tended to have poor correlations in maximum flexion angle of hip and knee joints. Similar trajectories of hip and knee angles were observed in Kinect and motion capture groups. Conclusions: Our results strongly suggest that Kinect could be a reliable device for evaluating gait parameters, including gait velocity, gait cycle time, step length, minimum flexion angle of the hip joint, and maximum flexion angle of the knee joint.
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Affiliation(s)
- Takuya Usami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan - Nagoya City University East Medical Center, Nagoya, Aichi 464-8547, Japan
| | - Kazuki Nishida
- Center for Advanced Medicine and Clinical Research Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Hirotaka Iguchi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Taro Okumura
- National Hospital Organization Toyohashi Medical Center, Nagoya, Aichi 440-8510, Japan
| | - Hiroaki Sakai
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Ruido Ida
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Mitsuya Horiba
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Shuuto Kashima
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Kento Sahashi
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Hayato Asai
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Yuko Nagaya
- Nagoya City University East Medical Center, Nagoya, Aichi 464-8547, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Yoshino Ueki
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Gen Kuroyanagi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan - Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
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15
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Sasaki R, Niki Y, Kaneda K, Yamada Y, Nagura T, Nakamura M, Jinzaki M. A novel anteroposterior axis of the tibia for total knee arthroplasty: An upright weight-bearing computed tomography analysis. Knee 2022; 36:80-86. [PMID: 35561561 DOI: 10.1016/j.knee.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 03/13/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The traditional anteroposterior (AP) axis (i.e., Akagi's line) has been widely used as the tibial component AP axis during total knee arthroplasty (TKA). However, this AP axis has been defined based on computed tomography (CT) in a non-weight-bearing supine position. In this study, AP axes of the tibial plateau from upright CT in weight-bearing and non-weight-bearing positions were determined and compared. METHODS This study included 43 knees from 23 healthy volunteers. CT images were obtained in weight-bearing and non-weight-bearing standing positions using a 320-detector row upright CT scanner. The line perpendicular to surgical transepicondylar axis projected onto the tibia plateau was determined as the AP axis in upright weight-bearing and non-weight-bearing conditions. Angular differences between these two conditions were measured. RESULTS The upright weight-bearing AP axis was positioned in a mean of 7.4 ± 4.3° of internal rotation relative to the traditional AP axis. Distance between the traditional and upright weight-bearing AP axis was 2.9 ± 1.6 mm at the edge of the tibial plateau. The upright non-weight-bearing AP axis was positioned in a mean of 3.5 ± 4.1° of internal rotation relative to the traditional AP axis. Mean angular difference between weight-bearing and non-weight-bearing conditions was 3.9 ± 4.1°. CONCLUSIONS The upright weight-bearing AP axis was positioned in 7.4° of internal rotation relative to the traditional AP axis, showing one-seventh of the tibial tuberosity away from the medial border of the tibial tubercle, which represents a practical landmark for the tibial component AP axis during TKA.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Kazuya Kaneda
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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16
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Biggs P, Holsgaard-Larsen A, Holt CA, Naili JE. Gait function improvements, using Cardiff Classifier, are related to patient-reported function and pain following hip arthroplasty. J Orthop Res 2022; 40:1182-1193. [PMID: 34330149 DOI: 10.1002/jor.25149] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
Summarizing results of three-dimensional (3D) gait analysis into a comprehensive measure of overall gait function is valuable to discern to what extent gait function is affected, and later recovered after surgery and rehabilitation. This study aimed to investigate whether preoperative gait function, quantified and summarized using the Cardiff Classifier, can predict improvements in postoperative patient-reported activities of daily living, and overall gait function 1 year after total hip arthroplasty (THA). Secondly, to explore relationships between pre-to-post surgical change in gait function versus changes in patient-reported and performance-based function. Thirty-two patients scheduled for THA and 25 nonpathological individuals were included in this prospective cohort study. Patients were evaluated before THA and 1 year postoperatively using 3D gait analysis, patient-reported outcomes, and performance-based tests. Kinematic and kinetic gait parameters, derived from 3D gait analysis, were quantified using the Cardiff Classifier. Linear regressions investigated the predictive value of preoperative gait function on postoperative outcomes of function, and univariate correlations explored relationships between pre-to-post surgical changes in outcome measures. Preoperative gait function, by means of Cardiff Classifier, explained 35% and 30% of the total variance in change in patient-reported activities of daily living, and in gait function, respectively. Moderate-to-strong correlations were found between change in gait function and change in patient-reported function and pain, while no correlations were found between change in gait function and performance-based function. Clinical significance: Preoperative gait function predicts postsurgical function to a moderate degree, while improvements in gait function after surgery are more closely related to how patients perceive function than their maximal performance of functional tests.
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Affiliation(s)
- Paul Biggs
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK
| | - Anders Holsgaard-Larsen
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Cathy A Holt
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK
| | - Josefine E Naili
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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17
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Rapagna S, Roberts BC, Solomon LB, Reynolds KJ, Thewlis D, Perilli E. Relationships between tibial articular cartilage, in vivo external joint moments and static alignment in end-stage knee osteoarthritis: A micro-CT study. J Orthop Res 2022; 40:1125-1134. [PMID: 34191337 DOI: 10.1002/jor.25140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/16/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
Biomechanical factors (e.g., joint loading) have a significant role in the progression of osteoarthritis (OA). However, some relationships between in vivo joint loading indices and tibial cartilage thickness are conflicting. This study investigated relationships between pre-operative in vivo external knee joint moments, joint alignment and regional tibial cartilage thickness using micro-CT in subjects with end-stage knee OA. Tibial plateaus from 25 patients that underwent knee replacement for OA were micro-CT scanned (17 µm/voxel). Prior to surgery, subjects underwent gait analysis to calculate external knee moments. The mechanical axis deviation (MAD) was obtained from pre-operative radiographs. Cartilage thickness (Cart.Th) was analyzed from micro-CT images, in anteromedial, anterolateral, posteromedial and posterolateral subregions of interest. Medial-to-lateral Cart.Th ratios were also explored. Relationships between Cart.Th and joint loading indices were examined using Pearson's correlations. Significant correlations were found between Cart.Th and joint loading indices, positive anteromedially with the first peak knee adduction moment (r = 0.55, p < 0.01) and external rotation moment (ERM; r = 0.52, p < 0.01), and negative with MAD (r = -0.76, p < 0.001). In the lateral regions, these correlations had opposite signs. The medial-to-lateral Cart.Th ratio correlated strongly with ERM (r = 0.63, p = 0.001) and MAD (r = -0.75, p < 0.001). Joint loading indices correlated with regional cartilage thickness values and their medial-to-lateral ratios in end-stage knee OA subjects, with higher regional loads corresponding to thinner cartilage. These relationships have the opposite sign compared to the subchondral bone microarchitecture found in our previous study on the same specimens, which may suggest a complementary bone-cartilage interplay in response to loading.
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Affiliation(s)
- Sophie Rapagna
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Bryant C Roberts
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia.,Department of Oncology & Metabolism and Insigneo Institute for in silico Medicine, The University of Sheffield, Sheffield, UK
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Karen J Reynolds
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Egon Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
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18
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Giuntoli M, Scaglione M, Bonicoli E, Piolanti N, Puccioni G, Zepeda K, Giannini E, Marchetti S, Indelli PF. Intraoperative Load Sensing in Total Knee Arthroplasty Leads to a Functional but Not Clinical Difference: A Comparative, Gait Analysis Evaluation. J Funct Morphol Kinesiol 2022; 7:jfmk7010023. [PMID: 35225909 PMCID: PMC8883885 DOI: 10.3390/jfmk7010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Although Total Knee Arthroplasty (TKA) is a successful procedure, a significant number of patients are still unsatisfied, reporting instability at the mid-flexion range (Mid-Flexion Instability-MFI). To avoid this complication, many innovations, including load sensors (LS), have been introduced. The intraoperative use of LS may facilitate the balance of the knee during the entire range of motion to avoid MFI postoperatively. The objective of this study was to perform a Gait Analysis (GA) evaluation of a series of patients who underwent primary TKA using a single LS technology. METHODS The authors matched and compared two groups of patients treated with the same posterior stabilized TKA design. In Group A, 10 knees were intraoperatively balanced with LS technology, while 10 knees (Group B) underwent standard TKA. The correct TKA alignment was preoperatively determined aiming for a mechanical alignment. Clinical evaluation was performed according to the WOMAC, Knee Society Score (KSS) and Forgotten Joint Score, while functional evaluation was performed using a state-of-the-art GA platform. RESULTS We reported excellent clinical results in both groups without any statistical difference in patient reported outcome measurements (PROMs); from a functional standpoint, several GA space-time parameters were closer to normal in the sensor group when compared to the standard group, but a statistically significant difference was not reached. CONCLUSIONS Gait Analysis represents a valid method to evaluate TKA kinematics. This study, with its limitations, showed that pressure sensitive technology represents a valid aid for surgeons aiming to improve the postoperative stability of TKA; however, other factors (i.e., level of intra-articular constraint and alignment) may play a major role in reproducing the normal knee biomechanics.
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Affiliation(s)
- Michele Giuntoli
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
- Correspondence:
| | - Michelangelo Scaglione
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Enrico Bonicoli
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Nicola Piolanti
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Gianmarco Puccioni
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Karlos Zepeda
- Harlem Campus, Touro College of Osteopathic Medicine, Harlem, New York, NY 10027, USA;
| | | | - Stefano Marchetti
- Department of Orthopaedic Surgery, University of Pisa, Via Paradisa 2, Cisanello, 56124 Pisa, Italy; (M.S.); (E.B.); (N.P.); (G.P.); (S.M.)
