Slow gait speed after bilateral total knee arthroplasty is associated with suboptimal improvement of knee biomechanics View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-08-28

AUTHORS

Du Hyun Ro, Hyuk-Soo Han, Dong Yeon Lee, Seong Hwan Kim, Yoon-Ho Kwak, Myung Chul Lee

ABSTRACT

PurposeThe aim of this study was to investigate gait speed changes 2 years after bilateral total knee arthroplasty (TKA) and identify kinetic and kinematic factors associated with such changes by comparing patients with age- and sex-matched controls.MethodsThe study group included 34 female patients with end-stage knee osteoarthritis (OA) who underwent bilateral TKA and 42 age- and sex-matched controls without knee pain or OA. Standard TKA was performed on all arthritic patients with placement of posterior stabilized fixed-bearing implants. Kinetic and kinematic parameters were evaluated using a commercial optoelectric gait analysis system. Gait speed, kinetic and kinematic changes and determinants of speed were assessed via principal component analysis and multiple regression analysis.ResultsThe average gait speed of an arthritic patient was 90.2 ± 18.4 cm/s and improved to 96.0 ± 12.3 cm/s after TKA (p = 0.032). However, the speed remained slower than that of controls (111.2 ± 8.2 cm/s, p < 0.001). With regard to kinetics, the peak knee extension moment (KEM) generated by the quadriceps was unchanged after TKA and weaker than that of controls (p < 0.001). The proportions of KEM contributing to the total sagittal moment were also smaller in the pre-/post-operative groups than in the control group (13–14% vs. 19%). On the other hand, the ankle plantar flexion moment (APFM) was increased after TKA (p = 0.007) and its proportion of the total sagittal moment was greater than in controls (46% vs. 42%). With regard to kinematics, knee range of motion (ROM) improved after TKA (p = 0.025), but was smaller than that of controls (p < 0.001). In controls, gait speed was determined principally by hip and knee joint moments. However, in the TKA group, speed was determined by the knee ROM and APFM.ConclusionsDespite showing improvement, the gait speed of TKA patients remained slower than that of controls. Slow gait speed after bilateral TKA was associated with suboptimal improvement of knee biomechanics. Quadriceps strengthening exercises and the achievement of greater ROM during gait are advised for the further improvement of gait speed.Level of evidenceRetrospective cohort study, Level III. More... »

PAGES

1671-1680

References to SciGraph publications

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  • 2016-04-11. Are there different factors affecting walking speed and gait cycle variability between men and women in community-dwelling older adults? in AGING CLINICAL AND EXPERIMENTAL RESEARCH
  • 2012-05-06. The effects of knee arthroplasty on walking speed: A meta-analysis in BMC MUSCULOSKELETAL DISORDERS
  • 2014-08-07. No difference in gait between posterior cruciate retention and the posterior stabilized design after total knee arthroplasty in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2005-12-06. The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00167-017-4682-8

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    http://dx.doi.org/10.1007/s00167-017-4682-8

