Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Department of Orthopedic Surgery, Hanmaeum Changwon Hospital, Changwon-Si, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2018 Jun;26(6):1671-1680. doi: 10.1007/s00167-017-4682-8. Epub 2017 Aug 28.
The aim of this study was to investigate gait speed changes 2 years after bilateral total knee arthroplasty (TKA) and identify kinetic and kinematic factors associated with such changes by comparing patients with age- and sex-matched controls.
The study group included 34 female patients with end-stage knee osteoarthritis (OA) who underwent bilateral TKA and 42 age- and sex-matched controls without knee pain or OA. Standard TKA was performed on all arthritic patients with placement of posterior stabilized fixed-bearing implants. Kinetic and kinematic parameters were evaluated using a commercial optoelectric gait analysis system. Gait speed, kinetic and kinematic changes and determinants of speed were assessed via principal component analysis and multiple regression analysis.
The average gait speed of an arthritic patient was 90.2 ± 18.4 cm/s and improved to 96.0 ± 12.3 cm/s after TKA (p = 0.032). However, the speed remained slower than that of controls (111.2 ± 8.2 cm/s, p < 0.001). With regard to kinetics, the peak knee extension moment (KEM) generated by the quadriceps was unchanged after TKA and weaker than that of controls (p < 0.001). The proportions of KEM contributing to the total sagittal moment were also smaller in the pre-/post-operative groups than in the control group (13-14% vs. 19%). On the other hand, the ankle plantar flexion moment (APFM) was increased after TKA (p = 0.007) and its proportion of the total sagittal moment was greater than in controls (46% vs. 42%). With regard to kinematics, knee range of motion (ROM) improved after TKA (p = 0.025), but was smaller than that of controls (p < 0.001). In controls, gait speed was determined principally by hip and knee joint moments. However, in the TKA group, speed was determined by the knee ROM and APFM.
Despite showing improvement, the gait speed of TKA patients remained slower than that of controls. Slow gait speed after bilateral TKA was associated with suboptimal improvement of knee biomechanics. Quadriceps strengthening exercises and the achievement of greater ROM during gait are advised for the further improvement of gait speed.
Retrospective cohort study, Level III.
本研究旨在探讨双侧全膝关节置换术（TKA）2 年后步态速度的变化，并通过与年龄和性别匹配的对照组进行比较，确定与这种变化相关的动力学和运动学因素。
研究组纳入了 34 名患有终末期膝关节骨关节炎（OA）的女性患者，这些患者均接受了双侧 TKA，并纳入了 42 名无膝关节疼痛或 OA 的年龄和性别匹配的对照组。所有关节炎患者均接受了标准 TKA，并采用后稳定固定承重植入物。使用商业光电步态分析系统评估动力学和运动学参数。通过主成分分析和多元回归分析评估步态速度、动力学和运动学变化以及速度的决定因素。
关节炎患者的平均步态速度为 90.2±18.4cm/s，TKA 后提高至 96.0±12.3cm/s（p=0.032）。然而，速度仍慢于对照组（111.2±8.2cm/s，p<0.001）。在动力学方面，股四头肌产生的峰值膝关节伸展力矩（KEM）在 TKA 后保持不变，且弱于对照组（p<0.001）。术前/术后组中 KEM 占总矢状面力矩的比例也小于对照组（13-14%对 19%）。另一方面，TKA 后踝关节跖屈力矩（APFM）增加（p=0.007），其占总矢状面力矩的比例大于对照组（46%对 42%）。在运动学方面，TKA 后膝关节活动范围（ROM）改善（p=0.025），但小于对照组（p<0.001）。在对照组中，步态速度主要由髋关节和膝关节力矩决定。然而，在 TKA 组中，速度由膝关节 ROM 和 APFM 决定。
尽管 TKA 患者的步态速度有所改善，但仍慢于对照组。双侧 TKA 后步态速度较慢与膝关节生物力学改善不理想有关。建议进行股四头肌强化锻炼，并在步态中实现更大的 ROM，以进一步提高步态速度。
回顾性队列研究，III 级。