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA;
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19
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Bilek F, Deniz G, Esmez O, Belhan O. Spatiotemporal parameters of the operated and non-operated knees before and after unilateral total knee arthroplasty. Gait Posture 2022; 91:192-197. [PMID: 34736097 DOI: 10.1016/j.gaitpost.2021.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/06/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis is a common condition in various orthopedic clinics and hospitals. The aim of this study was to investigate the effects of unilateral total knee arthroplasty (TKA) application on short and long-term spatiotemporal gait parameters, maximum plantar pressure (MPP), and functional status in patients with knee osteoarthritis. RESEARCH QUESTION What is the change process in spatiotemporal parameters without any intervention before and after TKA surgery? METHODS This study is a prospective and cross-sectional study. Participants were assessed preoperatively at the 1st week (Pre1W), postoperative 1st month (Post1M) and 6th month (Post6M). Spatiotemporal parameters and MMP were assessed using the Win Track platform (Medicapteurs Technology, France) and functional states were assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the Lequesne Index. RESULTS Significant improvements were found in the WOMAC and Lequesne Index values in the Post1M and Post6M periods compared to the preoperative period. However, the improvement in WOMAC and Lequesne Index scores in the Post6M period was significant compared to the scores in the Post1M period (p < 0.01). Spatiotemporal parameters deteriorated in the Post1M period, while improvements were observed in the Post6M period. We observed that patients had worse gait parameters in the near postoperative period than before surgery. It was the period with the greatest improvements in long-term outcomes. SIGNIFICANCE In the light of our study results, we think that early gait disturbances in patients who underwent direct TKA may be caused by physiological processes. Therefore, we believe that there is no need for any intervention for gait disorders that occur in the early postoperative period.
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Affiliation(s)
- Furkan Bilek
- Fırat University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 23119 Elazig, Turkey.
| | - Gulnihal Deniz
- Fırat University, Faculty of Medicine, Department of Anatomy, 23119 Elazig, Turkey.
| | - Omer Esmez
- Fırat University, Faculty of Medicine, Department of Orthopedics, 23119 Elazig, Turkey.
| | - Oktay Belhan
- Fırat University, Faculty of Medicine, Department of Orthopedics, 23119 Elazig, Turkey.
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20
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Rao L, Taylor WR, Horn N, List R, Preiss S, Schütz P. Can tibio-femoral kinematic and kinetic parameters reveal poor functionality and underlying deficits after total knee replacement? A systematic review. Knee 2022; 34:62-75. [PMID: 34883331 DOI: 10.1016/j.knee.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/13/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extensive efforts have been made to understand joint kinematics and kinetics in total knee arthroplasty (TKA) in subjects with satisfactory outcomes during daily functional activities and clinical tests, but it remains unclear whether such movement characteristics hold the potential to indicate the underlying aetiology of unsatisfactory or bad TKA outcomes. PURPOSE To investigate which kinematic and kinetic parameters assessed during passive clinical tests and functional activities of daily living are associated with poor functionality and underlying deficits after total knee replacement. METHODS We focused on studies characterizing the kinematic or kinetic parameters of the knee joint that are associated with poor clinical outcome after TKA. Seventeen articles were included for the review, and kinematic and kinetic data from 719 patients with minimal follow up of 6 months were extracted and analyzed. RESULTS Passive posterior translation at 90°flexionexhibited good potential for differentiating stable and unstable TKAs. Anterior-posterior (A-P) translation of the medial condyle at 0-30° and 30-60° flexion, A-P translation of the lateral condyle at 60-90°during closed chain exercises, as well asknee extension moment during stair ascent and descent, knee abduction moment during stair descent, knee internal rotation moment and plantar flexion moment during walking, 2ndpeak ground reaction force during stair ascent and walkingshowed the greatest promise as functional biomarkers for a dissatisfied/poor outcome knee after TKA. CONCLUSION In this study, we systematically reviewed the state-of-the-art knowledge of kinematics and kinetics associated with functional deficits, and found 11 biomechanical parameters that showed promise for supportingdecision making in TKA.
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Affiliation(s)
- L Rao
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - W R Taylor
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland.
| | - N Horn
- Schulthess Clinic, Zürich, Switzerland
| | - R List
- Schulthess Clinic, Zürich, Switzerland
| | - S Preiss
- Schulthess Clinic, Zürich, Switzerland
| | - P Schütz
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
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21
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Similar Biomechanical Behavior in Gait Analysis between Ceramic-on-Ceramic and Ceramic-on-XLPE Total Hip Arthroplasties. Life (Basel) 2021; 11:life11121366. [PMID: 34947897 PMCID: PMC8704359 DOI: 10.3390/life11121366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 12/02/2022] Open
Abstract
In vitro measurements are widely used to implement gait kinematic and kinetic parameters to predict THA wear rate. Clinical tests of materials and designs are crucial to prove the accuracy and validate such measurements. This research aimed to examine the effect of CoC and CoXLPE kinematics and kinetics on wear during gait, the essential functional activity of humans, by comparing in vivo data to in vitro results. Our study hypothesis was that both implants would present the same hip joint kinematics and kinetics during gait. In total, 127 unilateral primary cementless total hip arthroplasties were included in the research. There were no statistically significant differences observed at mean peak abduction, flexion, and extension moments and THA kinematics between the two groups. THA gait kinematics and kinetics are crucial biomechanical inputs associated with implant wear. In vitro studies report less wear in CoC than CoXLPE when tested in a matched gait kinematic protocol. Our findings confirm that both implants behave identically in terms of kinematics in a clinical environment, thus strengthening CoC advantage in in vitro results. Correlated to all other significant factors that affect THA wear, it could address in a complete prism the wear on CoC and CoXLPE.
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22
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Li Z, Sun X, Li W, Zhang M. Tranexamic Acid versus Epsilon-Aminocaproic Acid in Total Knee Arthroplasty: A Meta-Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1758066. [PMID: 34777729 PMCID: PMC8580677 DOI: 10.1155/2021/1758066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/20/2021] [Indexed: 11/30/2022]
Abstract
Objective At present, the effect of tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA) on total knee arthroplasty (TKA) remains controversial. Therefore, the aim of this meta-analysis is to compare the differences between the effects of TXA and EACA in TKA. Methods We used electronic databases, including PubMed, Embase, MEDLINE, Ovid, ScienceDirect, Cochran Library, Google Scholar, clinical trial, and Chinese related databases, for literature search to find any effect of TXA and EACA in TKA. The differences between groups were compared by odds ratio (OR), weighted mean difference (WMD), and 95% confidence interval (CI). A total of four studies, including 3 randomized controlled trials (RCT) and 1 cohort study, were involved in this meta-analysis, involving 1836 participants. Among these participants, 816 belonged to the TXA group and 1020 belonged to the EACA group. Results Meta-analysis indicated no difference in surgery time (WMD = 0.01, 95% CI -0.35 to 0.36), total amount of blood loss (WMD = 0.14, 95% CI -0.09 to 0.37), transfusion rate (OR = 0.74, 95% CI 0.20 to 2.78), transfusion units per patient (SMD = -0.15, 95% CI -0.54 to 0.25), complications (OR = 0.75, 95% CI 0.37 to 1.55), and length of stay (SMD = -0.01, 95% CI -0.11 to 0.08). Conclusions Our results suggest that the effect of TXA is not superior to EACA in TKA. However, this conclusion still needs to be further confirmed by multicenter and large-sample clinical trials.
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Affiliation(s)
- Zhihui Li
- Department of Trauma Center, Huaihe Hospital of Henan University, Kaifeng 475000, China
| | - Xiaotong Sun
- Department of Trauma Orthopedics, Zaozhuang Municipal Hospital, No. 41 Longtou Road, Zaozhuang City, Shandong Province, China
| | - Weihua Li
- Department of Trauma Center, Huaihe Hospital of Henan University, Kaifeng 475000, China
| | - Minghui Zhang
- Department of Trauma Center, Huaihe Hospital of Henan University, Kaifeng 475000, China
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23
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Yocum D, Reinbolt J, Weinhandl JT, Standifird TW, Fitzhugh E, Cates H, Zhang S. Principal Component Analysis of Knee Joint Differences Between Bilateral and Unilateral Total Knee Replacement Patients During Level Walking. J Biomech Eng 2021; 143:111003. [PMID: 34159353 DOI: 10.1115/1.4051524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/08/2022]
Abstract
Many unilateral total knee replacement (TKR) patients will need a contralateral TKR. Differences in knee joint biomechanics between bilateral patients and unilateral patients are not well established. The purpose of this study was to examine knee joint differences in level walking between bilateral and unilateral patients, and asymptomatic controls, using principal component analysis. Knee joints of 1st replaced limbs of 15 bilateral patients (69.40 ± 5.04 years), 15 replaced limbs of unilateral patients (66.47 ± 6.15 years), and 15 asymptomatic controls (63.53 ± 9.50 years) were analyzed during level walking. Principal component analysis examined knee joint sagittal- and frontal-plane kinematics and moments, and vertical ground reaction force (GRF). A one-way analysis of variance analyzed differences between principal component scores of each group. TKR patients exhibited more flexed and abducted knees throughout stance, decreased sagittal knee range of motion (ROM), increased early-stance adduction ROM, decreased loading-response knee extension and push-off knee flexion moments, decreased loading-response and push-off peak knee abduction moment (KAbM), increased KAbM at midstance, increased midstance vertical GRF, and decreased loading-response and push-off vertical GRF. Additionally, bilateral patients exhibited reduced sagittal knee ROM, increased adduction ROM, decreased sagittal knee moments throughout stance, decreased KAbM throughout stance, an earlier loading-response peak vertical GRF, and a decreased push-off vertical GRF, compared to unilateral patients. TKR patients, especially bilateral patients had stiff knee motion in the sagittal-plane, increased frontal-plane joint laxity, and a quadriceps avoidance gait.
