Kurihara Yasushi, Ohsugi Hironori, Tosaka Tomonari, Matsuda Tadamitsu, Tsuneizumi Yoshikazu, Tsukeoka Tadashi
Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture, 283-8555, Japan.
Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan.
J Clin Orthop Trauma. 2023 Apr 7;39:102150. doi: 10.1016/j.jcot.2023.102150. eCollection 2023 Apr.
The knee adduction moment (KAM) is considered an index for estimating the knee mechanical load, and increased KAM peak and KAM impulse are related to increased medial knee load and progression of knee joint degeneration. We aimed to verify the biomechanical factors of gait related to medial knee loading in patients 6 months after TKA.
Thirty-nine women who underwent TKA were enrolled. A three-dimensional gait analysis was performed 6 months postoperatively to generate data on the lower limb joint angle, moment, and power at the backward component (braking phase) and forward component (propulsion phase) peaks of the ground reaction force. Medial knee loading was evaluated using the time-integrated value of KAM during the stance period (KAM impulse). The higher the value of the KAM impulse, the higher the medial knee joint load. The relationships between the KAM impulse and the data for biomechanical factors were evaluated using partial correlation analysis with gait speed as a control factor.
In the braking phase, the KAM impulse positively correlated with the knee adduction angle (r = 0.377) and negatively correlated with the toe-out angle (r = -0.355). The KAM impulse positively correlated with the knee adduction angle (r = 0.402), the hip flexion moment (r = 0.335), and the hip adduction moment (r = 0.565) and negatively correlated with the toe-out angle (r = -0.357) in the propulsive phase.
The KAM impulse 6 months after TKA was related to the knee adduction angle, hip flexion moment, hip adduction moment, and toe-out angle. These findings may provide fundamental data for controlling variable medial knee joint load after TKA and implementing patient management strategies to ensure implant durability.
膝关节内收力矩（KAM）被认为是评估膝关节机械负荷的指标，KAM峰值和KAM冲量增加与膝关节内侧负荷增加及膝关节退变进展相关。我们旨在验证全膝关节置换术（TKA）后6个月患者中与膝关节内侧负荷相关的步态生物力学因素。
纳入39例行TKA的女性患者。术后6个月进行三维步态分析，以获取地面反作用力向后分量（制动期）和向前分量（推进期）峰值时的下肢关节角度、力矩和功率数据。使用站立期KAM的时间积分值（KAM冲量）评估膝关节内侧负荷。KAM冲量值越高，膝关节内侧关节负荷越高。以步速作为控制因素，采用偏相关分析评估KAM冲量与生物力学因素数据之间的关系。
在制动期，KAM冲量与膝关节内收角度呈正相关（r = 0.377），与足外旋角度呈负相关（r = -0.355）。在推进期，KAM冲量与膝关节内收角度（r = 0.402）、髋关节屈曲力矩（r = 0.335）和髋关节内收力矩（r = 0.565）呈正相关，与足外旋角度呈负相关（r = -0.357）。
TKA后6个月的KAM冲量与膝关节内收角度、髋关节屈曲力矩、髋关节内收力矩和足外旋角度相关。这些发现可能为控制TKA后膝关节内侧关节负荷变化及实施患者管理策略以确保植入物耐久性提供基础数据。
