Tassani Simone, Tio Laura, Castro-Domínguez Francisco, Monfort Jordi, Monllau Juan Carlos, González Ballester Miguel Angel, Noailly Jérôme
BCN MedTech, DTIC, Universitat Pompeu Fabra, Barcelona, Spain.
IMIM, Barcelona, Spain.
Front Bioeng Biotechnol. 2022 Mar 11;10:820186. doi: 10.3389/fbioe.2022.820186. eCollection 2022.
The objective of this study was to investigate the relationship between the choice of clinical treatment, gait functionality, and kinetics in patients with comparable knee osteoarthritis. This was an observational case-control study. The study was conducted in a university biomechanics laboratory. Knee osteoarthritis patients were stratified into the following groups: clinical treatment (conservative/total knee replacement (TKR) planned), sex (male/female), age (60-67/68-75), and body mass index (BMI) (<30/≥30). All patients had a Kellgren-Lawrence score of 2 or 3 (N = 87). All patients underwent gait analysis, and two groups of dependent variables were extracted: • Spatiotemporal gait variables: gait velocity, stride time, and double-support time, which are associated with patient functionality. • Kinetic gait variables: vertical, anterior-posterior, and mediolateral ground reaction forces, vertical free moment, joint forces, and moments at the ankle, knee, and hip. Multifactorial and multivariate analyses of variance were performed. Functionality relates to treatment decisions, with patients in the conservative group walking 25% faster and spending 24% less time in the double-support phase. However, these differences vary with age and are reduced in older subjects. Patients who planned to undergo TKR did not present higher knee forces, and different joint moments between clinical treatments depended on the age and BMI of the subjects. Knee osteoarthritis is a multifactorial disease, with age and BMI being confounding factors. The differences in gait between the two groups were mitigated by confounding factors and risk factors, such as being a woman, elderly, and obese, reducing the variability of the gait compression loads. These factors should always be considered in gait studies of patients with knee osteoarthritis to control for confounding effects.
本研究的目的是调查具有可比性的膝关节骨关节炎患者的临床治疗选择、步态功能和动力学之间的关系。这是一项观察性病例对照研究。该研究在大学的生物力学实验室进行。膝关节骨关节炎患者被分为以下几组：临床治疗（保守治疗/计划进行全膝关节置换术（TKR））、性别（男/女）、年龄（60 - 67岁/68 - 75岁）和体重指数（BMI）（<30/≥30）。所有患者的凯尔格伦 - 劳伦斯评分为2或3（N = 87）。所有患者均接受了步态分析，并提取了两组因变量：• 时空步态变量：步态速度、步幅时间和双支撑时间，这些与患者功能相关。• 动力学步态变量：垂直、前后和内外侧地面反作用力、垂直自由力矩、关节力以及踝关节、膝关节和髋关节处的力矩。进行了多因素和多变量方差分析。功能与治疗决策相关，保守组患者的步行速度快25%，在双支撑阶段花费的时间少24%。然而，这些差异随年龄而变化，在老年受试者中有所减小。计划接受TKR的患者并未表现出更高的膝关节力，临床治疗之间不同的关节力矩取决于受试者的年龄和BMI。膝关节骨关节炎是一种多因素疾病，年龄和BMI是混杂因素。两组之间步态的差异被混杂因素和风险因素（如女性、老年和肥胖）所减轻，从而降低了步态压缩负荷的变异性。在对膝关节骨关节炎患者进行步态研究时，应始终考虑这些因素以控制混杂效应。