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Affiliation(s)
- Derek Yocum
- South Bend Orthopaedics, South Bend, IN 46635
| | - Jeffrey Reinbolt
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN 37916
| | - Joshua T Weinhandl
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996
| | - Tyler W Standifird
- Department of Exercise Science and Outdoor Recreation, Utah Valley University, Orem, UT 84058
| | - Eugene Fitzhugh
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996
| | - Harold Cates
- Tennessee Orthopaedic Clinics, Knoxville, TN 37923
| | - Songning Zhang
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996
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24
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Bourdon CE, Broberg JS, McCalden RW, Naudie DD, MacDonald SJ, Lanting BA, Teeter MG. Comparison of long-term kinematics and wear of total knee arthroplasty implant designs. J Mech Behav Biomed Mater 2021; 124:104845. [PMID: 34555623 DOI: 10.1016/j.jmbbm.2021.104845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/23/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022]
Abstract
We sought to evaluate wear and kinematics in well-established implants of posterior stabilized (PS) and cruciate retaining (CR) designs. Ninety-one knees implanted for at least five years were examined. The implants were Genesis II PS (Smith & Nephew, Memphis, TN), Sigma PS (DePuy Synthes, Warsaw, IN), or Sigma CR. Radiostereometric analysis (RSA) images were acquired at multiple flexion angles and the 3D positions of the implant components were determined using model-based RSA software. The location of the center of the contact area between the femoral and polyethylene components was used to obtain contact kinematics, and the magnitude of the virtual intersection between the components indicated linear wear. All three groups had paradoxical anterior motion on both condyles, experienced similar net external rotation, and exhibited instances of internal rotation during flexion. The maximum observed wear rate was significantly greater for the Sigma PS than the Genesis II PS on the medial condyle (mean difference = 0.032 mm/year, p = 0.044), but not the lateral condyle, while there was no difference between the Sigma PS and Sigma CR for either condyle. Knees with lateral condylar separation had greater maximum wear rates on the medial condyle (mean difference = 0.033 mm/year, p = 0.001), while those with medial condylar separation had greater maximum wear rates on the lateral condyle (mean difference = 0.044 mm/year, p = 0.014). At long term follow-up in patients with well-functioning implants, there were differences in kinematics and wear resistance between implants. These results suggest that implant design affects long-term kinematics and wear in well-functioning implants and that condylar separation should be avoided to minimize wear.
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Affiliation(s)
- Caleigh E Bourdon
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Jordan S Broberg
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada; Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Richard W McCalden
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Douglas D Naudie
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Steven J MacDonald
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Brent A Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, Canada; Orthopaedics Program, Lawson Health Research Institute, Canada.
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Christensen JC, Capin JJ, Hinrichs LA, Aljehani M, Stevens-Lapsley JE, Zeni JA. Gait mechanics are influenced by quadriceps strength, age, and sex after total knee arthroplasty. J Orthop Res 2021; 39:1523-1532. [PMID: 33034899 PMCID: PMC8635453 DOI: 10.1002/jor.24878] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 02/04/2023]
Abstract
Although most patients are satisfied with outcomes after total knee arthroplasty (TKA), many retain preoperative altered gait mechanics. Identifying patient characteristics associated with gait mechanics will improve rehabilitation strategies and enhance our understanding of movement disorders. Therefore, the purpose of this study was to identify which patient characteristics are related to gait mechanics in the surgical limb during walking post-TKA. Patient characteristics included age, body mass, sex, quadriceps strength, self-reported function, and knee pain. General linear regression was used to compare patient characteristics associated with gait mechanics, after controlling for gait speed, functional capacity and time from surgery. We tested 191 patients cross-sectionally at 6-24 months after primary, unilateral TKA. Quadriceps weakness in the surgical limb was associated with less peak vertical ground reaction force (PvGRF) (β = .245, p = .044), knee extension moment (β = .283, p = .049), and knee extension excursion (β = .298, p = .038). Older age (β = .168, p = .050) was associated with less PvGRF. Quadriceps strength in the nonsurgical limb (β = -.357, p = .021) was associated with greater knee extension excursion in the surgical limb. Females with TKA (β = -.276, p = .007) had less knee flexion excursion compared to males. Faster gait speed was also associated with greater PvGRF (β = .585, p < .001), knee extensor moment (β = .481, p < .001), and knee flexion excursion (β = .318, p < .001). Statement of Clinical Significance: This study showed quadriceps weakness, slower gait speed, older age and being female were related to altered gait mechanics post-TKA. These findings will help clinicians better educate patients and develop targeted interventions for improving care in patients post-TKA.
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Affiliation(s)
- Jesse C. Christensen
- Veterans AffairsSalt Lake City Health Care System, Department of Physical Medicine and Rehabilitation,University of Utah, Department of Physical Therapy & Athletic Training, 520 So. Wakara Way, Salt Lake City, UT, USA, 84108
| | - Jacob J. Capin
- Eastern Colorado Veterans Affairs, Geriatric Research Education and Clinical Center,University of Colorado, Department of Physical Medicine and Rehabilitation, 13001 E. 17th Pl., Aurora, CO, USA, 80045
| | - Lauren A. Hinrichs
- University of Colorado, Department of Physical Medicine and Rehabilitation, 13001 E. 17th Pl., Aurora, CO, USA, 80045
| | - Moiyad Aljehani
- Department of Physical Therapy, University of Delaware, 540 S. College Ave., Newark, DE, USA, 19713,Department of Physical Therapy, Umm Al-Qura University, P.O. Box 715, Makkah, 21421, Saudi Arabia
| | - Jennifer E. Stevens-Lapsley
- University of Colorado, Department of Physical Medicine and Rehabilitation, 13001 E. 17th Pl., Aurora, CO, USA, 80045
| | - Joseph A. Zeni
- Doctor of Physical Therapy – North, Department of Rehabilitation and Movement Science, School of Health Professions, Rutgers, The State University of New Jersey, 65 Bergen St. Suite 120, Newark, NJ, USA, 07107
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26
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Overground Walking Biomechanics of Dissatisfied Persons With Total Knee Replacements. J Appl Biomech 2021; 37:365-372. [PMID: 34051697 DOI: 10.1123/jab.2020-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/24/2021] [Accepted: 04/08/2021] [Indexed: 11/18/2022]
Abstract
Patient dissatisfaction following total knee replacement (TKR) procedures is likely influenced by both subjective and objective aspects. Increased pain and reduced performance on clinical tests have been shown in persons who are dissatisfied with the outcome of their surgery. However, it is unknown how overground walking kinematics and kinetics might differ in the dissatisfied versus satisfied patients following TKR surgery. This study compared the lower-extremity walking kinematics and kinetics of patients dissatisfied with their TKR to that of satisfied patients and healthy controls. Thirty nine subjects completed walking trials, including nine dissatisfied and 15 satisfied TKR patients and 15 healthy controls. A 2 × 3 repeated -measures analysis of variance was used to assess differences between groups and limbs (P < .05). Dissatisfied persons showed significantly reduced loading-response and push-off peak vertical ground reaction forces, flexion range of motion, loading-response extension moments, and loading-response abduction moments compared to the controls. Peak loading-response and push-off vertical ground reaction forces and flexion range of motion were reduced in the replaced limb of dissatisfied patients compared with their nonreplaced limb. Push-off plantar flexion moments were reduced in the dissatisfied patients compared with the satisfied and healthy controls. Dissatisfied patients also reported increased knee joint pain and reduced preferred gait speed. Moreover, dissatisfied patients experienced mechanical limb asymmetries not present in those satisfied with their surgery result. Thus, patients dissatisfied with their total knee replacement outcome were found to be experiencing significant negative physiological changes.
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27
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Kim JK, Park IW, Ro DH, Mun BS, Han HS, Lee MC. Is a Titanium Implant for Total Knee Arthroplasty Better? A Randomized Controlled Study. J Arthroplasty 2021; 36:1302-1309. [PMID: 33349499 DOI: 10.1016/j.arth.2020.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Lighter weight and lower modulus are potential advantages of titanium (Ti) implants over cobalt chrome (CoCr) implants in total knee arthroplasty (TKA). This study was conducted to determine whether Ti implants in TKA resulted in better clinical outcomes and radiologic results. METHODS One hundred and eight patients (216 knees) with knee arthritis warranting bilateral primary TKA were randomly allocated to undergo Ti rotating-platform TKA in one knee and CoCr rotating-platform TKA in the contralateral knee. The mean follow-up period was 5.3 years (range, 1-7 years). The weight of Ti implants was one-third lighter than that of CoCr implants (133.9 g vs 390.1 g, P < .01). Clinical outcomes were evaluated using clinical scores, patient preferences (lightness, comfort, naturalness, and satisfaction), gait analysis (kinetic and kinematic data), range of motion, and degree of pain. Radiologic results were evaluated based on the radiolucent line (RLL), degree of medial tibial bone loss, and loosening as seen on X-ray. RESULTS No significant differences were observed in clinical scores or patient preference. Regarding implant weight, approximately 70% of patients did not perceive the Ti implant as lighter. No significant differences were observed in gait analysis, range of motion, or degree of pain. The RLL was seen in 9% of the Ti implant group and 19% of the CoCr implant group. CONCLUSION The lighter Ti implant did not show any clinical benefit over CoCr implants. The lightness of the Ti implant is not sufficient to matter or be noticeable. However, the Ti implant showed lower rate of RLL than the CoCr implant. LEVEL OF EVIDENCE level I, randomized controlled trial.
