Bonnefoy-Mazure Alice, Armand Stéphane, Sagawa Yoshisama, Suvà Domizio, Miozzari Hermes, Turcot Katia
Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals, Geneva University, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Faculty of Medecine, Geneva, Switzerland.
Laboratoire d'Exploration Fonctionnelle Clinique du Mouvement, CHRU de Besançon, Besançon, France; Centre d'Investigation Clinique INSERM CIT 808, CHRU de Besançon, Besançon, France.
J Arthroplasty. 2017 Mar;32(3):793-800. doi: 10.1016/j.arth.2016.03.050. Epub 2016 Apr 4.
The aim of this study was to describe the evolution of kinematic and clinical outcomes of a large patient cohort with knee osteoarthritis from before surgery (V1) to 3 months (V2) and 1 year (V3) after a total knee arthroplasty (TKA).
The patients were evaluated at each visit (118 patients at V1, 93 patients at V2, and 79 patients at V3) during a clinical gait analysis and were compared with a matched control group of healthy adults (CG). The kinematic parameters, the Western Ontario and MacMaster Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Gait velocity and knee range of motion (ROM) as well as clinical parameters were compared at each visit with CG was based on the unpaired samples t-test. To determine changes in the data at baseline, 3 months, and 1 year after surgery in the patient groups, repeated-measure analysis of variance was conducted (P < .05). Pearson correlation was used to examine relationships between clinical and biomechanical outcomes.
One year after TKA (V3) compared to V1 and V2, the ROM of the operated knee during gait was significantly improved (V1: 44.2 ± 8.8° vs V3: 47.5 ± 7.1°, P < .001, and V2: 42.2 ± 9.3° vs V3: 47.5 ± 7.1°, P = .001), as was the gait velocity (V1: 1.0 ± 0.2 and V2: 1.1 ± 0.2 m/s vs V3: 1.3 ± 0.2 m/s, P < .001). The WOMAC and knee pain were significantly better 1 year after TKA. No strong relationships have been found between clinical parameters and knee kinematics.
This study showed that 1 year after TKA, patients exhibited improved gait velocity and ROM and experienced a significant decrease in the level of pain and an increased clinical score (although different from CG).
本研究的目的是描述一大群膝关节骨关节炎患者在全膝关节置换术(TKA)前(V1)至术后3个月(V2)和1年(V3)的运动学和临床结果的演变。
在临床步态分析期间,对每次就诊的患者进行评估(V1时118例患者,V2时93例患者,V3时79例患者),并与匹配的健康成年人对照组(CG)进行比较。评估运动学参数、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、生活质量和患者满意度。每次就诊时,基于未配对样本t检验将步态速度和膝关节活动范围(ROM)以及临床参数与CG进行比较。为了确定患者组在基线、术后3个月和1年后数据的变化,进行了重复测量方差分析(P <.05)。使用Pearson相关性检验临床和生物力学结果之间的关系。
与V1和V2相比,TKA术后1年(V3),步态期间患侧膝关节的ROM显著改善(V1:44.2±8.8° vs V3:47.5±7.1°,P <.001;V2:42.2±9.3° vs V3:47.5±7.1°,P =.001),步态速度也显著改善(V1:1.0±0.2和V2:1.1±0.2 m/s vs V3:1.3±0.2 m/s,P <.001)。TKA术后1年,WOMAC和膝关节疼痛明显改善。未发现临床参数与膝关节运动学之间有强相关性。
本研究表明,TKA术后1年,患者的步态速度和ROM有所改善,疼痛水平显著降低,临床评分增加(尽管与CG不同)。