Paterson K L, Sosdian L, Hinman R S, Wrigley T V, Kasza J, Dowsey M, Choong P, Bennell K L
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, VIC, Australia.
Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia.
Clin Biomech (Bristol). 2017 Nov;49:72-77. doi: 10.1016/j.clinbiomech.2017.08.013. Epub 2017 Sep 5.
Sex and body mass may influence knee biomechanics associated with poor total knee arthroplasty (TKA) outcomes for knee osteoarthritis (OA). This study aimed to determine if gait differed between men and women, and overweight and class I obese patients with severe knee OA awaiting TKA.
34 patients with severe knee OA (average age 70.0 (SD 7.2) years, body mass index 30.3 (4.1kg/m)) were recruited from a TKA waiting list. Three-dimensional gait analysis was performed at self-selected walking speed. Comparisons were made between men and women, and overweight (body mass index (BMI) 25.0-29.9kg/m) and class I obese (BMI 30.0-34.9kg/m) participants. Biomechanical outcomes included absolute and body size-adjusted peak knee adduction moment (KAM), KAM impulse, peak knee flexion moment, as well as peak knee flexion and varus-valgus angles, peak varus-valgus thrust, and peak vertical ground reaction force (GRF).
Men had a higher absolute peak KAM, KAM impulse and peak GRF compared to women, and this sex-difference in frontal plane moments remained after adjusting for body size. However, when additionally adjusting for static knee alignment, differences disappeared. Knee biomechanics were similar between obesity groups after adjusting for the greater body weight of those with class I obesity.
Men had greater KAM and KAM impulse even after adjustment for body size; however adjustment for their more varus knees removed this difference. Obesity group did not influence knee joint kinematics or moments. This suggests sex- and obesity-differences in these variables may not be associated with TKA outcomes.
性别和体重可能会影响与膝关节骨关节炎（OA）全膝关节置换术（TKA）效果不佳相关的膝关节生物力学。本研究旨在确定等待TKA的重度膝关节OA的男性与女性之间，以及超重和I类肥胖患者之间的步态是否存在差异。
从TKA等待名单中招募了34例重度膝关节OA患者（平均年龄70.0（标准差7.2）岁，体重指数30.3（4.1kg/m²））。以自选步行速度进行三维步态分析。对男性与女性之间，以及超重（体重指数（BMI）25.0 - 29.9kg/m²）和I类肥胖（BMI 30.0 - 34.9kg/m²）参与者进行比较。生物力学结果包括绝对和经体型调整的膝关节内收力矩峰值（KAM）、KAM冲量、膝关节屈曲力矩峰值，以及膝关节屈曲和内翻-外翻角度峰值、内翻-外翻推力峰值和垂直地面反作用力（GRF）峰值。
与女性相比，男性的绝对KAM峰值、KAM冲量和GRF峰值更高，并且在调整体型后，这种额面力矩的性别差异仍然存在。然而，在进一步调整静态膝关节对线后，差异消失。在调整了I类肥胖者更大的体重后，肥胖组之间的膝关节生物力学相似。
即使在调整体型后，男性仍具有更大的KAM和KAM冲量；然而，对他们更内翻的膝关节进行调整后消除了这种差异。肥胖组并未影响膝关节运动学或力矩。这表明这些变量中的性别和肥胖差异可能与TKA结果无关。
