对侧膝关节可能并非单侧全膝关节置换术后生物力学结果的有效对照。
The contralateral knee may not be a valid control for biomechanical outcomes after unilateral total knee arthroplasty.
作者信息
Aljehani Moiyad, Madara Kathleen, Snyder-Mackler Lynn, Christiansen Cory, Zeni Joseph A
机构信息
University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA; Umm Al-Qura University, Department of Physical Therapy, P.O. Box 715, Makkah, 21421, Saudi Arabia.
University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA.
出版信息
Gait Posture. 2019 May;70:179-184. doi: 10.1016/j.gaitpost.2019.01.030. Epub 2019 Mar 8.
BACKGROUND
Although unilateral symptoms and unilateral total knee arthroplasty (TKA) are common, many patients have bilateral radiographic osteoarthritis (OA). Because the contralateral (non-operated) limb is often used as a comparison for clinical and biomechanical outcomes, it is important to know if the presence of OA influences movement patterns in either limb.
RESEARCH QUESTION
The purpose of this study was to compare bilateral sagittal plane biomechanics between subjects with and without contralateral knee OA after unilateral TKA.
METHODS
Fifty-three subjects who underwent unilateral TKA underwent three-dimensional gait analysis 6-24 months after surgery participated in this cross-sectional study. Kellgren-Lawrence (KL) OA severity in the contralateral limb was measured, and subjects were classified into either a non-OA (KL 0 or 1) or OA (KL 2-4) group. Mixed-model ANOVA tests with factors of group and limb were used to compare biomechanical measures. In the presence of a significant interaction effect, post-hoc comparisons were performed.
RESULTS
The OA group had more knee flexion at initial contact, less knee flexion and extension excursions, and less knee extension in the contralateral limb compared to the non-OA group. The non-OA group had significant differences between limbs, with more knee flexion at initial contact, less knee joint excursion, and less peak knee extension on the operated limb compared to the contralateral limb, whereas there were no limb differences for the OA group. Kinetic variables were not different in the ANOVA models.
SIGNIFICANCE AND INTERPRETATION
Subjects with contralateral knee OA have more symmetrical gait, although they adopt a more abnormal and stiff-legged gait pattern bilaterally. Researchers and clinicians should consider radiographic disease severity, not just symptoms, in the contralateral limb when identifying appropriate subject samples for unilateral biomechanical studies. Symmetrical movement patterns between limbs after surgery should not be the sole factor upon which movement recovery is based.
背景
尽管单侧症状和单侧全膝关节置换术（TKA）很常见，但许多患者存在双侧影像学骨关节炎（OA）。由于对侧（未手术）肢体常被用作临床和生物力学结果的对照，了解OA的存在是否会影响任一肢体的运动模式很重要。
研究问题
本研究的目的是比较单侧TKA后对侧膝关节有或无OA的受试者之间的双侧矢状面生物力学。
方法
53例行单侧TKA的受试者在术后6 - 24个月接受三维步态分析，参与了这项横断面研究。测量对侧肢体的Kellgren-Lawrence（KL）OA严重程度，受试者被分为非OA（KL 0或1）组或OA（KL 2 - 4）组。使用具有组和肢体因素的混合模型方差分析测试来比较生物力学指标。在存在显著交互作用的情况下，进行事后比较。
结果
与非OA组相比，OA组在初始接触时膝关节屈曲更多，对侧肢体的膝关节屈曲和伸展幅度更小，膝关节伸展更少。非OA组的肢体之间存在显著差异，与对侧肢体相比，手术侧肢体在初始接触时膝关节屈曲更多，膝关节活动度更小，膝关节伸展峰值更小，而OA组没有肢体差异。方差分析模型中的动力学变量没有差异。
意义和解释
对侧膝关节有OA的受试者步态更对称，尽管他们双侧采用更异常和僵硬的步态模式。研究人员和临床医生在为单侧生物力学研究确定合适的受试者样本时，应考虑对侧肢体的影像学疾病严重程度，而不仅仅是症状。术后肢体之间的对称运动模式不应是运动恢复所基于的唯一因素。
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