Güven Melih, Kocadal Onur, Akman Budak, Şayli Uğur, Altıntaş Faik
Department of Orthopaedics and Traumatology, Faculty of Medicine, Yeditepe University, Kozyatagi, Istanbul, Turkey.
J Knee Surg. 2017 Nov;30(9):951-959. doi: 10.1055/s-0037-1599247. Epub 2017 Mar 10.
Pedobarographic gait analysis is a useful tool for the determination of loading distributions and alterations on the lower extremity and their reflection on the foot sole after many orthopaedic surgical applications. To date, there have been no studies evaluating the relationship between component alignment and changes of pedobarographic gait analysis in total knee arthroplasty (TKA). We aimed to investigate the effects of TKA and prosthetic alignment on the distribution of pedobarographic parameters. Quantitative gait patterns of 47 patients were prospectively evaluated by using pedobarography 1 week before surgery and at the seventh month, on average, postoperatively. Component positions were assessed, and all applications were divided into three groups according to tibial component position as varus, neutral, and valgus. Pedobarographic results were compared between pre- and postoperative values for all applications and compared among the groups. Mean postoperative tibiofemoral angle was 5.4 degrees in valgus, and preoperative knee scores were markedly improved postoperatively. The range of tibial component alignment changed between 1 and 4 degrees in the varus and valgus groups. Plantar loading parameters (force and pressure) were significantly decreased in all operated knees, especially in forefoot and midfoot. In varus tibial components, plantar loading values decreased in midfoot and hindfoot. However, in the neutral and valgus groups, similar alterations of plantar loadings were obtained, which included decreasing in forefoot and midfoot with significant increase in hindfoot. Plantar loading distribution changed statistically significantly after TKA despite good clinical and radiographic results. Tibial component alignment was also responsible for plantar loading distribution. Tibial components in varus position create different foot loading characteristics compared with neutral and valgus aligned components. Pedobarographic evaluation in TKA allows clinicians to obtain a proper understanding of abnormal gait caused by component malposition.
足底压力步态分析是一种有用的工具，可用于确定许多骨科手术应用后下肢的负荷分布和变化及其在足底的反映。迄今为止，尚无研究评估全膝关节置换术（TKA）中假体对线与足底压力步态分析变化之间的关系。我们旨在研究TKA和假体对线对足底压力参数分布的影响。对47例患者术前1周和术后平均7个月时的定量步态模式进行前瞻性足底压力分析评估。评估假体位置，并根据胫骨假体位置将所有病例分为三组：内翻、中立和外翻。比较所有病例术前和术后的足底压力分析结果，并在组间进行比较。术后平均胫股角外翻5.4度，术前膝关节评分术后明显改善。内翻和外翻组胫骨假体对线范围在1至4度之间变化。所有手术膝关节的足底负荷参数（力和压力）均显著降低，尤其是前足和中足。对于内翻胫骨假体，中足和后足的足底负荷值降低。然而，在中立和外翻组中，获得了类似的足底负荷变化，包括前足和中足降低，后足显著增加。尽管临床和影像学结果良好，但TKA后足底负荷分布仍有统计学显著变化。胫骨假体对线也影响足底负荷分布。与中立和外翻对线的假体相比，内翻位置的胫骨假体产生不同的足部负荷特征。TKA中的足底压力分析评估使临床医生能够正确理解由假体位置不当引起的异常步态。
