South Bend Orthopaedics, South Bend, IN, USA; Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA.
Department of Kinesiology, California State University Long Beach, Long Beach, CA, USA.
Knee. 2022 Jan;34:9-16. doi: 10.1016/j.knee.2021.11.009. Epub 2021 Dec 4.
Many total knee replacement (TKR) patients need to have a contralateral knee replacement. Biomechanical differences between first and second replaced limbs of bilateral TKR have not been examined during stair negotiation. Additionally, it is unknown whether hip and ankle biomechanics of bilateral patients are altered. We examined hip, knee, and ankle biomechanics of first and second replaced limbs bilateral patients, as well as replaced and non-replaced limbs of unilateral patients, during stair ascent and descent.
Eleven bilateral TKR patients (70.09 ± 5.41 years, 1.71 ± 0.08 m, 91.78 ± 13.00 kg) and 15 unilateral TKR patients (64.93 ± 5.11 years, 1.75 ± 0.09 m, 89.18 ± 17.55 kg) were recruited. Patients performed three to five trials of stair ascent and descent. The second step, during ascent, was the step of interest when analyzing each limb. A 2 × 2 (limb × group) analysis of variance was performed to determine differences between limbs and groups.
During ascent, bilateral patients exhibited decreased peak loading-response knee extension (KEM) and push-off plantarflexion moments. Unilateral replaced limb KEM was lower than non-replaced limbs. During descent, bilateral patients descended the staircase significantly slower, had lower peak loading-response vertical ground reaction force and KEM, and push-off KEM. Bilateral patients had higher peak loading-response hip extension and push-off plantarflexion moments, and increased knee adduction ROM, compared with unilateral TKA patients.
Bilateral patients exhibited similar hip, knee, and ankle joint moments between first and second replaced limbs. Substantial differences in hip, knee, and ankle biomechanics during stair negotiation in bilateral patients compared with unilateral patients may indicate a more complex adaptation strategy present in these patients.
许多全膝关节置换（TKR）患者需要进行对侧膝关节置换。在上下楼梯时，双侧 TKR 首次和再次置换肢体之间的生物力学差异尚未得到检验。此外，双侧患者的髋踝关节生物力学是否改变也不得而知。我们检查了双侧 TKR 患者首次和再次置换肢体的髋、膝和踝关节生物力学，以及单侧 TKR 患者的置换和非置换肢体的髋、膝和踝关节生物力学，同时进行了上下楼梯。
招募了 11 例双侧 TKR 患者（70.09 ± 5.41 岁，1.71 ± 0.08 m，91.78 ± 13.00 kg）和 15 例单侧 TKR 患者（64.93 ± 5.11 岁，1.75 ± 0.09 m，89.18 ± 17.55 kg）。患者进行了 3 到 5 次上下楼梯试验。在分析每条肢体时，第二步（上楼梯时）是感兴趣的一步。进行了 2×2（肢体×组）方差分析，以确定肢体和组之间的差异。
在上楼梯时，双侧患者表现出降低的峰值负荷反应膝关节伸展（KEM）和蹬离跖屈力矩。单侧置换肢体的 KEM 低于非置换肢体。在下楼梯时，双侧患者明显下降楼梯速度较慢，峰值负荷反应垂直地面反作用力和 KEM 以及蹬离 KEM 较低。与单侧 TKA 患者相比，双侧患者的峰值负荷反应髋关节伸展和蹬离跖屈力矩较高，膝关节内收 ROM 增加。
双侧患者在首次和再次置换肢体之间表现出相似的髋、膝和踝关节力矩。双侧患者与单侧患者相比，在上下楼梯时髋、膝和踝关节生物力学有很大差异，这可能表明这些患者存在更复杂的适应策略。