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Affiliation(s)
- Jong-Keun Kim
- Department of Orthopedic Surgery, Hanil General Hospital, Seoul, South Korea
| | - In Woong Park
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Bong-Su Mun
- Department of Orthopedic Surgery, Hanil General Hospital, Seoul, South Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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28
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Ghirardelli S, Asay JL, Leonardi EA, Amoroso T, Andriacchi TP, Indelli PF. Kinematic Comparison between Medially Congruent and Posterior-Stabilized Third-Generation TKA Designs. J Funct Morphol Kinesiol 2021; 6:jfmk6010027. [PMID: 33804113 PMCID: PMC8006233 DOI: 10.3390/jfmk6010027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background: This study compares knee kinematics in two groups of patients who have undergone primary total knee arthroplasty (TKA) using two different modern designs: medially congruent (MC) and posterior-stabilized (PS). The aim of the study is to demonstrate only minimal differences between the groups. Methods: Ten TKA patients (4 PS, 6 MC) with successful clinical outcomes were evaluated through 3D knee kinematics analysis performed using a multicamera optoelectronic system and a force platform. Extracted kinematic data included knee flexion angle at heel-strike (KFH), peak midstance knee flexion angle (MSKFA), maximum and minimum knee adduction angle (KAA), and knee rotational angle at heel-strike. Data were compared with a group of healthy controls. Results: There were no differences in preferred walking speed between MC and PS groups, but we found consistent differences in knee function. At heel-strike, the knee tended to be more flexed in the PS group compared to the MC group; the MSKFA tended to be higher in the PS group compared to the MC group. There was a significant fluctuation in KAA during the swing phase in the PS group compared to the MC group, PS patients showed a higher peak knee flexion moment compared to MC patients, and the PS group had significantly less peak internal rotation moments than the MC group. Conclusions: Modern, third-generation TKA designs failed to reproduce normal knee kinematics. MC knees tended to reproduce a more natural kinematic pattern at heel-strike and during axial rotation, while PS knees showed better kinematics during mid-flexion.
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29
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Yi C, Jiang F, Yang C, Chen Z, Ding Z, Liu J. Reference Frame Unification of IMU-Based Joint Angle Estimation: The Experimental Investigation and a Novel Method. SENSORS 2021; 21:s21051813. [PMID: 33807746 PMCID: PMC7962048 DOI: 10.3390/s21051813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/14/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
Inertial measurement unit (IMU)-based joint angle estimation is an increasingly mature technique that has a broad range of applications in clinics, biomechanics and robotics. However, the deviations of different IMUs’ reference frames, referring to IMUs’ individual orientations estimating errors, is still a challenge for improving the angle estimation accuracy due to conceptual confusion, relatively simple metrics and the lack of systematical investigation. In this paper, we clarify the determination of reference frame unification, experimentally study the time-varying characteristics of reference frames’ deviations and accordingly propose a novel method with a comprehensive metric to unify reference frames. To be specific, we firstly define the reference frame unification (RFU) and distinguish it with drift correction that has always been confused with the term RFU. Secondly, we design a mechanical gimbal-based experiment to study the deviations, where sensor-to-body alignment and rotation-caused differences of orientations are excluded. Thirdly, based on the findings of the experiment, we propose a novel method to utilize the consistency of the joint axis under the hinge-joint constraint, gravity acceleration and local magnetic field to comprehensively unify reference frames, which meets the nonlinear time-varying characteristics of the deviations. The results on ten human subjects reveal the feasibility of our proposed method and the improvement from previous methods. This work contributes to a relatively new perspective of considering and improving the accuracy of IMU-based joint angle estimation.
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Affiliation(s)
- Chunzhi Yi
- School of Mechatronics Engineering, Harbin Institute of Technology, Harbin 150001, China; (C.Y.); (C.Y.); (Z.D.)
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
| | - Feng Jiang
- School of Computer Science and Technology, Harbin Institute of Technology, Harbin 150001, China
- Correspondence:
| | - Chifu Yang
- School of Mechatronics Engineering, Harbin Institute of Technology, Harbin 150001, China; (C.Y.); (C.Y.); (Z.D.)
| | - Zhiyuan Chen
- School of Computer Science, University of Nottingham Malaysia Campus, Semenyih 43500, Malaysia;
| | - Zhen Ding
- School of Mechatronics Engineering, Harbin Institute of Technology, Harbin 150001, China; (C.Y.); (C.Y.); (Z.D.)
| | - Jie Liu
- AI Research Institute, Harbin Institute of Technology, Shenzhen 518055, China;
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30
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Faschingbauer M, Hacker S, Seitz A, Dürselen L, Boettner F, Reichel H. The tibial cut in total knee arthroplasty influences the varus alignment, the femoral roll-back and the tibiofemoral rotation in patients with constitutional varus. Knee Surg Sports Traumatol Arthrosc 2021; 29:641-651. [PMID: 32306132 DOI: 10.1007/s00167-020-05996-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Different alignment types for a better outcome after TKA were described. However, it is not clear how kinematic alignment influences knee joint kinematic. The purpose of this study was to analyze whether adapted tibial cuts in constitutional varus knees affect knee joint kinematics regarding femoral roll-back, varus/valgus angle, and femorotibial rotation. METHODS Seven cadaveric knees with constitutional varus alignment were examined in the native state and after implantation of a cruciate retaining (CR)-TKA with 0°, 3° and 6° tibia cuts using an established knee joint simulator. The effects of varus alignment on femorotibial rollback and rotation was determined. In addition, the native knee joint and different tibial cuts in CR-TKA were compared with Student's t test. RESULTS Total knee replacement with a 3° and 6° varus tibia cut had the greatest varus deviation to the native knee (mean 1.6° ± 0.09°, respectively); while, knees with a 0° (mean 0.2° ± 0.01°) tibia cut were most similar to the constitutional varus knee joint. The femoral roll-back in the medial compartment was increased in the native knee (5.7-12.5 mm). A 6° varus cut had a restricted translation in the medial compartment (2-3.2 mm). In the lateral compartment, the extensive translation was observed with a 0° varus cut, followed by 3° and 6° and the native knee. All cuts showed significantly different mean values. Only the cuts at 3° and at 6° in the medial compartment and the cuts at 0° and at 3° in the lateral compartment did not differ significantly. In respect to tibiofemoral rotation, 0° and 3° varus cuts across all loads had the least difference to the native knee (3.4°), with a 0° varus cut showing a higher absolute internal rotation of the tibia than the native knee. Changes in knee kinematics of the tibiofemoral rotation showed significantly different mean values. CONCLUSION The potentially improved outcome parameters in TKA with adapted tibia cuts in constitutional varus knees cannot be completely explained by the changes to knee kinematics. Mechanical alignment seems to result in more balanced load distribution and kinematics more closely resembling the native knee. From a kinematic point of view, it is not recommended to place the tibia in more than 3° of varus. LEVEL OF EVIDENCE Biomechanical study.
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Affiliation(s)
- Martin Faschingbauer
- Department of Orthopedic Surgery, RKU, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - S Hacker
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - A Seitz
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - L Dürselen
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Helmholtzstraße 14, 89081, Ulm, Germany
| | - F Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - H Reichel
- Department of Orthopedic Surgery, RKU, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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31
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Quantifying Achievable Levels of Improvement in Knee Joint Biomechanics During Gait After Total Knee Arthroplasty Relative to Osteoarthritis Severity. J Appl Biomech 2021; 37:130-138. [PMID: 33450729 DOI: 10.1123/jab.2020-0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/18/2022]
Abstract
Total knee arthroplasty (TKA) surgery improves knee joint kinematics and kinetics during gait for most patients, but a lack of evidence exists for the level and incidence of improvement that is achieved. The objective of this study was to quantify patient-specific improvements in knee biomechanics relative to osteoarthritis (OA) severity levels. Seventy-two patients underwent 3-dimensional (3D) gait analysis before and 1 year after TKA surgery, as well as 72 asymptomatic adults and 72 with moderate knee OA. A combination of principal component analysis and discriminant analyses were used to categorize knee joint biomechanics for patients before and after surgery relative to asymptomatic, moderate, and severe OA. Post-TKA, 63% were categorized with knee biomechanics consistent with moderate OA, 29% with severe OA, and 8% asymptomatic. The magnitude and pattern of the knee adduction moment and angle (frontal plane features) were the most significant contributors in discriminating between pre-TKA and post-TKA knee biomechanics. Standard of care TKA improves knee biomechanics during gait to levels most consistent with moderate knee OA and predominately targets frontal plane features. These results provide evidence for the level of improvement in knee biomechanics that can be expected following surgery and highlight the biomechanics most targeted by surgery.
