nach oben

Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

01.07.2012 | Knee

Variability of gait parameters in patients with total knee arthroplasty

verfasst von: Rita M. Kiss, Zoltán Bejek, Miklós Szendrői

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 7/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Gait analysis has provided important information about the variability of gait for patients prior to and after total knee arthroplasty (TKA). The objective of this research was to clarify how the different surgical techniques influence gait variability.

Methods

Gait analysis was performed at 0.8, 1.0, and 1.2 m/s in three groups of patients (operated on using the conventional technique, conventional technique combined with computer-assisted navigation, and the minimally invasive technique combined with computer-assisted navigation; n = 15 each) and a control group (n = 15; healthy, age, body mass, and body height matched). Gait analysis was performed preoperatively and 6 and 12 months after the surgery. Gait parameter variability was characterized by the coefficient of variance of spatio-temporal parameters and by the mean coefficient of variance of angular parameters.

Results

One year after surgery, the variability of spatio-temporal parameters recovered to normal in patients operated on using the conventional technique; however, the variability of articular motion of the affected side decreased and the variability of articular motion of the non-affected side and pelvis increased compared to the control group. In patients operated on using the minimally invasive technique, the variability of spatio-temporal and angular parameters was similar to that of the control group.

Conclusion

The type of surgical technique significantly influences the variability and stability of gait. Difference in the variability of angular parameters predicts gait instability and increased risk of falling after TKA with the conventional surgical technique. The minimally invasive technique ensures a recovery of gait variability and stability. Thus, particular attention must be paid to improving gait stability during postoperative rehabilitation.

Level of evidence

II.

Alton F, Baldey L, Caplan S, Morrissey MC (1998) A kinematic comparison of over ground and treadmill walking. Clin Biomech 13:434–440CrossRef

Beauchet O, Allali G, Berrut G, Dubost V (2007) Is low lower-limb kinematic variability always an index of stability? Gait Posture 26:327–328PubMedCrossRef

Bejek Z, Paroczai R, Szendrői M, Kiss RM (2011) Gait analysis following TKA: comparison of conventional technique, computer assisted navigation and minimally invasive technique combined with computer assisted navigation. Knee Surg Sports Traumatol Arthrosc 19:285–291PubMedCrossRef

Brach JS, Berlin JE, Van Swearingen JM, Newman AB, Studenski SA (2005) Too much or too little step width variability is associated with a fall history in older person, who walked at or near normal gait speed. J Neuroeng Rehabil 2:21–34PubMedCrossRef

Brandes M, Ringling M, Winter C, Hillman A, Rosenbaum D (2011) Changes in physical activity and health-related quality of life during the first year after total hip arthroplasty. Arthritis Care Res 63:328–334

Catani F, Benedetti MG, Bianchi L, Marchionni V, Giannini S, Leardini A (2011) Muscle activity around the knee and gait performance in unicompartmental knee arthroplasty patients: a comparative study on fixed and mobile-bearing designs. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-011-1620-z

Dillon CF, Rasch EK, Gu Q, Hirsch R (2006) Prevalence of knee ostearthritis in the United States: arthritis data from the third national health and nutrition examination survey 1991–1994. J Rheumatol 33:2271–2279PubMed

Dingwell JC, Marin LC (2006) Kinematic variability and local dynamic stability of upper body motions when walking at different speeds. J Biomech 39:444–452PubMedCrossRef

Dubost V, Kressig RW, Gonthier R, Herrmann FR, Aminian K, Najafi B, Beauchet O (2006) Relationship between dual tasks related changes in stride velocity and stride time variability in healthy older adults. Hum Mov Sci 25:372–382PubMedCrossRef

10.

England SA, Granata KP (2007) The influence of gait speed on local dynamic stability of walking. Gait Posture 27:172–178CrossRef

11.

Fuchs A, Kelso JA (1994) A theoretical note on models of interlimb coordination. J Exp Psychol Hum Percept Perform 20:1088–1097PubMedCrossRef

12.

Fuchs S, Floren M, Skwara A, Tibesku CO (2002) Quantitative gait analysis in unconstrained total knee arthroplasty patients. Int J Rehabil Res 25:65–70PubMedCrossRef

13.

Georgoulis AD, Moraiti C, Ristanis S, Stergiou N (2006) A novel approach to measure variability in the anterior cruciate ligament deficient knee during walking: the use of approximate entropy on orthopaedics. J Clin Monit Comp 20:11–18CrossRef

14.

Hatfield GL, Hubley-Kozey CL, Astephen Wilson JL, Dunbar MJ (2011) The effect of total knee arthroplasty on knee joint kinematics and kinetics during gait. J Arthroplasty 26:309–318PubMedCrossRef

15.

Hausdorff JM (2005) Gait variability: methods, modeling and meaning. J Neuroeng Rehabil 20:19CrossRef

16.

Hausdorff JM (2007) Gait dynamics, fractals and falls: finding meaning in the stride-to-stride fluctuations of human walking. Hum Mov Sci 26:555–589PubMedCrossRef

17.

