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 Utah, Department of Physical Therapy & Athletic Training, Veterans Affairs Salt Lake City Health Care System, Department of Physical Medicine and Rehabilitation, 520 So. Wakara Way, Salt Lake City, UT 84108, USA.
Gait Posture. 2022 Jan;91:266-275. doi: 10.1016/j.gaitpost.2021.10.020. Epub 2021 Oct 30.
Despite the success rate of Total Knee Arthroplasty (TKA), many patients undergo contralateral TKA. It is possible that altered gait mechanics after unilateral TKA play a role in the progression of contralateral OA progression.
The purpose of this study was to identify biomechanical predictors of radiographic OA progression in the contralateral (non-surgical) knee after unilateral (primary/initial) TKA. In addition, this study quantified for patients who had contralateral OA progression.
Biomechanical outcomes were collected 6-24 months after unilateral primary TKA and were used to predict changes in contralateral OA severity at follow-up. Participants were divided into "Progressor" and "Non-Progressor" groups based on changes in Kellgren-Lawrence (KL) OA grade and Joint Space Width (JSW) between baseline and follow-up testing sessions. Biomechanical factors during walking were peak knee adduction moment, knee flexion/extension excursions, knee angle at initial foot contact, and peak knee flexion/extension. Multiple independent t-tests were used to examine the magnitude of differences in biomechanical variables between the groups. Logistic regression was used to examine the association between the biomechanical predictors and change in KL scores and JSW.
The mean time between surgery and follow-up x-rays was 8.8 (2.4) years. Of 40 participants, 62.5-78% had contralateral radiographic knee OA progression by follow-up. There were no significant differences in the biomechanical variables between groups. For the regression analysis, none of the biomechanical variables were found to be predictors for contralateral OA progression.
Although abnormal biomechanics are known risk factors for primary knee OA, it is possible that the mechanisms that result in OA progression of the contralateral limb are different than primary knee OA progression. Future work should evaluate other objective measures of OA progression and determine if cumulative measures of joint loading are related to OA worsening.
尽管全膝关节置换术（TKA）的成功率很高，但许多患者仍需要进行对侧 TKA。单侧 TKA 后步态力学的改变可能在对侧 OA 进展中起作用。
本研究的目的是确定单侧（初次/初始）TKA 后对侧（非手术）膝关节放射学 OA 进展的生物力学预测因子。此外，本研究还定量评估了对侧 OA 进展的患者。
在单侧初次 TKA 后 6-24 个月收集生物力学结果，并用于预测随访时对侧 OA 严重程度的变化。根据基线和随访测试期间 Kellgren-Lawrence（KL）OA 分级和关节间隙宽度（JSW）的变化，将参与者分为“进展者”和“非进展者”组。在步行过程中，膝关节内收力矩峰值、膝关节屈伸幅度、初始足触地时膝关节角度和膝关节屈伸角度峰值等生物力学因素。使用多个独立 t 检验比较两组间生物力学变量的差异程度。使用逻辑回归检验生物力学预测因子与 KL 评分和 JSW 变化之间的关联。
手术与随访 X 射线之间的平均时间为 8.8（2.4）年。在 40 名参与者中，62.5-78%在随访时出现对侧放射学膝关节 OA 进展。两组间的生物力学变量无显著差异。在回归分析中，没有一个生物力学变量被发现是对侧 OA 进展的预测因子。
尽管异常的生物力学是原发性膝关节炎的已知危险因素，但导致对侧肢体 OA 进展的机制可能与原发性膝关节炎进展不同。未来的工作应评估其他 OA 进展的客观指标，并确定关节负荷的累积测量值是否与 OA 恶化有关。