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Unicompartmental knee arthroplasty results in a better gait pattern than total knee arthroplasty: Gait analysis with a smartphone application. Jt Dis Relat Surg 2021; 32:22-27. [PMID: 33463414 PMCID: PMC8073428 DOI: 10.5606/ehc.2021.79635] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/02/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The aim of this study was to compare the smartphone- based gait analysis data of patients who underwent total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). PATIENTS AND METHODS Between January 2016 and April 2019, a total of 51 patients (3 males, 48 females; mean age: 60.92 years; range, 51 to 70 years) who were operated with UKA or TKA in our clinic were retrospectively analyzed. The patients were divided into two groups according to the type of procedure as the UKA group (n=17) and unilateral TKA group (n=34). Gait analysis was made via a smartphone application (Gait Analyzer software version 0.9.95.0) with data acquired from the accelerometer of the smartphone. This analysis was performed using data collected from the Acceleration Sensor LSM6DSO into the Samsung Galaxy Note 10 Plus phone. Gait velocity, step time, step length, cadence, step time symmetry, step length symmetry, and vertical COM (vert-COM) parameters were measured. RESULTS There were no statistically significant differences between the groups in respect of age, sex, body mass index, operated side, and follow-up duration. Compared to the TKA group, the UKA patients showed a better gait pattern in gait velocity (p=0.03), step time symmetry (p=0.005), and step length symmetry (p=0.024). No significant difference was detected in step time (p=0.807), step length (p=0.302), cadence (p=0.727) and vert-COM parameters (p=0.608). CONCLUSION The gait of UKA patients is closer to the physiological pattern with a better gait velocity, step time symmetry, and step length symmetry than TKA patients. The surgical treatment option of UKA for knee medial compartment osteoarthritis leads to a better gait pattern than TKA.
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Kobsar D, Masood Z, Khan H, Khalil N, Kiwan MY, Ridd S, Tobis M. Wearable Inertial Sensors for Gait Analysis in Adults with Osteoarthritis-A Scoping Review. SENSORS 2020; 20:s20247143. [PMID: 33322187 PMCID: PMC7763184 DOI: 10.3390/s20247143] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
Our objective was to conduct a scoping review which summarizes the growing body of literature using wearable inertial sensors for gait analysis in lower limb osteoarthritis. We searched six databases using predetermined search terms which highlighted the broad areas of inertial sensors, gait, and osteoarthritis. Two authors independently conducted title and abstract reviews, followed by two authors independently completing full-text screenings. Study quality was also assessed by two independent raters and data were extracted by one reviewer in areas such as study design, osteoarthritis sample, protocols, and inertial sensor outcomes. A total of 72 articles were included, which studied the gait of 2159 adults with osteoarthritis (OA) using inertial sensors. The most common location of OA studied was the knee (n = 46), followed by the hip (n = 22), and the ankle (n = 7). The back (n = 41) and the shank (n = 40) were the most common placements for inertial sensors. The three most prevalent biomechanical outcomes studied were: mean spatiotemporal parameters (n = 45), segment or joint angles (n = 33), and linear acceleration magnitudes (n = 22). Our findings demonstrate exceptional growth in this field in the last 5 years. Nevertheless, there remains a need for more longitudinal study designs, patient-specific models, free-living assessments, and a push for "Code Reuse" to maximize the unique capabilities of these devices and ultimately improve how we diagnose and treat this debilitating disease.
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Affiliation(s)
- Dylan Kobsar
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
- Correspondence:
| | - Zaryan Masood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Heba Khan
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Noha Khalil
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Marium Yossri Kiwan
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Sarah Ridd
- Department of Psychology, Neuroscience, and Behaviour, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Matthew Tobis
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
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Kotani N, Morishita T, Saita K, Kamada S, Maeyama A, Abe H, Yamamoto T, Shiota E, Inoue T. Feasibility of supplemental robot-assisted knee flexion exercise following total knee arthroplasty. J Back Musculoskelet Rehabil 2020; 33:413-421. [PMID: 31561326 DOI: 10.3233/bmr-181482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Hybrid Assistive Limb (HAL) is a robotic exoskeleton designed to support impaired limbs. OBJECTIVE We aimed to evaluate whether active exercise using a single-joint HAL (HAL-SJ) following total knee arthroplasty can facilitate the recovery of knee flexion. METHODS Twenty-two patients who underwent total knee arthroplasty were randomly allocated to the HAL-SJ group (n= 12) or conventional physical therapy (CPT) group (n= 10). On postoperative day 5, patients performed active knee flexion exercises either with or without HAL-SJ assistance every second day. Outcome measures included active and passive knee flexion range of motion (ROM), muscle strength, and pain intensity, as assessed by the visual analog scale, and were assessed on postoperative days 5 (pre-treatment) and 10 (post-treatment). Active ROM was measured at 6 months postoperatively; further long-term follow-up was performed by telephone interview. RESULTS Both groups showed significant improvement between postoperative days 5 and 10 in all outcome measures. Improvements in active ROM (p< 0.01), passive ROM (p< 0.01), muscle strength (p< 0.01), and pain (p< 0.01) were significantly greater in the HAL-SJ group than in the CPT group. Long-term outcomes were also significantly better in the HAL-SJ group. CONCLUSIONS HAL therapy enables patients to perform painless active movements and facilitates the recovery of knee function.
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Affiliation(s)
- Naoya Kotani
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.,Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kazuya Saita
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.,Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Satoshi Kamada
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan.,Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Akira Maeyama
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Etsuji Shiota
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Mennan C, Hopkins T, Channon A, Elliott M, Johnstone B, Kadir T, Loughlin J, Peffers M, Pitsillides A, Sofat N, Stewart C, Watt FE, Zeggini E, Holt C, Roberts S. The use of technology in the subcategorisation of osteoarthritis: a Delphi study approach. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100081. [PMID: 36474678 PMCID: PMC9718088 DOI: 10.1016/j.ocarto.2020.100081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/28/2020] [Indexed: 01/19/2023] Open
Abstract
Objective This UK-wide OATech Network + consensus study utilised a Delphi approach to discern levels of awareness across an expert panel regarding the role of existing and novel technologies in osteoarthritis research. To direct future cross-disciplinary research it aimed to identify which could be adopted to subcategorise patients with osteoarthritis (OA). Design An online questionnaire was formulated based on technologies which might aid OA research and subcategorisation. During a two-day face-to-face meeting concordance of expert opinion was established with surveys (23 questions) before, during and at the end of the meeting (Rounds 1, 2 and 3, respectively). Experts spoke on current evidence for imaging, genomics, epigenomics, proteomics, metabolomics, biomarkers, activity monitoring, clinical engineering and machine learning relating to subcategorisation. For each round of voting, ≥80% votes led to consensus and ≤20% to exclusion of a statement. Results Panel members were unanimous that a combination of novel technological advances have potential to improve OA diagnostics and treatment through subcategorisation, agreeing in Rounds 1 and 2 that epigenetics, genetics, MRI, proteomics, wet biomarkers and machine learning could aid subcategorisation. Expert presentations changed participants' opinions on the value of metabolomics, activity monitoring and clinical engineering, all reaching consensus in Round 2. X-rays lost consensus between Rounds 1 and 2; clinical X-rays reached consensus in Round 3. Conclusion Consensus identified that 9 of the 11 technologies should be targeted towards OA subcategorisation to address existing OA research technology and knowledge gaps. These novel, rapidly evolving technologies are recommended as a focus for emergent, cross-disciplinary osteoarthritis research programmes.
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Affiliation(s)
- Claire Mennan
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust & School of Pharmacy & Bioengineering, Keele University, Oswestry, Shropshire, SY10 7AG, UK
| | - Timothy Hopkins
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust & School of Pharmacy & Bioengineering, Keele University, Oswestry, Shropshire, SY10 7AG, UK
| | - Alastair Channon
- School of Computing & Mathematics, Keele University, Staffordshire, ST5 5BG, UK
| | - Mark Elliott
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, CV4 7AL, UK
| | - Brian Johnstone
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Timor Kadir
- Optellum Ltd, Oxford Centre for Innovation, Oxford, OX1 1BY, UK
| | - John Loughlin
- Biosciences Institute, International Centre for Life, Newcastle University, Newcastle upon Tyne, NE1 3BX, UK
| | - Mandy Peffers
- Institute of Ageing and Chronic Disease, The University of Liverpool, L69 7ZX, UK
| | - Andrew Pitsillides
- Comparative Biomedical Sciences, The Royal Veterinary College, London, NW1 0TU, UK
| | - Nidhi Sofat
- Institute of Infection and Immunity, St Georges University of London, SW17 0RE, UK
| | - Caroline Stewart
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust & School of Pharmacy & Bioengineering, Keele University, Oswestry, Shropshire, SY10 7AG, UK
| | - Fiona E. Watt
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, OX3 7FY, UK
| | - Eleftheria Zeggini
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute for Translational Genomics, Ingolstädter Landstr., 185764, Neuherberg, Germany
| | - Cathy Holt
- Cardiff University, Queen's Buildings, The Parade, Cardiff, CF24 3AA, UK
| | - Sally Roberts
- The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust & School of Pharmacy & Bioengineering, Keele University, Oswestry, Shropshire, SY10 7AG, UK
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Miles C, Greene A. The effect of treatment with a non-invasive foot worn biomechanical device on subjective and objective measures in patients with knee osteoarthritis- a retrospective analysis on a UK population. BMC Musculoskelet Disord 2020; 21:386. [PMID: 32546226 PMCID: PMC7298846 DOI: 10.1186/s12891-020-03382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
Background Osteoarthritis is a major cause of pain and disability worldwide, therefore ways of treating this condition are paramount to a successful health system. The purpose of the study was to investigate the changes in spatial-temporal gait parameters and clinical measurements following treatment with a non-invasive foot-worn biomechanical device on patients with knee osteoarthritis within the UK. Methods A retrospective analysis was carried out on 455 patients with knee osteoarthritis. All patients were evaluated using a computerized gait test and two self-assessment questionnaires (WOMAC and SF-36) at baseline and after 3 and 6 months of treatment. The biomechanical device is a shoe-like device with convex pods under the sole that have the capability of changing foot centre of pressure and training neuromuscular control. The device was individually calibrated for each patient to minimise symptoms whilst walking and train neuromuscular control. Patients used the device for short periods during activities of daily living. Repeated measures statistical analyses were performed to compare differences over time. Results After 6 months of treatment significant improvements were seen in all gait parameters (p < 0.01). Specifically, gait velocity, step length and single limb support of the more symptomatic knee improved by 13, 7.8 and 3%, respectively. These were supported by significant improvements in pain, function and quality of life (48.6, 45.7 and 22% respectively; p < 0.001). A sub-group analysis revealed no baseline differences between those who were recommended joint replacement and those who were not. Both groups improved significantly over time (p < 0.05 for all). Conclusions Our results suggest that the personalised biomechanical treatment can improve gait patterns, pain, function and quality of life. It may provide an additional solution to managing UK patients suffering from knee osteoarthritis but needs to be tested in a controlled setting first.
