Christensen Jesse C, LaStayo Paul C, Marcus Robin L, Stoddard Gregory J, Bo Foreman K, Mizner Ryan L, Peters Christopher L, Pelt Christopher E
University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States; University of Colorado, Department of Physical Medicine and Rehabilitation, Aurora, CO, United States.
University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States; University of Utah, Department of Physical Therapy & Athletic Training, Salt Lake City, UT, United States.
Knee. 2018 Jan;25(1):73-82. doi: 10.1016/j.knee.2017.11.010. Epub 2018 Jan 2.
Abnormal knee mechanics frequently follow total knee arthroplasty (TKA) surgery with these deficits amplifying as task demands increase. Knee-kinetic biofeedback could provide a means of attenuating gait abnormalities. The purposes of this study were as follows: (1) to describe the gait characteristic differences between patients with TKA and non-TKA adults during level (low-demand) and decline (high-demand) walking; and (2) where differences existed, to determine the impact of knee-kinetic biofeedback on normalizing these abnormalities.
Twenty participants six months following a primary TKA and 15 non-TKA peers underwent gait analysis testing during level and decline walking. Knee-kinetic biofeedback was implemented to patients with TKA to correct abnormal gait characteristics if observed.
Patients with TKA had lower knee extensor angular impulse (p<0.001), vGRF (p=0.001) and knee flexion motion (p=0.005) compared to the non-TKA group during decline walking without biofeedback. Patients with TKA normalized their knee extensor angular impulse (p=0.991) and peak vGRF (p=0.299) during decline walking when exposed to biofeedback. No between-group differences were observed during level walking. Groups were similar in age, gender, body mass index, physical activity level, pain interference and depression scores (p>0.05).
Patients with TKA demonstrate abnormal gait characteristics during a high-demand walking task when compared to non-TKA peers. Our findings indicate that knee-kinetic biofeedback can induce immediate improvements in gait characteristics during a high-demand walking task. There may be a potential role for the use of visual knee-kinetic biofeedback techniques to improve gait abnormalities during high-demand tasks following TKA.
全膝关节置换术(TKA)后常出现膝关节力学异常,且随着任务需求增加,这些缺陷会加剧。膝关节动力学生物反馈可能提供一种减轻步态异常的方法。本研究的目的如下:(1)描述TKA患者与非TKA成年人在平地(低需求)和下坡(高需求)行走时的步态特征差异;(2)在存在差异的情况下,确定膝关节动力学生物反馈对使这些异常正常化的影响。
20名初次TKA术后6个月的参与者和15名非TKA的同龄人在平地和下坡行走时接受了步态分析测试。如果观察到TKA患者存在异常步态特征,则对其实施膝关节动力学生物反馈以纠正。
在无生物反馈的下坡行走过程中,与非TKA组相比,TKA患者的膝关节伸肌角冲量较低(p<0.001)、垂直地面反作用力(vGRF)较低(p=0.001)以及膝关节屈曲运动较小(p=0.005)。当接受生物反馈时,TKA患者在下坡行走过程中其膝关节伸肌角冲量(p=0.991)和vGRF峰值(p=0.299)恢复正常。在平地行走过程中未观察到组间差异。两组在年龄、性别、体重指数、身体活动水平、疼痛干扰和抑郁评分方面相似(p>0.05)。
与非TKA同龄人相比,TKA患者在高需求行走任务中表现出异常的步态特征。我们的研究结果表明,膝关节动力学生物反馈可以在高需求行走任务中立即改善步态特征。视觉膝关节动力学生物反馈技术可能在改善TKA术后高需求任务期间的步态异常方面具有潜在作用。