The authors declare that they have no competing interests.
JR recruited and performed measurements on the subjects, contributed to the design of the study, and drafted the manuscript; MM recruited and performed measurements of the subjects, contributed to data analysis and helped draft the manuscript; QT recruited and performed measurements of the subjects, and helped draft the manuscript; JM conceived the study, participated in its design, and helped draft the manuscript; IM conceived the study, participated in the design, contributed to data and statistical analysis, and helped draft the manuscript. All authors read and approved the final manuscript.
The aim of the study was to assess gait in total knee arthroplasty (TKA) patients, using a technique that can to be used on a routine basis in a busy orthopaedic clinic.
A total of 103 subjects were recruited: 29 pre-op TKA patients; 17 TKA patients at 8 weeks post-op; 28 TKA patients at 52 weeks post-op; and 29 age-matched controls. Inertial measurement units (IMUs) were used to assess gait. Limb segment angles, knee angle and temporal parameters of gait were calculated. Specific gait parameters were quantified, and data analysed using MANOVA and discriminant analysis.
The gait of TKA patients as a group was only slightly improved at 12 months when compared with the pre-operative group, and both groups were significantly different to controls in several variables. Knee flexion range in stance was the most important variable in discriminating between patients and controls; knee flexion range in swing was the only variable that showed a significant difference between pre- and post-operative patients. When considered individually, only 1/29 patient was within the normal range for this variable pre-operatively, but 9/28 patients were within the normal range 12 months post-operatively.
Even after 12 months after surgery, many TKA patients have not improved their gait relative to pre-operative patients. Routine gait assessment may be used to guide post-operative rehabilitation, and to develop strategies to improve mobility of these patients.
National Joint Registry. 9 th Annual Report, 2012. Available for download from www.njrcentre.org.uk.
Goethesen O, Espehaug B, Havelin L, Petursson G, Lygre S, Ellison P, et al. Survival rates and causes of revision in cemented primary total knee replacement: a report from the Norwegian Arthroplasty Register 1994–2009. Bone Joint J. 2013;95-B:636–42. CrossRef
Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg. 2007;89-B:893–900. CrossRef
Wylde V, Dixon S, Blom A. The role of preoperative self-efficacy in predicting outcome after total knee replacement. Musculoskelet Care. 2012;10:110–8. CrossRef
McLelland JA, Webster KE, Feller JA. Gait analysis following total knee replacement: a systematic review. Knee. 2007;14:253–63. CrossRef
Smith JR, Rowe PJ, Blyth M, Jones B. The effect of electromagnetic navigation in total knee arthroplasty on knee kinematics during functional activities using flexible electrogoniometry. Clin Biomech. 2013;28:23–8. CrossRef
Monda M, Goldberg A, Smitham P, Thornton M, McCarthy I. Use of inertial measurement units to assess age-related changes in gait kinematics in an active population. J Ageing Phys Act (in press).
McCarthy ID, Hodgins D, Mor A, Elbaz A, Segal G. Analysis of knee flexion characteristics and how they alter with the onset of knee osteoarthritis: a case control study. BMC Musculoskeletal Diseases. 2013;14:169–76. CrossRef
Jolles BM, Grzesiak A, Eudier A, Dejnabadi H, Voracek C, Pichonaz C, et al. A randomised controlled clinical trial and gait analysis of fixed- and mobile-bearing total knee replacements with a five year follow up. J Bone Joint Surg Br. 2012;94-B:648–55. CrossRef
Zeni JA, Higginson JS. Differences in gait parameters between healthy subjects and persons with moderate and severe knee osteoarthritis: a result of altered walking speed? Clin Biomech. 2009;24:372–8. CrossRef
Benedetti MG, Catani F, Bilotta TW, Marcacci M, Mariani E, Giannini S. Muscle activation pattern and gait biomechanics after total knee replacement. Clin Biomech. 2003;18:871–6. CrossRef
Hubley-Kozey CL, Hatfield GL, Wilson JL, Dunbar MJ. Alterations in neuromuscular patterns between pre- and one-year post-total knee arthroplasty. Clin Biomech. 2010;25:995–1002. CrossRef
Mizner RL, Stephens JE, Snyder-Mackler L. Voluntary activation and decreased force production of the quadriceps femoris muscle after total knee arthroplasty. Phys Ther. 2003;83:359–65. PubMed
Jones L, Holt CA. An objective tool for assessing outcome of total knee replacement surgery. Proc Inst Mech Eng Part H. 2008;222:647–55. CrossRef
Tyler NA. Capabilities and accessibility: a model for progress. J Accessibility Des All. 2011;1:11.
- Gait assessment as a functional outcome measure in total knee arthroplasty: a cross-sectional study
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II