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Affiliation(s)
- Christopher Miles
- Sport and Exercise Science Research Centre, Department of Life Sciences, University of Roehampton, 19 Conifer drive, Brentwood, London, CM14 5TZ, UK.
| | - Andrew Greene
- Sport and Exercise Science Research Centre, Department of Life Sciences, University of Roehampton, 19 Conifer drive, Brentwood, London, CM14 5TZ, UK
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Bade MJ, Christensen JC, Zeni JA, Christiansen CL, Dayton MR, Forster JE, Cheuy VA, Stevens-Lapsley JE. Movement pattern biofeedback training after total knee arthroplasty: Randomized clinical trial protocol. Contemp Clin Trials 2020; 91:105973. [PMID: 32171937 PMCID: PMC7263966 DOI: 10.1016/j.cct.2020.105973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) reduces joint symptoms, but habitual movement compensations persist years after surgery. Preliminary research on movement training interventions have signaled initial efficacy for remediating movement compensations and restoring knee joint loading symmetry during dynamic functional tasks after TKA. The purpose of this clinical trial is to determine if physical rehabilitation that includes movement training restores healthy movement patterns after TKA and reduces the risk of osteoarthritis (OA) progression in the contralateral knee. METHODS/DESIGN 150 participants will be enrolled into this randomized controlled trial. Participants will be randomly allocated to one of two dose-equivalent treatment groups: standard rehabilitation plus movement training (MOVE) or standard rehabilitation without movement training (CONTROL). Movement training will promote between-limb symmetry and surgical knee loading during activity-based exercises. Movement training strategies will include real-time biofeedback using in-shoe pressure sensors and verbal, visual, and tactile cues from the physical therapist. The primary outcome will be change in peak knee extension moment in the surgical knee during walking, from before surgery to six months after surgery. Secondary outcomes will include lower extremity movement symmetry during functional tasks, physical function, quadriceps strength, range of motion, satisfaction, adherence, contralateral knee OA progression, and incidence of contralateral TKA. DISCUSSION This study will provide insights into the efficacy of movement training after unilateral TKA, along with mechanisms for optimizing long-term physical function and minimizing negative sequelae of compensatory movement patterns.
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Affiliation(s)
- Michael J Bade
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Eastern Colorado VA Geriatric Research, Education, and Clinical Center (GRECC), Aurora, CO, United States of America.
| | - Jesse C Christensen
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Eastern Colorado VA Geriatric Research, Education, and Clinical Center (GRECC), Aurora, CO, United States of America
| | - Joseph A Zeni
- Rutgers University, School of Health Professions, Newark, NJ, United States of America
| | - Cory L Christiansen
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Eastern Colorado VA Geriatric Research, Education, and Clinical Center (GRECC), Aurora, CO, United States of America
| | - Michael R Dayton
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Jeri E Forster
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Veterans Affairs Rocky Mountain Mental Illness, Research, Education and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States of America
| | - Victor A Cheuy
- University of California, San Francisco, CA, United States of America
| | - Jennifer E Stevens-Lapsley
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Eastern Colorado VA Geriatric Research, Education, and Clinical Center (GRECC), Aurora, CO, United States of America
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Young-Shand KL, Dunbar MJ, Astephen Wilson JL. Individual Gait Features Are Associated with Clinical Improvement After Total Knee Arthroplasty. JB JS Open Access 2020; 5:e0038. [PMID: 33123659 PMCID: PMC7418919 DOI: 10.2106/jbjs.oa.19.00038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Over 20% of patients do not report clinically relevant pain relief or functional improvements after total knee arthroplasty (TKA). The aim of this study was to investigate the effect of demographics, pre-TKA knee-joint biomechanics, and postoperative changes in knee biomechanics on meaningful improvements in self-reported pain and function after TKA. METHODS Forty-six patients underwent 3-dimensional gait analysis and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire before and 1 year after TKA. Response to treatment in terms of pain relief and functional improvement ("pain and function responders") was defined as improvements in WOMAC scores that met minimal clinically important difference thresholds in the pain and function domains. Differences between responder and non-responder demographics, severity of the osteoarthritis as seen radiographically, and knee kinematics and kinetics before TKA were explored using the t test and Mann-Whitney U test. Correlations and regression models were used to examine demographics, baseline knee kinematics and kinetics, and post-TKA kinematic and kinetic improvements associated with being a pain responder and a function responder separately. Analyses were conducted using a hypothesis-driving approach. RESULTS Of the 46 patients, 34 were pain responders and 36 were function responders. Preoperatively, both responder groups had a higher radiographic severity (Kellgren-Lawrence) grade (p = 0.03) and pain responders were more symptomatic according to their WOMAC score (p < 0.04). Less preoperative stance-phase flexion-extension angle range (p ≤ 0.03), lower preoperative stance-phase adduction (varus) angle magnitude (p = 0.01), and less postoperative reduction in the adduction angle magnitude (p ≤ 0.009) were independently associated with more self-reported improvement in pain and function. CONCLUSIONS Patients with a higher radiographic severity grade, with specific frontal and sagittal knee kinematic patterns during gait before TKA, and who demonstrated less reduction in frontal plane angles during gait after TKA had greater self-reported pain and function score improvements after standard TKA. Gait analysis may aid preoperative identification of kinematic subgroups associated with self-reported improvements after TKA, and provide evidence that may inform triaging, surgical planning, and expectation management strategies. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kathryn L. Young-Shand
- Department of Surgery (M.J.D. and J.L.A.W.) and
School of Biomedical Engineering (K.L.Y.-S., M.J.D., and J.L.A.W.), Dalhousie
University, Halifax, Nova Scotia, Canada
| | - Michael J. Dunbar
- Department of Surgery (M.J.D. and J.L.A.W.) and
School of Biomedical Engineering (K.L.Y.-S., M.J.D., and J.L.A.W.), Dalhousie
University, Halifax, Nova Scotia, Canada
| | - Janie L. Astephen Wilson
- Department of Surgery (M.J.D. and J.L.A.W.) and
School of Biomedical Engineering (K.L.Y.-S., M.J.D., and J.L.A.W.), Dalhousie
University, Halifax, Nova Scotia, Canada
- Department of Surgery, McMaster University, Hamilton,
Ontario, Canada
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Smith SHL, Reilly P, Bull AMJ. A musculoskeletal modelling approach to explain sit-to-stand difficulties in older people due to changes in muscle recruitment and movement strategies. J Biomech 2020; 98:109451. [PMID: 31685221 DOI: 10.1016/j.jbiomech.2019.109451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
By 2050 the proportion of over 65s is predicted to be 20% of the population. The consequences of an age-related reduction in muscle mass have not been fully investigated and, therefore, the aim of the present study was to quantify the muscle and joint contact forces using musculoskeletal modelling, during a sit-to-stand activity, to better explain difficulties in performing everyday activities for older people. A sit-to-stand activity with and without the use of arm rests was observed in ninety-five male participants, placed into groups of young (aged 18-35 years), middle-aged (aged 40-60 years) or older adults (aged 65 years and over). Older participants demonstrated significantly lower knee extensor and joint forces than the young when not using arm rests, compensating through elevated hip extensor and ankle plantarflexor muscle activity. The older group were also found to have higher shoulder joint contact forces whilst using arm rests. This tendency to reorganise muscle recruitment to include neighbouring groups or other parts of the body could make everyday activities more susceptible to age-related functional decline. Reductions in leg strength, via age- or atrophy- related means, creates increased reliance on the upper body and may result in further lower limb atrophy through disuse. The eventual decline of upper body function reduces strength reserves, leading to increased vulnerability, dependence on others and risk of institutionalisation.
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Affiliation(s)
- Samuel H L Smith
- Department of Bioengineering, Imperial College London, Kensington, London SW7 2AZ, UK.
| | - Peter Reilly
- Department of Bioengineering, Imperial College London, Kensington, London SW7 2AZ, UK; Department of Orthopaedics, Imperial College NHS Trust, Praed St, London W2 1NY, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, Kensington, London SW7 2AZ, UK
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Ro DH, Kang T, Han DH, Lee DY, Han HS, Lee MC. Quantitative evaluation of gait features after total knee arthroplasty: Comparison with age and sex-matched controls. Gait Posture 2020; 75:78-84. [PMID: 31627118 DOI: 10.1016/j.gaitpost.2019.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait function after total knee arthroplasty (TKA) is suboptimal. However, quantified analysis with comparing a control group is lacking. RESEARCH QUESTION The aims of this study were 1) to compare the gait before and after TKA and 2) to compare postoperative gait to that of an age-sex matched control group. METHODS This study consisted of 46 female and 38 male patients with end-stage knee osteoarthritis who underwent bilateral TKA, and 84 age- and sex-matched controls without knee pain and osteoarthritis. Seven gait parameters, including lower extremity alignment, knee adduction moment (KAM), knee flexion angle, external knee flexion moment, hip adduction angle, external hip adduction moment, and the varus-valgus arc during the stance phase, were collected using a commercial opto-electric gait analysis system. Principal component analysis was used for data processing and the standardized mean differences (SMDs) of the principal component scores were compared. RESULTS The most significant gait change after TKA was the alignment (SMD 1.62, p < 0.001). The average stance phase alignment changed from varus 7.3° to valgus 0.5°. The second significant change was a decrease of the KAM (SMD 1.08, p < 0.001). These two features were closely correlated (r = 0.644, p < 0.001). The gait feature that differed most from the controls was the varus-valgus arc during the stance phase (SMD 1.68, p < 0.001), which was constrained by 31% after TKA (p < 0.001) and was only 37% compared to the controls (p < 0.001). SIGNIFICANCE Improvement in gait after TKA was obtained through alignment correction. However, TKA significantly constrained coronal knee motion. TKA improved gait suboptimally; the gait was significantly different from that of controls.