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1091374583

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/28849392


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        "description": "PurposeThe aim of this study was to investigate gait speed changes 2\u00a0years after bilateral total knee arthroplasty (TKA) and identify kinetic and kinematic factors associated with such changes by comparing patients with age- and sex-matched controls.MethodsThe study group included 34 female patients with end-stage knee osteoarthritis (OA) who underwent bilateral TKA and 42 age- and sex-matched controls without knee pain or OA. Standard TKA was performed on all arthritic patients with placement of posterior stabilized fixed-bearing implants. Kinetic and kinematic parameters were evaluated using a commercial optoelectric gait analysis system. Gait speed, kinetic and kinematic changes and determinants of speed were assessed via principal component analysis and multiple regression analysis.ResultsThe average gait speed of an arthritic patient was 90.2\u00a0\u00b1\u00a018.4\u00a0cm/s and improved to 96.0\u00a0\u00b1\u00a012.3\u00a0cm/s after TKA (p\u00a0=\u00a00.032). However, the speed remained slower than that of controls (111.2\u00a0\u00b1\u00a08.2\u00a0cm/s, p\u00a0<\u00a00.001). With regard to kinetics, the peak knee extension moment (KEM) generated by the quadriceps was unchanged after TKA and weaker than that of controls (p\u00a0<\u00a00.001). The proportions of KEM contributing to the total sagittal moment were also smaller in the pre-/post-operative groups than in the control group (13\u201314% vs. 19%). On the other hand, the ankle plantar flexion moment (APFM) was increased after TKA (p\u00a0=\u00a00.007) and its proportion of the total sagittal moment was greater than in controls (46% vs. 42%). With regard to kinematics, knee range of motion (ROM) improved after TKA (p\u00a0=\u00a00.025), but was smaller than that of controls (p\u00a0<\u00a00.001). In controls, gait speed was determined principally by hip and knee joint moments. However, in the TKA group, speed was determined by the knee ROM and APFM.ConclusionsDespite showing improvement, the gait speed of TKA patients remained slower than that of controls. Slow gait speed after bilateral TKA was associated with suboptimal improvement of knee biomechanics. Quadriceps strengthening exercises and the achievement of greater ROM during gait are advised for the further improvement of gait speed.Level of evidenceRetrospective cohort study, Level III.", 
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    29 schema:description PurposeThe aim of this study was to investigate gait speed changes 2 years after bilateral total knee arthroplasty (TKA) and identify kinetic and kinematic factors associated with such changes by comparing patients with age- and sex-matched controls.MethodsThe study group included 34 female patients with end-stage knee osteoarthritis (OA) who underwent bilateral TKA and 42 age- and sex-matched controls without knee pain or OA. Standard TKA was performed on all arthritic patients with placement of posterior stabilized fixed-bearing implants. Kinetic and kinematic parameters were evaluated using a commercial optoelectric gait analysis system. Gait speed, kinetic and kinematic changes and determinants of speed were assessed via principal component analysis and multiple regression analysis.ResultsThe average gait speed of an arthritic patient was 90.2 ± 18.4 cm/s and improved to 96.0 ± 12.3 cm/s after TKA (p = 0.032). However, the speed remained slower than that of controls (111.2 ± 8.2 cm/s, p < 0.001). With regard to kinetics, the peak knee extension moment (KEM) generated by the quadriceps was unchanged after TKA and weaker than that of controls (p < 0.001). The proportions of KEM contributing to the total sagittal moment were also smaller in the pre-/post-operative groups than in the control group (13–14% vs. 19%). On the other hand, the ankle plantar flexion moment (APFM) was increased after TKA (p = 0.007) and its proportion of the total sagittal moment was greater than in controls (46% vs. 42%). With regard to kinematics, knee range of motion (ROM) improved after TKA (p = 0.025), but was smaller than that of controls (p < 0.001). In controls, gait speed was determined principally by hip and knee joint moments. However, in the TKA group, speed was determined by the knee ROM and APFM.ConclusionsDespite showing improvement, the gait speed of TKA patients remained slower than that of controls. Slow gait speed after bilateral TKA was associated with suboptimal improvement of knee biomechanics. Quadriceps strengthening exercises and the achievement of greater ROM during gait are advised for the further improvement of gait speed.Level of evidenceRetrospective cohort study, Level III.
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    35 schema:keywords MethodsThe study group
    36 ROM
    37 TKA group
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    39 achievement
    40 age
    41 aim
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    44 ankle plantar flexion moment
    45 arthritic patients
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    47 average gait speed
    48 bilateral total knee arthroplasty
    49 biomechanics
    50 changes
    51 changes 2
    52 cohort study
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    56 determinants
    57 determinants of speed
    58 end-stage knee osteoarthritis
    59 exercise
    60 extension moment
    61 factors
    62 female patients
    63 fixed-bearing implants
    64 flexion moment
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    66 gait
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    69 greater ROM
    70 group
    71 hand
    72 hip
    73 implants
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    75 joint moments
    76 kinematic changes
    77 kinematic factors
    78 kinematic parameters
    79 kinematics
    80 kinetics
    81 knee ROM
    82 knee arthroplasty
    83 knee biomechanics
    84 knee extension moment
    85 knee osteoarthritis
    86 knee pain
    87 knee range
    88 level III
    89 levels
    90 moment
    91 motion
    92 multiple regression analysis
    93 operative group
    94 osteoarthritis
    95 pain
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    99 placement
    100 plantar flexion moment
    101 posterior
    102 principal component analysis
    103 proportion
    104 quadriceps
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