Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
Clin Biomech (Bristol). 2021 Feb;82:105278. doi: 10.1016/j.clinbiomech.2021.105278. Epub 2021 Jan 24.
The assessment of functional recovery of patients after a total knee replacement includes the quantification of gait deviations. Comparisons to comfortable gait of healthy controls may incorrectly suggest biomechanical gait deviations, since the usually lower walking speed of patients already causes biomechanical differences. Moreover, taking peak values as parameter might not be sensitive to actual differences. Therefore, this study investigates the effect of matching walking speed and full-waveform versus discrete analyses.
Gait biomechanics of 25 knee replacement patients were compared to 22 controls in two ways: uncorrected and corrected for walking speed employing principal component analyses, to reconstruct control gait biomechanics at walking speeds matched to the patients. Ankle, knee and hip kinematics and kinetics were compared over the full gait cycle using statistical parametric mapping against using peak values.
All joint kinematics and kinetics gait data were impacted by applying walking speed correction, especially the kinetics of the knee. The lower control walking speeds used for reference generally reduced the magnitude of differences between patient and control gait, however some were enlarged. Full-waveform analysis identified greater deviating gait cycle regions beyond the peaks, but did not make peak value analyses redundant.
Matching walking speed of controls affects identification of gait deviations in patients with a total knee replacement, reducing deviations confounded by walking speed and revealing hidden gait deviations related to possible compensations. Full-waveform analysis should be used along peak values for a comprehensive quantification of differences in gait biomechanics.
全膝关节置换术后患者功能恢复的评估包括步态偏差的量化。与健康对照者的舒适步态进行比较可能会错误地提示生物力学步态偏差，因为患者通常较低的步行速度已经导致了生物力学差异。此外，以峰值作为参数可能对实际差异不敏感。因此，本研究调查了匹配步行速度和全波形与离散分析的效果。
以两种方式比较了 25 例膝关节置换患者和 22 例对照者的步态生物力学：未校正和校正步行速度，采用主成分分析，以重建与患者匹配的步行速度的对照步态生物力学。使用统计参数映射比较了整个步态周期的踝关节、膝关节和髋关节运动学和动力学，而不是使用峰值值。
所有关节运动学和动力学步态数据都受到应用步行速度校正的影响，尤其是膝关节的动力学。为参考而使用的较低的对照步行速度通常会降低患者和对照步态之间差异的幅度，但有些差异会扩大。全波形分析确定了在峰值之外存在更大的偏离步态周期区域，但并未使峰值值分析变得多余。
匹配对照者的步行速度会影响全膝关节置换患者步态偏差的识别，减少因步行速度而混淆的偏差，并揭示与可能的代偿相关的隐藏步态偏差。应沿峰值值使用全波形分析，以全面量化步态生物力学的差异。
