Gait analysis of patients following total knee replacement: A systematic review

Abstract

Gait analysis has been used to objectively measure patients' function following total knee replacement (TKR). Whilst the findings of this research may have important implications for the understanding of the outcomes of TKR, the methodology of existing research appears to be diverse and many of the results inconsistent. The objective of this systematic review was to synthesise reported findings and to summarise the methods used by researchers in this field. Eleven articles published in the medical literature that used gait analysis to compare patients following TKR with controls were identified for inclusion in this review. Each article was assessed for methodologic quality and data was compared across studies through the calculation of effect sizes. Consistently large effect sizes showed that patients following TKR walk with less total knee motion during gait and with less knee flexion during swing than controls. Kinetic discrepancies between patients and controls were also identified. The substantial methodologic differences between studies may contribute to the inconsistencies in reported findings for many gait outcomes. Future research is needed to determine the clinical relevance of these findings.

Introduction

Total knee replacement (TKR) is a widely used intervention in the management of knee osteoarthritis. The increasing prevalence of TKR highlights the need to appropriately assess post-operative outcome of this procedure [1]. Gait analysis is a tool that has been used by researchers to measure functional outcome following TKR. It has been proposed that gait analysis is valuable in the clinical management of patients undergoing TKR through its ability to monitor forces through the knee [2]. In particular, the adduction moment across the knee has received attention due to its association with TKR component loosening [3].

Despite the potential usefulness of gait analysis, there are marked discrepancies in the research methods that have been reported. Variations in subject characteristics, prosthetic designs and methodology of gait analysis make comparison of findings between studies difficult. Nonetheless, assessment of TKR patients using gait analysis continues to be reported. It is therefore important to identify discrepancies between studies to allow for more appropriate comparison of findings and potentially to assist in directing future research. To date there has been no attempt to systematically review the findings of gait analysis in patients following TKR. The aim of this systematic review was therefore to identify common themes in the methods of research in the gait analysis of TKR patients and to summarise the findings reported in this literature.