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Affiliation(s)
- Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Taehoon Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Do Hwan Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Dong Yeon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Dávila Castrodad IM, Recai TM, Abraham MM, Etcheson JI, Mohamed NS, Edalatpour A, Delanois RE. Rehabilitation protocols following total knee arthroplasty: a review of study designs and outcome measures. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S255. [PMID: 31728379 DOI: 10.21037/atm.2019.08.15] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Total knee arthroplasty (TKA) is among the most common elective procedures performed worldwide. Recent efforts have been made to significantly improve patient outcomes, specifically with postoperative rehabilitation. Despite the many rehabilitation modalities available, the optimal rehabilitation strategy has yet to be determined. Therefore, this systematic review focuses on evaluating existing postoperative rehabilitation protocols. Specifically, this review analyses the study designs, rehabilitation methods, and outcome measures of postoperative rehabilitation protocols for TKA recipients in the past five years. The PubMed, EMBASE, and Cochrane Library databases were queried for studies evaluating rehabilitation protocols following primary TKA. Of the 11,013 studies identified within the last five years, 70 met the inclusion and exclusion criteria. After assessing for relevance and removing duplicates, a final count of 20 studies remained for analysis. Level-of-evidence was determined by the American Academy of Orthopaedic Surgeons (AAOS) classification system. Our findings demonstrated that continuous passive motion and inpatient rehabilitation may not provide additional benefit to the patient or healthcare system. However, early rehabilitation, telerehabilitation, outpatient therapy, high intensity, and high velocity exercise may be successful forms of rehabilitation. Additionally, weight-bearing biofeedback, neuromuscular electrical stimulation, and balance control appear to be beneficial adjuncts to conventional rehabilitation. Postoperative rehabilitation following TKA facilitates patient recovery and improves quality of life. This systematic review analyzed the existing rehabilitation protocols from the past five years. Some studies did not accurately describe the conventional rehabilitation protocols, the duration of therapy sessions, and the timing of these sessions. As such, future studies should explicitly describe their methodology. This will allow high-quality assessments and the conception of standardized protocols.
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Affiliation(s)
- Iciar M Dávila Castrodad
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Thea M Recai
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Megha M Abraham
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Jennifer I Etcheson
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Nequesha S Mohamed
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Armin Edalatpour
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
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De Vroey H, Staes F, Vereecke E, Vanrenterghem J, Deklerck J, Van Damme G, Hallez H, Claeys K. Lower extremity gait kinematics outcomes after knee replacement demonstrate arthroplasty-specific differences between unicondylar and total knee arthroplasty: A pilot study. Gait Posture 2019; 73:299-304. [PMID: 31401372 DOI: 10.1016/j.gaitpost.2019.07.196] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of the present study is to compare sagittal gait kinematics of ankle, knee and hip joints between subjects with unicondylar and total knee arthroplasty and age matched healthy controls. Since unicondylar knee replacement is a less invasive procedure, which more closely preserves knee joint anatomy, we hypothesized that one year post unicondylar knee arthroplasty patients would demonstrate more normal gait patterns than patients with total knee arthroplasty. RESEARCH QUESTION Do unicondylar and total knee arthroplasty patients display similar gait kinematics one year after surgery? METHODS Fourteen subjects (8 posterior stabilized and 6 medial unicondylar knee replacements) that were one year post surgery, and 6 healthy control subjects underwent a 3D gait analysis and a physical examination (range of motion, muscle strength). Statistical parametric mapping was used to compare gait kinematics of the lower limbs between groups. Additionally, differences in peak angles and clinical outcomes were assessed using a one-way ANOVA between subjects analysis. RESULTS Both knee replacement groups showed reduced knee flexion range of motion and reduced muscle strength at the operated leg compared to the control group. Subjects with TKA demonstrated reduced knee flexion at loading response and midstance of the gait cycle. Both UKA and TKA demonstrated significantly less knee flexion during swing. SIGNIFICANCE The results of this study demonstrate arthroplasty-specific differences in muscle strength, range of motion and gait kinematics of the lower limb one year after knee surgery. Future planning of post-surgery follow-up should addresses these arthroplasty-specific weaknesses and gait deviations.
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Affiliation(s)
- Henri De Vroey
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Filip Staes
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Evie Vereecke
- Department of Development and Regeneration, KULAK, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Jos Vanrenterghem
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Jan Deklerck
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Geert Van Damme
- Department of Orthopaedic Surgery, AZ Sint-Lucas, Sint-Lucaslaan 29, 8310 Bruges, Belgium.
| | - Hans Hallez
- Department of Computer Science, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Kurt Claeys
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium; Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
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Astephen Wilson JL, Lamontagne M, Wilson DR, Beaulé PE, Mwale F, Yee A. Patient-Specific Functional Analysis: The Key to the Next Revolution Towards the Treatment of Hip and Knee Osteoarthritis. J Orthop Res 2019; 37:1754-1759. [PMID: 31042316 DOI: 10.1002/jor.24317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/19/2019] [Accepted: 04/08/2019] [Indexed: 02/04/2023]
Abstract
Lower extremity joint arthroplasty surgery remains one of the most successful interventions in orthopaedics. While improvements in patient mobility and physical functioning following surgery are well-documented, there remains significant post-operative functional deficits in many patients. This highlights a need and an opportunity towards improving functional and patient-reported outcomes of arthroplasty surgery. This review summarizes key opportunities arising from the recent 2018 Orthopaedic Research Society Meeting in New Orleans, USA. In this review, the Canadian Orthopaedic Research Society (i.e., CORS) highlights key research advances, case examples, scientific messages, and personalized medical care approaches toward improving physical functioning in our knee and hip joint arthroplasty patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1754-1759, 2019.
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Affiliation(s)
- Janie L Astephen Wilson
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mario Lamontagne
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.,School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada.,Department of Mechanical Engineering, University of Ottawa, Ontario, Canada
| | - David R Wilson
- Department of Orthopaedics and Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Fackson Mwale
- Department of Surgery, McGill University, Montreal, Quebec, Canada
| | - Albert Yee
- Division of Orthopaedics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Agarwal A, Miller S, Hadden W, Johnston L, Wang W, Arnold G, Abboud RJ. Comparison of gait kinematics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl 2019; 101:391-398. [PMID: 31155888 DOI: 10.1308/rcsann.2019.0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study is aimed to compare kinematic gait data of patients who have undergone total and unicondylar knee replacement. MATERIALS AND METHODS This single-surgeon retrospective cohort study evaluated 13 patients with unilateral total knee arthroplasty (TKA) and 14 unicondylar knee arthroplasty (UKA). Gait analysis was carried out using a Vicon motion analysis system. The limits of knee flexion during stance phase, at heel strike and at loading response were measured. RESULTS The total range of motion of the UKA knees was significantly greater than the TKA knees. UKA knees exhibited significantly greater knee extension during the stance phase than the TKA knees. Unlike TKA, UKA knees demonstrated improved knee flexion during the gait cycle when compared to the contralateral non-operated knee. The hips also demonstrated near normal hip flexion in UKA patients. Predictably, UKA knees had significantly greater varus compared with TKA in the coronal plane. Spatiotemporal variables demonstrated similar walking speed and step length to aid a fair comparison between knee replacement groups. CONCLUSIONS The UKA knees moved more physiologically in the sagittal plane with a greater range of motion during gait. Despite having a stiff gait pattern, the patients undergoing TKA demonstrated a more neutral alignment in the coronal plane. Neither type of knee arthroplasty restored knee kinematics to those of the non-operated side.
