Sosdian L, Dobson F, Wrigley T V, Paterson K, Bennell K, Dowsey M, Choong P, Allison K, Hinman R S
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC Australia.
The University of Melbourne, Department of Surgery, St Vincent's Hospital, Melbourne, Australia.
Knee. 2014 Dec;21(6):994-1008. doi: 10.1016/j.knee.2014.09.009. Epub 2014 Oct 12.
Knee arthroplasty (KA) is recognized as an effective treatment of knee joint osteoarthritis and up to 90% of patients experience substantial pain relief. There has been no systematic review synthesizing the longitudinal changes in gait following KA. The aims of this systematic review were to determine the effects of KA on (i) frontal plane and (ii) sagittal plane kinematic and kinetic parameters during the stance phase of gait.
MEDLINE (PubMed), CINAHL, SPORTdiscus (EBSCO), and Cochrane Library (Wiley) were searched until April 10th, 2014. 1,765 articles were identified, of which 19 studies describing 3-dimensional gait analysis pre- and post-KA were included. Study quality was evaluated by two reviewers independently using the Downs and Black checklist.
Following KA, in the frontal plane, the maximum knee adduction angle and external knee adduction moment (KAM) tended to decrease. In the sagittal plane, findings suggest that the maximum knee flexion moment is increased. From the ten studies that included a healthy reference group, it was unclear whether gait variables returned to normal following KA.
Overall, it appears that KA results in a decreased peak KAM and maximum knee adduction angles, an increased peak knee flexion moment and inconsistent changes in the peak knee flexion angle. Knowledge gaps remain due to methodological inconsistencies across studies, limited statistical analysis, and largely heterogeneous sample populations. More research is needed to determine whether KA restores gait patterns to normal, or if additional rehabilitation may be needed to optimize gait following surgery for osteoarthritis.
膝关节置换术（KA）被认为是治疗膝关节骨关节炎的有效方法，高达90%的患者疼痛得到显著缓解。目前尚无系统综述综合分析KA术后步态的纵向变化。本系统综述的目的是确定KA对步态站立期（i）额状面和（ii）矢状面运动学和动力学参数的影响。
检索MEDLINE（PubMed）、CINAHL、SPORTdiscus（EBSCO）和Cochrane图书馆（Wiley），检索截至2014年4月10日的文献。共识别出1765篇文章，其中纳入了19项描述KA术前和术后三维步态分析的研究。由两名评价者独立使用唐斯和布莱克检查表对研究质量进行评价。
KA术后，在额状面，最大膝关节内收角和膝关节内收外力矩（KAM）有下降趋势。在矢状面，结果表明最大膝关节屈曲力矩增加。在纳入健康对照组的10项研究中，尚不清楚KA术后步态变量是否恢复正常。
总体而言，KA似乎导致KAM峰值和最大膝关节内收角降低，膝关节屈曲峰值力矩增加，而膝关节屈曲峰值角度变化不一致。由于各研究方法不一致、统计分析有限以及样本人群差异较大，仍存在知识空白。需要更多研究来确定KA是否能使步态模式恢复正常，或者骨关节炎手术后是否需要额外的康复治疗来优化步态。
