Szczypiór-Piasecka Karina, Adamczewska Paulina, Kołodziej Łukasz, Ziętek Paweł
Department of Rehabilitation of the Musculoskeletal System, Pomeranian Medical University, 1 Unii Lubelskiej Street, 71-252 Szczecin, Poland.
Student Research Group for Orthopedic Rehabilitation and Manual Therapy at the Department of Orthopedics, Traumatology and Musculoskeletal Oncology, Pomeranian Medical University, 1 Unii Lubelskiej Street, 71-252 Szczecin, Poland.
J Clin Med. 2025 Jun 26;14(13):4548. doi: 10.3390/jcm14134548.
Gait abnormalities in advanced knee osteoarthritis (KOA) are characterized by decreased stride length, walking speed, and cadence. Total knee arthroplasty (TKA) is intended to improve temporal-spatial gait parameters; however, the extent and timing of functional recovery remain under investigation. To assess changes in stride length, walking speed, and cadence following TKA in short- and long-term perspectives, and to compare outcomes with a non-operated KOA cohort. A prospective observational study was conducted involving 46 patients with unilateral KOA (grades III-IV, Kellgren-Lawrence scale) who underwent cemented TKA via a medial parapatellar approach. Group I ( = 34) was assessed one day prior to surgery and six weeks postoperatively. Group II ( = 12), a follow-up subset, was reassessed 1.5 years postoperatively. Group III ( = 34) served as a non-operated control group, assessed only preoperatively. Temporal-spatial gait parameters were evaluated under standardized conditions using a two-dimensional video analysis (Kinovea software version 0.8.27). Stride length (m) and walking speed (m/s) were assessed during continuous walking along a 15 m corridor, with at least three valid gait cycles averaged per trial. Cadence (steps/min) was determined during a one-minute walk and verified frame-by-frame. No structured outpatient physiotherapy was provided; all patients followed a standardized in-hospital rehabilitation protocol. In Group I, the mean stride length increased from 0.40 ± 0.10 m to 0.42 ± 0.10 m ( = 0.247), walking speed improved from 0.41 ± 0.027 m/s to 0.47 ± 0.022 m/s ( = 0.063), and cadence increased significantly from 72.9 ± 7.8 to 77.1 ± 8.6 steps/min ( = 0.044). In Group II, the mean stride length rose from 0.39 ± 0.10 m to 0.52 ± 0.09 m ( < 0.001), walking speed improved from 0.44 ± 0.02 m/s to 0.69 ± 0.01 m/s ( < 0.001), and cadence increased from 73.7 ± 8.8 to 103.6 ± 7.4 steps/min ( < 0.001). Compared to the control group (Group III: stride length 0.42 ± 0.09 m; walking speed 0.41 ± 0.02 m/s; cadence 73.9 ± 7.9 steps/min), Group II demonstrated superior values across all parameters ( < 0.001 for each comparison). No significant correlations were observed between BMI and gait outcomes. Total knee arthroplasty resulted in progressive improvement in temporal-spatial gait parameters. While early postoperative gains were limited, substantial functional restoration was observed at long-term follow-up, emphasizing the importance of extended recovery monitoring in post-TKA evaluation.
晚期膝关节骨关节炎（KOA）的步态异常表现为步幅长度、步行速度和步频降低。全膝关节置换术（TKA）旨在改善时空步态参数；然而，功能恢复的程度和时间仍在研究中。从短期和长期角度评估TKA术后步幅长度、步行速度和步频的变化，并将结果与未手术的KOA队列进行比较。进行了一项前瞻性观察研究，纳入46例单侧KOA（Kellgren-Lawrence分级III-IV级）患者，他们通过内侧髌旁入路接受了骨水泥型TKA。第一组（n = 34）在手术前一天和术后六周进行评估。第二组（n = 12）作为随访亚组，在术后1.5年重新评估。第三组（n = 34）作为未手术的对照组，仅在术前进行评估。在标准化条件下使用二维视频分析（Kinovea软件版本0.8.27）评估时空步态参数。在沿着15米走廊连续行走期间评估步幅长度（米）和步行速度（米/秒），每次试验平均至少有三个有效步态周期。在一分钟步行期间确定步频（步/分钟）并逐帧验证。未提供结构化的门诊物理治疗；所有患者均遵循标准化的住院康复方案。在第一组中，平均步幅长度从0.40±0.10米增加到0.42±0.10米（P = 0.247），步行速度从0.41±0.027米/秒提高到0.47±0.022米/秒（P = 0.063），步频从72.9±7.8显著增加到77.1±8.6步/分钟（P = 0.044）。在第二组中，平均步幅长度从0.39±0.10米增加到0.52±0.09米（P < 0.001），步行速度从0.44±0.02米/秒提高到0.69±0.01米/秒（P < 0.001），步频从73.7±8.8增加到103.6±7.4步/分钟（P < 0.001）。与对照组（第三组：步幅长度0.42±0.09米；步行速度0.41±0.02米/秒；步频73.9±7.9步/分钟）相比，第二组在所有参数上均表现出更高的值（每次比较P < 0.001）。未观察到BMI与步态结果之间存在显著相关性。全膝关节置换术导致时空步态参数逐渐改善。虽然术后早期的改善有限，但在长期随访中观察到了显著的功能恢复，强调了在TKA术后评估中延长恢复监测的重要性。
