Study on the correlation between early three-dimensional gait analysis and clinical efficacy after robot-assisted total knee arthroplasty

Functional Capacity at Rehabilitation Discharge Predicts Physical Activity Characteristics 24 Weeks Later for People With Total Knee Arthroplasty: A Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

To determine the association between performance-based and patient-reported functional capacity at the conclusion of 12-week rehabilitation with average daily step counts and peak walking cadence 38 weeks after total knee arthroplasty (TKA).

DESIGN

Secondary analysis of a randomized controlled trial.

SETTING

Veterans Affairs Medical Center.

PARTICIPANTS

A total of 87 US military Veterans (age: 67±7y, 87% male).

INTERVENTIONS

Twelve-week rehabilitation beginning 2 weeks post-TKA plus random assignment to either a telehealth-based physical activity behavior change intervention or control group.

MAIN OUTCOME MEASURES

Performance-based (timed Up-and-Go [TUG], 30-second sit-to-stand) and patient-reported measures (Western Ontario and McMaster Universities Osteoarthritis Index, Veterans RAND 12-Item Health Survey [VR-12]) were assessed at rehabilitation discharge (14wk post-TKA). Physical activity was measured using thigh-mounted accelerometry 38 weeks post-TKA. Relationships between participant characteristics (age, sex, body mass index, group assignment), functional capacity at discharge, and long-term physical activity outcomes (average daily step count and peak walking cadence) were evaluated using single- and multiple-variable linear and logistic regressions.

RESULTS

Univariate analyses: TUG time (r=-0.33, P=.002) and VR-12 physical health subscore (r=0.23, P=.036) were correlated with average daily step count at week 38. TUG time (r=-0.31, P=.006) was correlated with peak walking cadence. Multivariate analyses: multiple linear regression controlling for age, sex, and body mass index identified TUG (B=-301.25, P=.039) and VR-12 physical health (B=93.1, P=.049) as predictors of daily step count. TUG time (B=-1.5, P=.012) and assignment to physical activity behavior change intervention (B=13.7, P<.001) predicted peak walking cadence. No significant predictors of attaining a 7500 steps per day threshold were identified.

CONCLUSIONS

Functional capacity at discharge is related to physical activity characteristics 38 weeks post-TKA. Although behavior change interventions are needed to address physical activity deficits postoperatively, the link between functional capacity and activity suggests additional need to address functional capacity limitations during TKA rehabilitation.

Evaluation of the efficacy after Total Knee Arthroplasty by Gait analysis in patients with Knee Osteoarthritis: a meta-analysis

BACKGROUND

Total knee replacement (TKA) is a frequent modality performed in patients with knee osteoarthritis (OA). The aim of this study was to perform a meta-analysis and systematic review to evaluate the efficacy after TKA by gait analysis in patients with OA.

METHODS

PubMed, EMBASE, the Cochrane library, and Web of Science were searched for relevant studies from inception to July 2024. STATA SE 14.0 software was used for statistical analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guideline.

RESULTS

A total of 2525 reports were identified with 24 studies meeting pre-designed inclusion criteria. Several gait parameters were investigated. In patients with knee OA after TKA, there existed an increase in the Max knee flexion (WMD, 3.12; 95% CI, 0.93 to 5.32; I2 = 73.9%, P < 0.001), the Cadence (WMD, 4.05; 95% CI, 2.28 to 5.82; I2 = 48.9%, P = 0.068), the stride length (WMD, 0.05; 95% CI, 0.01 to 0.09; I2 = 77.1%, P < 0.001), the walking speed (WMD, 0.08; 95% CI, 0.02 to 0.14; I2 = 93.3%, P < 0.001), and the step length (WMD, 0.04; 95% CI, 0.00 to 0.07; I2 = 89.3%, P < 0.001) while a decrease in the double support time (WMD, -0.04; 95% CI, - 0.08 to -0.01; I2 = 0.0%, P = 0.585). Besides, no statistically significant differences were observed in the Knee range of motion (ROM), the Max knee rotation at stance phase, the Max knee extension, the step width, the stride time and the step time. Sensitivity analysis showed that all the results were robust.

CONCLUSIONS

In summary, the study found that, in patients with knee OA undergoing TKA may have great effects on improving gait parameters. If there are more high-quality studies in the future, we should make a more comprehensive evaluation of walking function by gait analysis together with other evaluation systems such as muscle strength and proprioception measurement.

Robotic-arm assisted versus manual total knee arthroplasty: Functional gait analysis from a randomised controlled trial

The primary aim of this study was to assess whether measures of functional gait assessment were improved with robotic total knee arthroplasty (rTKA) when compared to manual TKA (mTKA). Gait analysis was performed as part of a randomised controlled trial. Walking and relaxed standing assessments were performed using an instrumented mat system. Spatiotemporal variables included gait cycle parameters, anteroposterior and lateral sway, and plantar pressure ratios. Measurements were recorded at pre-operative baseline and 12 months post-operatively. 100 patients were randomised, 50 to each group. Complete gait cycle data were available for 26 rTKA and 23 mTKA patients. Cadence and walking velocity showed overall improvements following surgery, with no difference between the two groups. In the operated limb, overall step and stride times decreased, while step and stride lengths increased. Subgroup analysis showed reduced propulsion time with rTKA, and decreased foot flat and mid stance times with mTKA. Lateral sway was decreased in the rTKA group. Plantar pressure ratios showed an overall increase in hindfoot loading on the operated limb, with no difference between the two groups. No other significant differences were identified between rTKA and mTKA at 12 months, and limitations may include statistical error. A small sample of the study cohort was followed up; analysis may represent the results of satisfied patients with well-functioning TKA. Further study could incorporate proprioceptive and 3D gait analysis techniques to analyse knee kinetics and kinematics with robotic surgery. Pressure mapping could further subdivide the plantar surfaces to explore any nuances in differential loading.

Multicenter, prospective cohort study: immediate postoperative gains in active range of motion following robotic-assisted total knee replacement compared to a propensity-matched control using manual instrumentation

BACKGROUND

Range of motion (ROM) following total knee replacement (TKR) has been associated with patient satisfaction and knee function, and is also an early indicator of a successful procedure. Robotic-assisted TKR (raTKR) is considered to reproduce more precise resections, and, as a result, may be associated with improved early patient satisfaction compared to manual TKR (mTKR). The purpose of this study was to evaluate the early postoperative active ROM (aROM) between raTKR and mTKR.

METHODS

A total of 216 mTKR patients were propensity-matched, in terms of age, gender, comorbidities, and BMI, to 216 raTKR cases. Intraoperative and immediate postoperative adverse events were collected. Knee flexion and extension aROM were measured preoperatively and at one- and three months after operation.

RESULTS

Changes in flexion aROM were significantly greater in raTKR vs. mTKR at one- (6.9°, 95% CI: 3.5, 10.4°) and three months (4.9°, 95% CI: 2.1, 7.7°). Flexion aROM was greater at three postoperative months compared to preoperative aROM only in the raTKR group, and raTKR patients had higher odds of achieving ≥ 90° of flexion at one month after operation (OR: 2.15, 95% CI: 1.16, 3.99). There were no significant differences between groups in intraoperative (P > 0.999) or postoperative adverse events.

CONCLUSIONS

Compared with mTKR, raTKR resulted  in less loss of aROM immediately after operation and a faster recovery of aROM within three months after operation.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT# 03737149).