Valenzuela Kevin A, Zhang Songning, Schroeder Lauren E, Weinhandl Joshua T, Cates Harold E
California State University, Long Beach, 1250 Bellflower Blvd., Long Beach, CA 90840, USA.
The University of Tennessee, Knoxville, 1914 Andy Holt Ave., Knoxville, TN 37996, USA.
Clin Biomech (Bristol). 2019 Jul;67:38-44. doi: 10.1016/j.clinbiomech.2019.04.020. Epub 2019 Apr 30.
Total knee replacement patients have shown reductions in knee flexion range of motion, knee extensor moments, and gait speed during stair ascent and stair descent. However, it is unknown how patients dissatisfied with their total knee replacement differ from those who are satisfied during more difficult activities such as stair negotiation. Therefore, the purpose of this study was to compare knee biomechanics of patients who are dissatisfied with their joint replacement to those who are satisfied and healthy participants during stair negotiation.
Nine dissatisfied, fifteen satisfied patients and fifteen healthy participants participated, completing stair ascent and descent trials on an instrumented staircase. A 2 × 3 ANOVA was used to analyze biomechanical differences between groups and limbs during both activities.
The dissatisfied group showed reduced 2nd peak vertical GRF (P ≤ 0.0040) and loading-response knee extension moments (P ≤ 0.0041) in their operated limb compared to their non-operated limb and to satisfied and healthy groups during stair ascent. First peak vertical GRF (P < 0.0088) and both loading-response (P < 0.0117) and push-off abduction moments (P < 0.0028) showed reduced values in operated limbs compared to non-operated limbs for all groups. During stair descent, the dissatisfied group showed reduced loading-response and push-off knee extension moments (P ≤ 0.006) in their operated limb compared to their non-operated limb and the healthy group. The loading-response knee extension (P < 0.0379) and abduction moments (P ≤ 0.0048) were also reduced in the dissatisfied group compared to the satisfied group.
Patients who were dissatisfied showed asymmetrical loading of the knees in conjunction, which may have contributed to their dissatisfaction.
全膝关节置换患者在上下楼梯时膝关节屈曲活动范围、膝关节伸肌力矩和步态速度均有所降低。然而，在诸如上下楼梯等更具挑战性的活动中，对全膝关节置换不满意的患者与满意的患者之间存在何种差异尚不清楚。因此，本研究的目的是比较对关节置换不满意的患者与满意的患者以及健康参与者在上下楼梯时的膝关节生物力学。
9名不满意的患者、15名满意的患者和15名健康参与者参与了研究，他们在装有仪器的楼梯上完成了上下楼梯试验。采用2×3方差分析来分析两组在两种活动期间以及双侧肢体之间的生物力学差异。
在上下楼梯时，与未手术侧肢体以及满意组和健康组相比，不满意组手术侧肢体的第二峰值垂直地面反作用力（P≤0.0040）和负重反应期膝关节伸展力矩（P≤0.0041）降低。所有组中，与未手术侧肢体相比，手术侧肢体的第一峰值垂直地面反作用力（P<0.0088）以及负重反应期（P<0.0117）和离地期外展力矩（P<0.0028）均降低。在上下楼梯时，与未手术侧肢体以及健康组相比，不满意组手术侧肢体的负重反应期和离地期膝关节伸展力矩（P≤0.006）降低。与满意组相比，不满意组的负重反应期膝关节伸展力矩（P<0.0379）和外展力矩（P≤0.0048）也降低。
不满意的患者表现出膝关节联合负重不对称，这可能是导致他们不满意的原因。
