Institute of Motion Analysis and Sports Medicine, endogap Clinic for Joint Replacement, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany.
Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.
Clin Biomech (Bristol). 2024 Jan;111:106150. doi: 10.1016/j.clinbiomech.2023.106150. Epub 2023 Nov 13.
To assess the in-field walking mechanics during downhill hiking of patients with total knee arthroplasty five to 14 months after surgery and an age-matched healthy control group and relate them to the knee flexor and extensor muscle strength.
Participants walked on a predetermined hiking trail at a self-selected, comfortable pace wearing an inertial sensor system for recording the whole-body 3D kinematics. Sagittal plane hip, knee, and ankle joint angles were evaluated over the gait cycle at level walking and two different negative slopes. The concentric and eccentric lower extremity muscle strength of the knee flexors and extensors isokinetically at 50 and 120°/s were measured.
Less knee flexion angles during stance have been measured in patients in the operated limb compared to healthy controls in all conditions (level walking, moderate downhill, steep downhill). The differences increased with steepness. Muscle strength was lower in patients for both muscle groups and all measured conditions. The functional hamstrings to quadriceps ratio at 120°/sec correlated with knee angle during level and downhill walking at the moderate slope in patients, showing higher ratios with lower peak knee flexion angles.
The study shows that even if rehabilitation has been completed successfully and complication-free, five to 14 months after surgery, the muscular condition was still insufficient to display a normal gait pattern during downhill hiking. The muscle balance between quadriceps and hamstring muscles seems related to the persistence of a stiff knee gait pattern after knee arthroplasty. LoE: III.
评估全膝关节置换术后 5 至 14 个月患者在术后下坡行走时的场内行走力学，并将其与膝关节屈肌和伸肌力量相关联。
参与者穿着惯性传感器系统，以自我选择的舒适速度在预定的徒步旅行路线上行走，以记录整个身体的 3D 运动学。在水平行走和两个不同负斜率的步态周期中评估矢状面髋关节、膝关节和踝关节角度。等速测量膝关节屈肌和伸肌在 50 和 120°/s 时的向心和离心下肢肌肉力量。
与健康对照组相比，患者在所有条件（水平行走、中度下坡、陡峭下坡）下的站立时膝关节屈曲角度均较小。随着坡度的增加，差异增大。在所有测量条件下，两组患者的肌肉力量均较低。在患者中，以 120°/sec 测量的功能性腘绳肌与股四头肌比值与水平和中等斜率下坡行走时的膝关节角度相关，显示出较高的比值与较低的峰值膝关节屈曲角度相关。
该研究表明，即使康复已成功完成且无并发症，术后 5 至 14 个月，肌肉状况仍不足以在下坡行走时显示正常的步态模式。股四头肌和腘绳肌之间的肌肉平衡似乎与膝关节置换后僵硬膝关节步态模式的持续存在有关。证据等级：III。
