Thorsen Tanner, Wen Chen, Porter Jared, Reinbolt Jeffery, Weinhandl Joshua T, Zhang Songning
School of Kinesiology and Nutrition, The University of Southern Mississippi, Hattiesburg, MS, USA.
Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA.
Clin Biomech (Bristol). 2023 Feb;102:105900. doi: 10.1016/j.clinbiomech.2023.105900. Epub 2023 Jan 30.
Downhill walking is a necessary part of daily life and an effective activity in post-operative rehabilitation following total knee arthroplasty. The purpose of this study was to determine differences in the behavior of total, medial, and lateral tibiofemoral compressive forces as well as knee extensor and flexor muscle forces between different limbs of patients with total knee arthroplasty (replaced, non-replaced) during downhill and level walking.
Musculoskeletal modeling and simulation were implemented to determine muscle forces and tibiofemoral compressive forces in 25 patients with total knee arthroplasty. A 2 × 2 [Limb (replaced, non-replaced) × Slope (0°, 10°)] Statistical parametric mapping repeated measures analysis of variance was conducted on selected variables.
Statistical parametric mapping did not identify any between-limb differences for compressive or muscle forces. Differences in joint compressive and muscle forces persisted throughout different intervals of stance-phase between level and downhill walking. Knee extensor muscle forces were distinctly greater during level walking for nearly all of stance phase. Knee flexor muscle force was greater during downhill walking for >60% of stance. Statistical parametric mapping did identify regions of significance between level and downhill walking that coincided temporally (near loading response and push off) with peak joint moment and joint compressive forces traditionally reported using discrete variable analyses.
Downhill walking may be a safe and useful rehabilitation tool for post-knee arthroplasty rehabilitation that will not disproportionally load either the replaced or the non-replaced joint and where the quadriceps muscles can be strengthened during a gait-specific task.
下坡行走是日常生活的必要组成部分，也是全膝关节置换术后康复的有效活动。本研究的目的是确定全膝关节置换术患者（置换侧、未置换侧）不同肢体在下坡行走和平地行走过程中，胫股总压力、内侧和外侧胫股压力以及膝关节伸肌和屈肌力量的行为差异。
采用肌肉骨骼建模和模拟来确定25例全膝关节置换术患者的肌肉力量和胫股压力。对选定变量进行2×2[肢体（置换侧、未置换侧）×坡度（0°、10°）]统计参数映射重复测量方差分析。
统计参数映射未发现压力或肌肉力量的肢体间差异。在平地行走和下坡行走的不同站立阶段，关节压力和肌肉力量的差异持续存在。在几乎整个站立阶段，平地行走时膝关节伸肌力量明显更大。在超过60%的站立阶段，下坡行走时膝关节屈肌力量更大。统计参数映射确实确定了平地行走和下坡行走之间的显著区域，这些区域在时间上（接近负荷反应和蹬离）与传统上使用离散变量分析报告的峰值关节力矩和关节压力一致。
下坡行走可能是膝关节置换术后康复的一种安全且有用的康复工具，它不会给置换关节或未置换关节带来不成比例的负荷，并且可以在特定步态任务中增强股四头肌力量。
