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.
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, VIC, Australia.
Gait Posture. 2018 Mar;61:263-268. doi: 10.1016/j.gaitpost.2018.01.014. Epub 2018 Mar 20.
Gait biomechanics, sex, and obesity can contribute to suboptimal outcomes from primary total knee arthroplasty. The aims of this study were to i) determine if sex and/or obesity influence the amount of change in gait biomechanics from pre-surgery to six months post-surgery and; ii) assess if gait returns to normal in men and women.
Three-dimensional gait analysis was performed on 43 patients undergoing primary total knee arthroplasty for knee osteoarthritis (pre- and six months post-operative) and 40 asymptomatic controls. Mixed linear regression models were fit to assess which factors influenced change in gait biomechanics within the arthroplasty cohort, and interaction terms were included to assess if biomechanics returned to normal following surgery.
Male peak knee adduction moment (p < 0.001) and impulse (p < 0.001) decreased six months following arthroplasty, whilst gait in women remained unchanged after surgery. Obesity did not influence gait changes in men or women. Gait of female arthroplasty participants did not differ from female controls after surgery except for sagittal plane knee range of motion (p = 0.003), whilst men differed from controls for peak knee adduction moment (p = 0.011), knee range of motion (p < 0.001), and peak knee flexion moment (p < 0.001).
Sex, but not obesity, influenced changes in gait biomechanics after arthroplasty. Men retained abnormal gait patterns after surgery, whilst women did not. Further research should determine the long-term implications of gait abnormalities seen in men after arthroplasty.
步态生物力学、性别和肥胖可能导致初次全膝关节置换术的效果欠佳。本研究的目的是：i）确定性别和/或肥胖是否会影响从术前到术后六个月步态生物力学的变化量；ii）评估男性和女性的步态是否恢复正常。
对43例因膝关节骨关节炎接受初次全膝关节置换术的患者（术前和术后六个月）以及40例无症状对照者进行三维步态分析。采用混合线性回归模型来评估哪些因素影响置换术队列中步态生物力学的变化，并纳入交互项以评估术后生物力学是否恢复正常。
置换术后六个月，男性的膝关节内收峰值力矩（p<0.001）和冲量（p<0.001）下降，而女性的步态在术后保持不变。肥胖对男性或女性的步态变化均无影响。术后，除矢状面膝关节活动范围外（p=0.003），女性置换术参与者的步态与女性对照者无差异，而男性在膝关节内收峰值力矩（p=0.011）、膝关节活动范围（p<0.001）和膝关节屈曲峰值力矩（p<0.001）方面与对照者存在差异。
性别而非肥胖影响了置换术后步态生物力学的变化。男性术后仍保留异常步态模式，而女性则没有。进一步的研究应确定置换术后男性出现的步态异常的长期影响。
