Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, United States of America.
Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America.
PLoS One. 2022 Apr 22;17(4):e0267340. doi: 10.1371/journal.pone.0267340. eCollection 2022.
Individuals who undergo total knee arthroplasty (TKA) for treatment of knee osteoarthritis often experience suboptimal outcomes. Investigation of neuromuscular control strategies in these individuals may reveal factors that contribute to these functional deficits. The purpose of this pilot study was to determine the relationship between patient function and modular control during gait before and after TKA.
Electromyography data from 36 participants (38 knees) were collected from 8 lower extremity muscles on the TKA-involved limb during ≥5 over-ground walking trials before (n = 30), 6-months after (n = 26), and 24-months after (n = 13) surgery. Muscle modules were estimated using non-negative matrix factorization. The number of modules was determined from 500 resampled trials.
A higher number of modules was related to better performance-based and patient-reported function before and 6-months after surgery. Participants with organization similar to healthy, age-matched controls trended toward better function 24-months after surgery, though these results were not statistically significant. We also observed plasticity in the participants' modular control strategies, with 100% of participants who were present before and 24-months after surgery (10/10) demonstrating changes in the number of modules and/or organization of at least 1 module.
This pilot work suggests that functional improvements following TKA may initially present as increases in the number of modules recruited during gait. Subsequent improvements in function may present as improved module organization.
This work is the first to characterize motor modules in TKA both before and after surgery and to demonstrate changes in the number and organization of modules over the time course of recovery, which may be related to changes in patient function. The plasticity of modular control following TKA is a key finding which has not been previously documented and may be useful in predicting or improving surgical outcomes through novel rehabilitation protocols.
接受全膝关节置换术（TKA）治疗膝骨关节炎的患者通常会出现术后效果不理想的情况。研究这些患者的神经肌肉控制策略可能会发现导致这些功能缺陷的因素。本初步研究的目的是确定 TKA 前后步态中患者功能与模块控制之间的关系。
从 36 名参与者（38 个膝关节）的 TKA 受累肢体的 8 个下肢肌肉中收集了至少 5 次地面行走试验的肌电图数据，分别在手术前（n = 30）、手术后 6 个月（n = 26）和 24 个月（n = 13）时进行。使用非负矩阵分解估计肌肉模块。通过 500 次重采样试验确定模块数量。
在手术前和手术后 6 个月，模块数量越多，与基于表现和患者报告的功能越好相关。组织与健康、年龄匹配的对照组相似的参与者在手术后 24 个月时，功能趋于更好，尽管这些结果没有统计学意义。我们还观察到参与者的模块控制策略具有可塑性，100%的参与者在手术前和 24 个月后（10/10）显示出模块数量和/或组织的变化至少有 1 个模块。
这项初步工作表明，TKA 后功能的改善最初可能表现为步态中募集的模块数量增加。随后功能的改善可能表现为模块组织的改善。
这项工作是首次对 TKA 前后的运动模块进行描述，并证明了模块数量和组织的变化随时间的恢复过程，这可能与患者功能的变化有关。TKA 后模块控制的可塑性是一个关键发现，以前没有记录过，可能有助于通过新的康复方案预测或改善手术结果。
