Kline Paul W, Jacobs Cale A, Duncan Stephen T, Noehren Brian
Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY 40536-0200, USA.
Rehabilitation Sciences Program, College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY 40536-0200, USA; Department of Orthopaedics & Sports Medicine, College of Medicine, University of Kentucky, 125 E. Maxwell Street, Suite 201, Lexington, KY 40508, USA.
Gait Posture. 2019 Feb;68:397-402. doi: 10.1016/j.gaitpost.2018.12.019. Epub 2018 Dec 16.
Following rehabilitation for total knee arthroplasty, "quadriceps avoidance gait", defined by limited knee flexion angle excursion during walking, persists and contributes to poor long-term outcomes. Given the presence of several post-surgical impairments, identifying the contribution of multiple factors to knee flexion angle excursion is important to developing targeted interventions to improve recovery after total knee arthroplasty.
Which outcomes continue to improve following rehabilitation for total knee arthroplasty? What are the primary contributors to impaired knee flexion angle excursion during walking following total knee arthroplasty?
Peak muscle strength and rate of torque development of the quadriceps, hip abductors, and hip external rotators, five-time sit-to-stand test, Knee Injury & Osteoarthritis Outcome Score, and gait mechanics were assessed in 24 participants at three and six months post-surgery. Paired sample t-tests or Wilcoxon Signed-Rank tests were used to compare outcomes between assessments. Stepwise multiple linear regression were used to assess the contribution of each measure to knee flexion angle excursion.
Significant improvements were noted in all outcomes except hip external rotation rate of torque development, gait speed, and knee flexion angle excursion. Quadriceps rate of torque development and knee pain significantly contributed to knee flexion angle excursion at three months (Adjusted R = 0.342), while quadriceps rate of torque development and peak hip external rotation strength significantly contributed at six months (Adjusted R = 0.436).
While higher pain levels at three months and greater peak hip external rotation muscle strength at six months contribute to impaired knee flexion angle excursion, quadriceps rate of torque development was the primary contributor to knee flexion angle excursion at both three and six months after surgery. Implementing strategies to maximize quadriceps rate of torque development during rehabilitation may help to reduce quadriceps avoidance gait after total knee arthroplasty.
全膝关节置换术后康复治疗后，“股四头肌回避步态”（其定义为步行过程中膝关节屈曲角度偏移受限）持续存在，并导致长期预后不良。鉴于存在多种术后功能障碍，确定多种因素对膝关节屈曲角度偏移的影响，对于制定有针对性的干预措施以改善全膝关节置换术后的恢复情况至关重要。
全膝关节置换术后康复治疗后，哪些结果仍在持续改善？全膝关节置换术后步行过程中膝关节屈曲角度偏移受损的主要因素有哪些？
对24名参与者在术后3个月和6个月时进行股四头肌、髋外展肌和髋外旋肌的峰值肌肉力量和扭矩发展速率、五次坐立试验、膝关节损伤与骨关节炎疗效评分以及步态力学评估。采用配对样本t检验或Wilcoxon符号秩检验来比较评估之间的结果。使用逐步多元线性回归来评估各项指标对膝关节屈曲角度偏移的影响。
除髋外旋扭矩发展速率、步态速度和膝关节屈曲角度偏移外，所有结果均有显著改善。股四头肌扭矩发展速率和膝关节疼痛在3个月时对膝关节屈曲角度偏移有显著影响（调整后R = 0.342），而股四头肌扭矩发展速率和髋外旋峰值力量在6个月时贡献显著（调整后R = 0.436）。
虽然3个月时较高的疼痛水平和6个月时较大的髋外旋峰值肌肉力量会导致膝关节屈曲角度偏移受损，但股四头肌扭矩发展速率是术后3个月和6个月时膝关节屈曲角度偏移的主要影响因素。在康复过程中实施策略以最大化股四头肌扭矩发展速率，可能有助于减少全膝关节置换术后的股四头肌回避步态。
