Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR; Department of Neuromedicine and Movement Science, Centre for Elite Sports Research, Norwegian University of Science and Technology, Trondheim, Norway.
J Arthroplasty. 2021 Sep;36(9):3326-3332. doi: 10.1016/j.arth.2021.04.038. Epub 2021 May 7.
Patients who have total knee arthroplasty (TKA) likely suffer from decreased postural stability because of postoperative changes in musculoskeletal structure and loss of proprioception. The purpose of this experimental biomechanical study was to determine if patients who have TKA improve their dynamic postural control during walking after TKA as compared with before TKA. The secondary purpose was to assess changes in postural control between post-TKA patients and healthy controls.
Twenty-three patients who had primary knee osteoarthritis scheduled to undergo unilateral or bilateral TKA were prospectively enrolled. Each patient was tested at 3 months, 6 months, and 12 months after TKA. Ten healthy controls matched for age, sex, and body mass index were selected from a database of previous healthy volunteers without knee osteoarthritis. Ten Vicon cameras and four AMTI force platforms were used to collect the marker and center of pressure (COP) data while participants performed gait.
Initial improvement in the double stance ratio was found by 6 months after TKA compared with before TKA. Patients showed improved postural control as evidenced by a faster mediolateral COP velocity and decreased double stance ratio at 12-month post-TKA compared with pre-TKA (P < .05). However, patients who underwent TKA exhibited limited ability to maintain consistent COP movement during walking with increased variability in COP parameters as compared with controls (P < .05).
Patients exhibited improvement in dynamic postural control after TKA with time, but had higher variability in COP parameters during gait than controls. It is possible that therapy aimed to improve proprioceptive balance after TKA may improve dynamic postural control.
全膝关节置换术（TKA）后，由于肌肉骨骼结构的改变和本体感觉丧失，患者可能会出现姿势稳定性下降。本实验生物力学研究的目的是确定 TKA 后患者在 TKA 前后行走时是否会改善动态姿势控制。次要目的是评估 TKA 后患者与健康对照组之间的姿势控制变化。
前瞻性纳入 23 名拟行单侧或双侧 TKA 的原发性膝骨关节炎患者。每位患者在 TKA 后 3 个月、6 个月和 12 个月进行测试。从无膝骨关节炎的先前健康志愿者数据库中选择 10 名年龄、性别和体重指数匹配的健康对照。使用 10 个 Vicon 摄像机和 4 个 AMTI 力台来收集标记和中心压力（COP）数据，同时参与者进行步态。
TKA 后 6 个月与 TKA 前相比，双足支撑比首次出现改善。患者在 TKA 后 12 个月与 TKA 前相比表现出更好的姿势控制，表现为 COP 速度更快，双足支撑比降低（P <.05）。然而，与对照组相比，TKA 患者在行走时维持一致的 COP 运动的能力有限，COP 参数的变异性增加（P <.05）。
患者在 TKA 后随时间推移表现出动态姿势控制的改善，但与对照组相比，COP 参数的变异性更高。TKA 后旨在改善本体感觉平衡的治疗方法可能会改善动态姿势控制。
