Capin Jacob J, Zeni Joseph A, Forster Jeri E, Cheuy Victor A, Peters Amy, Hogan Craig, Yang Charlie, Christiansen Cory L, Stevens-Lapsley Jennifer E, Bade Michael J
Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin, USA.
Clinical & Translational Science Institute of Southeast Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
J Orthop Res. 2025 Nov;43(11):1964-1972. doi: 10.1002/jor.70052. Epub 2025 Sep 9.
The primary purpose of this study was to determine the preoperative predictors of gait biomechanics 6 months after unilateral total knee arthroplasty (TKA). There were 126 participants (age 64.4 ± 7.1 years, 75 females) who underwent instrumented biomechanical assessments while walking at a self-selected pace preoperatively, 10 weeks after (post-rehabilitation), and 6 months after unilateral TKA. Outcomes were peak knee extension moment (pKEM), knee angle excursion, and vertical ground reaction force (vGRF) ratio (surgical/contralateral). Potential clinical, demographic, and biomechanical predictors were tested univariately and considered a candidate for the final model if p < 0.15. Each multivariate model initially contained all candidates, and backward selection was used to determine the final model. Greater 6-month surgical limb pKEM was predicted (r = 0.31) by greater preoperative pKEM (β = 0.44, p < 0.0001), better quadriceps activation (β = 0.23, p = 0.004), and male sex (β = -0.21, p = 0.009). Greater 6-month surgical knee excursion was predicted (r = 0.34) by greater preoperative excursion (β = 0.39, p < 0.0001), male sex (β = -0.28, p = 0.0007), and preoperative quadriceps strength (β = 0.16, p = 0.047). Six-month vGRF ratio was predicted (r = 0.16) by preoperative vGRF ratio (β = 0.37, p < 0.0001) and study treatment group (β = 0.18, p = 0.03). Preoperative biomechanical variables at post-rehabilitation were also the strongest predictors of 6-month biomechanics. Statement of Clinical Significance: The strongest and most consistent predictor of gait biomechanics 6 months after TKA was the respective preoperative gait biomechanics variable, which may have important clinical implications for surgical decision making and prehabilitation/rehabilitation strategies. Biofeedback targeting vGRF predicted vGRF symmetry, but no other gait parameters, suggesting targeted interventions are needed. Improving quadriceps strength and activation may also facilitate knee biomechanics.
本研究的主要目的是确定单侧全膝关节置换术（TKA）后6个月步态生物力学的术前预测因素。共有126名参与者（年龄64.4±7.1岁，75名女性），他们在术前、康复后10周以及单侧TKA后6个月以自我选择的速度行走时接受了仪器化生物力学评估。结果指标为膝关节伸展力矩峰值（pKEM）、膝关节角度偏移以及垂直地面反作用力（vGRF）比率（手术侧/对侧）。对潜在的临床、人口统计学和生物力学预测因素进行单变量测试，若p<0.15，则将其视为最终模型的候选因素。每个多变量模型最初包含所有候选因素，并采用向后选择法来确定最终模型。术前pKEM越高（β=0.44，p<0.0001）、股四头肌激活越好（β=0.23，p=0.004）以及男性（β=-0.21，p=0.009），预测6个月时手术侧肢体pKEM越高（r=0.31）。术前偏移越大（β=0.39，p<0.0001）、男性（β=-0.28，p=0.0007）以及术前股四头肌力量越大（β=0.16，p=0.047），预测6个月时手术侧膝关节偏移越大（r=0.34）。术前vGRF比率（β=0.37，p<0.0001）和研究治疗组（β=0.18，p=0.03）可预测6个月时的vGRF比率（r=0.16）。康复后术前生物力学变量也是6个月生物力学的最强预测因素。临床意义声明：TKA后6个月步态生物力学最强且最一致的预测因素是各自的术前步态生物力学变量，这可能对手术决策和术前/康复策略具有重要临床意义。针对vGRF的生物反馈可预测vGRF对称性，但对其他步态参数无预测作用，这表明需要进行有针对性的干预。增强股四头肌力量和激活也可能有助于改善膝关节生物力学。