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Affiliation(s)
- A Agarwal
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - S Miller
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - W Hadden
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - L Johnston
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - W Wang
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - G Arnold
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - R J Abboud
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
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Ro DH, Kim JK, Lee DW, Lee J, Han HS, Lee MC. Residual varus alignment after total knee arthroplasty increases knee adduction moment without improving patient function: A propensity score-matched cohort study. Knee 2019; 26:737-744. [PMID: 30902513 DOI: 10.1016/j.knee.2019.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 01/09/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Targeting residual varus alignment in total knee arthroplasty may be functionally beneficial to preoperative varus patients. METHODS Bilateral TKA patients were enrolled. According to the postoperative hip-knee-ankle axis, patients were allocated into residual varus (3° ± 1°) alignment group or neutral (0° ± 1°) alignment group. Then, 1:2 propensity score matching was used to match preoperative variables. Finally, matched neutral (n = 45) and varus groups (n = 32) were followed-up for two years and compared. The primary outcome was the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were range of motion (ROM), Knee Society knee score and function score, spatiotemporal gait parameters, dynamic alignment, knee flexion angle, knee adduction moment (KAM) and internal knee extension moment. RESULTS At two years after surgery, the mean difference of WOMAC score was 0.3 (95% CI, [-3.1, 3.7]) between the two groups. All secondary outcomes, except KAM and dynamic alignment, showed no significant difference between the two groups. Residual varus alignment group showed increased KAM and maximum KAM was 19% higher (P = 0.006). CONCLUSIONS Residual varus alignment showed no clinical benefits, and both groups of patients had a functionally identical knee gait biomechanics, except for increased KAM and varus alignment. The authors consider that even in patients with varus alignment, the first principle is still achieving neutral alignment, which is helpful for reducing the KAM. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong-Keun Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Weon Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jangyun Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
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Comparison of 2 Forms of Kinetic Biofeedback on the Immediate Correction of Knee Extensor Moment Asymmetry Following Total Knee Arthroplasty During Decline Walking. J Orthop Sports Phys Ther 2019; 49:105-111. [PMID: 30124352 DOI: 10.2519/jospt.2019.7800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with total knee arthroplasty (TKA) display interlimb knee extensor moment (KEM) asymmetry during level walking that is exacerbated as task demands are increased. Studies using biofeedback to correct interlimb KEM asymmetry following TKA have reported mixed results. OBJECTIVE To compare the immediate effect of 2 forms of real-time kinetic biofeedback-vertical ground reaction force (vGRF) or KEM-on improving interlimb peak KEM symmetry during the weight-acceptance phase of decline walking in persons who have undergone TKA. METHODS In this cross-sectional, controlled laboratory study, 30 participants (17 men; mean ± SD age, 61.9 ± 8.5 years; body mass index, 28.4 ± 3.7 kg/m2) were allocated to either a vGRF or KEM real-time biofeedback group. Peak KEM interlimb asymmetry was obtained during both nonbiofeedback and biofeedback decline walking trials 3 months following TKA. RESULTS Significant interlimb asymmetry in peak KEM was observed in both groups during the nonbiofeedback condition (KEM, P = .02; vGRF, P<.01). The KEM biofeedback group demonstrated an immediate improvement in peak KEM asymmetry (P = .42). No change in peak KEM asymmetry was observed in the vGRF biofeedback group (P = .01). CONCLUSION Knee extensor moment biofeedback has an immediate effect on improving peak KEM asymmetry 3 months post TKA. J Orthop Sports Phys Ther 2019;49(2):105-111. Epub 20 Aug 2018. doi:10.2519/jospt.2019.7800.
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Biggs PR, Whatling GM, Wilson C, Metcalfe AJ, Holt CA. Which osteoarthritic gait features recover following total knee replacement surgery? PLoS One 2019; 14:e0203417. [PMID: 30682010 PMCID: PMC6347391 DOI: 10.1371/journal.pone.0203417] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022] Open
Abstract
Background Gait analysis can be used to measure variations in joint function in patients with knee osteoarthritis (OA), and is useful when observing longitudinal biomechanical changes following Total Knee Replacement (TKR) surgery. The Cardiff Classifier is an objective classification tool applied previously to examine the extent of biomechanical recovery following TKR. In this study, it is further developed to reveal the salient features that contribute to recovery towards healthy function. Methods Gait analysis was performed on 30 patients before and after TKR surgery, and 30 healthy controls. Median TKR follow-up time was 13 months. The combined application of principal component analysis (PCA) and the Cardiff Classifier defined 18 biomechanical features that discriminated OA from healthy gait. Statistical analysis tested whether these features were affected by TKR surgery and, if so, whether they recovered to values found for the controls. Results The Cardiff Classifier successfully discriminated between OA and healthy gait in all 60 cases. Of the 18 discriminatory features, only six (33%) were significantly affected by surgery, including features in all three planes of the ground reaction force (p<0.001), ankle dorsiflexion moment (p<0.001), hip adduction moment (p = 0.003), and transverse hip angle (p = 0.007). All but two (89%) of these features remained significantly different to those of the control group after surgery. Conclusions This approach was able to discriminate gait biomechanics associated with knee OA. The ground reaction force provided the strongest discriminatory features. Despite increased gait velocity and improvements in self-reported pain and function, which would normally be clinical indicators of recovery, the majority of features were not affected by TKR surgery. This TKR cohort retained pre-operative gait patterns; reduced sagittal hip and knee moments, decreased knee flexion, increased hip flexion, and reduced hip adduction. The changes that were associated with surgery were predominantly found at the ankle and hip, rather than at the knee.
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Affiliation(s)
- Paul Robert Biggs
- Cardiff School of Engineering, College of Physical Sciences, Cardiff University, Cardiff, United Kingdom
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - Gemma Marie Whatling
- Cardiff School of Engineering, College of Physical Sciences, Cardiff University, Cardiff, United Kingdom
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
| | - Chris Wilson
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
- University Hospital of Wales, Cardiff, United Kingdom
| | - Andrew John Metcalfe
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Cathy Avril Holt
- Cardiff School of Engineering, College of Physical Sciences, Cardiff University, Cardiff, United Kingdom
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
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Falck RS, Best JR, Li LC, Chan PCY, Feehan LM, Liu-Ambrose T. Can we improve cognitive function among adults with osteoarthritis by increasing moderate-to-vigorous physical activity and reducing sedentary behaviour? Secondary analysis of the MONITOR-OA study. BMC Musculoskelet Disord 2018; 19:447. [PMID: 30577819 PMCID: PMC6303889 DOI: 10.1186/s12891-018-2369-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/03/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Preliminary evidence suggests osteoarthritis is a risk factor for cognitive decline. One potential reason is 87% of adults with osteoarthritis are inactive, and low moderate-to-vigorous physical activity and high sedentary behaviour are each risk factors for cognitive decline. Thus, we investigated whether a community-based intervention to increase moderate-to-vigorous physical activity and reduce sedentary behaviour could improve cognitive function among adults with osteoarthritis. METHODS This was a secondary analysis of a six month, proof-of-concept randomized controlled trial of a community-based, technology-enabled counselling program to increase moderate-to-vigorous physical activity and reduce sedentary behaviour among adults with knee osteoarthritis. The Immediate Intervention (n = 30) received a Fitbit® Flex™ and four bi-weekly activity counselling sessions; the Delayed Intervention (n = 31) received the same intervention two months later. We assessed episodic memory and working memory using the National Institutes of Health Toolbox Cognition Battery. Between-group differences (Immediate Intervention vs. Delayed Intervention) in cognitive performance were evaluated following the primary intervention (i.e., Baseline - 2 Months) using intention-to-treat. RESULTS The intervention did not significantly improve cognitive function; however, we estimated small average improvements in episodic memory for the Immediate Intervention vs. Delayed Intervention (estimated mean difference: 1.27; 95% CI [- 9.27, 11.81]; d = 0.10). CONCLUSION This small study did not show that a short activity promotion intervention improved cognitive health among adults with osteoarthritis. However, the effects of increased moderate-to-vigorous physical activity and reduced sedentary behaviour are likely to be small and thus we recommend subsequent studies use larger sample sizes and measure changes in cognitive function over longer intervals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Protocol Registration System: NCT02315664 ; registered 12 December, 2014; https://clinicaltrials.gov/ct2/show/NCT02315664?cond=NCT02315664&rank=1.
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Affiliation(s)
- Ryan S. Falck
- Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| | - John R. Best
- Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| | - Linda C. Li
- Faculty of Medicine, Arthritis Research Canada, University of British Columbia, Vancouver, Canada
| | - Patrick C. Y. Chan
- Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
| | - Lynne M. Feehan
- Faculty of Medicine, Arthritis Research Canada, University of British Columbia, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3 Canada
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Komnik I, David S, Funken J, Haberer C, Potthast W, Weiss S. Compromised knee internal rotation in total knee arthroplasty patients during stair climbing. PLoS One 2018; 13:e0205492. [PMID: 30304032 PMCID: PMC6179266 DOI: 10.1371/journal.pone.0205492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
Due to the significant role of rotational properties for normal knee function, this study aimed to investigate transverse plane kinematics and kinetics in total knee arthroplasty and unicondylar knee arthroplasty patients during activities of daily living compared to a healthy control group, including stair ascent and descent. The study participants consisted of a total knee arthroplasty group including posterior cruciate retaining and posterior stabilized designs as well as a unicondylar knee arthroplasty group and a healthy control group. Three-dimensional kinematics and kinetics were captured using a Vicon system and two Kistler force plates embedded in the floor and another two in a staircase. Inverse dynamics of the lower limbs was computed in Anybody™ Modeling System. Transverse plane joint angles and joint moments were analyzed utilizing the statistical non-parametric mapping approach, considering the entire curve shape for statistical analysis. The patients with total knee arthroplasty exhibited significantly reduced knee internal rotation of the operated knee compared to the control group and the patients’ unimpaired limb, especially during the stair climbing tasks. Both unicondylar and total knee arthroplasty patients were found to have similar reduced internal rotation motion time series in stair descent. In conclusion, potential kinematic and kinetic benefits of unicondylar knee arthroplasty over total knee arthroplasty could not be proven in the current study. Aside from the usually mentioned reasons inducing constrained knee internal rotation in total knee arthroplasty patients, future studies should investigate to what extent co-contraction may contribute to this functional impairment in patients after knee arthroplasty surgery.
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Affiliation(s)
- Igor Komnik
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
- * E-mail:
| | - Sina David
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Johannes Funken
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | | | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stefan Weiss
- ARCUS Clinics Pforzheim, Pforzheim, Baden-Württemberg, Germany
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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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