Department of Orthopedics, Sanmen People's Hospital, Taizhou, Zhejiang, 317100, China.
Department of Orthopedics, Quzhou TCM Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University, Quzhou, Zhejiang, 324000, China.
J Orthop Surg Res. 2024 Sep 30;19(1):612. doi: 10.1186/s13018-024-05091-2.
Total knee replacement (TKA) is a frequent modality performed in patients with knee osteoarthritis (OA). The aim of this study was to perform a meta-analysis and systematic review to evaluate the efficacy after TKA by gait analysis in patients with OA.
PubMed, EMBASE, the Cochrane library, and Web of Science were searched for relevant studies from inception to July 2024. STATA SE 14.0 software was used for statistical analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guideline.
A total of 2525 reports were identified with 24 studies meeting pre-designed inclusion criteria. Several gait parameters were investigated. In patients with knee OA after TKA, there existed an increase in the Max knee flexion (WMD, 3.12; 95% CI, 0.93 to 5.32; I = 73.9%, P < 0.001), the Cadence (WMD, 4.05; 95% CI, 2.28 to 5.82; I = 48.9%, P = 0.068), the stride length (WMD, 0.05; 95% CI, 0.01 to 0.09; I = 77.1%, P < 0.001), the walking speed (WMD, 0.08; 95% CI, 0.02 to 0.14; I = 93.3%, P < 0.001), and the step length (WMD, 0.04; 95% CI, 0.00 to 0.07; I = 89.3%, P < 0.001) while a decrease in the double support time (WMD, -0.04; 95% CI, - 0.08 to -0.01; I = 0.0%, P = 0.585). Besides, no statistically significant differences were observed in the Knee range of motion (ROM), the Max knee rotation at stance phase, the Max knee extension, the step width, the stride time and the step time. Sensitivity analysis showed that all the results were robust.
In summary, the study found that, in patients with knee OA undergoing TKA may have great effects on improving gait parameters. If there are more high-quality studies in the future, we should make a more comprehensive evaluation of walking function by gait analysis together with other evaluation systems such as muscle strength and proprioception measurement.
全膝关节置换术（TKA）是治疗膝关节骨关节炎（OA）患者的常用方法。本研究旨在通过步态分析对 TKA 后疗效进行荟萃分析和系统评价。
从建库至 2024 年 7 月，检索 PubMed、EMBASE、Cochrane 图书馆和 Web of Science 中相关研究。根据系统评价和荟萃分析的首选报告项目（PRISMA 2020）指南，使用 STATA SE 14.0 软件进行统计分析。
共检索到 2525 篇报告，其中 24 项研究符合预先设定的纳入标准。研究调查了多种步态参数。在 TKA 治疗膝关节 OA 患者中，存在以下参数的增加：最大膝关节屈曲度（WMD，3.12；95%CI，0.93 至 5.32；I²=73.9%，P<0.001）、步频（WMD，4.05；95%CI，2.28 至 5.82；I²=48.9%，P=0.068）、步长（WMD，0.05；95%CI，0.01 至 0.09；I²=77.1%，P<0.001）、行走速度（WMD，0.08；95%CI，0.02 至 0.14；I²=93.3%，P<0.001）和步长（WMD，0.04；95%CI，0.00 至 0.07；I²=89.3%，P<0.001），同时双支撑时间（WMD，-0.04；95%CI，-0.08 至 -0.01；I²=0.0%，P=0.585）减少。此外，膝关节活动度（ROM）、站立相最大膝关节旋转、最大膝关节伸展、步宽、步时和步长时间无统计学差异。敏感性分析表明，所有结果均稳健。
综上所述，本研究发现 TKA 可显著改善膝关节 OA 患者的步态参数。如果未来有更多高质量的研究，我们应该结合肌肉力量和本体感觉测量等其他评估系统，通过步态分析对步行功能进行更全面的评估。