Hausdorff JM, Rios DA, Edelberg HK (2001) Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil 82:1050–1056PubMedCrossRef

18.

Heiderscheit BC (2000) Movement variability as a clinical measure for locomotion. J Appl Biomech 16:419–427

19.

Kang HG, Dingwell JB (2008) Effects of walking speed, strength and range of motion on gait stability in healthy older adults. J Biomech 41:2899–2905PubMedCrossRef

20.

Kang HG, Dingwell JB (2008) Separating the effects of age and walking speed on gait variability. Gait Posture 28:572–579CrossRef

21.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedCrossRef

22.

Kiss RM (2007) Verification of determining the spatial position of the lower extremity by ultrasound-based motion analyser. Period Politech Ser Civ Eng 51:39–43CrossRef

23.

Kiss RM (2010) Effects of walking speed and severity of hip osteoarthritis on gait variability. J Electromyogr Kinesiol 20:1052–1057PubMedCrossRef

24.

Kiss RM, Kocsis L, Knoll ZS (2004) Joint kinematics and spatial temporal parameters of gait measured by an ultrasound based system. Med Eng Phys 26:611–620PubMedCrossRef

25.

Knoll Z, Kocsis L, Kiss RM (2004) Gait patterns before and after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:7–14PubMedCrossRef

26.

Ko S, Ling SM, Schreiber C, Nesbit M, Ferrucci L (2011) Gait patterns during different walking conditions in older adults with and without knee osteoarthritis—results from Baltimore longitudinal study of aging. Gait Posture 33:205–210PubMedCrossRef

27.

Laskin RS, Beksac B, Phongjunakorn A, Pittors K, Davis J, Shim JC, Pavlov H, Petersen M (2004) Minimally invasive total knee replacement through a mini-midvastus incision: an outcome study. Clin Orthop Relat Res 428:74–81PubMedCrossRef

28.

Lewek MD, Scholz J, Rudolph KS, Snyder-Mackler L (2006) Stride-to-stride variability of knee motion in patients with knee osteoarthritis. Gait Posture 23:505–511PubMedCrossRef

29.

Lombardi AV Jr, Viacava AJ, Berend KR (2006) Rapid recovery protocols and minimally invasive surgery help achieve high knee flexion. Clin Orthop Relat Res 452:117–122PubMedCrossRef

30.

Maki BE (1997) Gait changes in older adults: predictors of falls or indicators of fear? J Am Geriatr Soc 45:313–320PubMed

31.

McClelland JA, Webster KE, Feller JA (2009) Variability of walking and other daily activities in patients with total knee replacement. Gait Posture 30:288–295PubMedCrossRef

32.

Moraiti C, Stergiou N, Ristanis S, Georgioulis A (2007) ACL deficiency affects stride-to-stride variability as measured using nonlinear methodology. Knee Surg Sports Traumatol Arthrosc 12:406–413

33.

Moraiti CO, Stergiou N, Vasilidid HS (2010) Anterior cruciate ligament reconstruction results in alteration in gait variability. Gait Posture 32:169–175PubMedCrossRef

34.

Newel KM, Corcos DM (1993) Issues in variability and motor control. In: Newel KM, Corcos DM (eds) Variability and motor control. Human Kinetics, Champaign, pp 1–12

35.

Owings TM, Grabiner MD (2003) Measuring step kinematic variability on an instrumented treadmill: how many steps are enough? J Biomech 36:1215–1218PubMedCrossRef

36.

Pool R (1989) Is it healthy to be chaotic? Science 243:604–607PubMedCrossRef

37.

Smith AJ, Lloyd DG, Wood DJ (2004) Pre-surgery knee joint loading pattern during walking predict the presence and severity of anterior knee pain after total knee arthroplasty. J Orthop Res 22:260–266PubMedCrossRef

38.

Smith AJ, Lloyd DG, Wood DJ (2006) A kinematic and kinetic analysis of walking after total knee arthroplasty with and without patellar resurfing. Clin Biomech 21:379CrossRef

39.

Stergiou N, Moraiti C, Glakas G, Ristanis S, Georgoulis A (2004) The effect of walking speed on the stability of the anterior cruciate ligament deficient knee. Clin Biomech 19:57–63CrossRef

40.

Tria AJ Jr, Coon TM (2003) Minimal incision total knee arthroplasty: early experience. Clin Orthop Relat Res 416:185–190PubMedCrossRef

41.

Yakhdani HRF, Bafgi HA, Meijer OG, Bruijn SM, van den Dikkenberg N, Stibbe AB, van Royen BJ, van Dieen JH (2010) Stability and variability of knee kinematics during gait in knee osteoarthritis before and after replacement surgery. Clin Biomech 25:230–236CrossRef

42.

Zeni JA, Higginson JS (2009) Differences in gait parameters between healthy subjects and persons with moderate and severe knee osteoarthritis: a result of altered walking speed? Clin Biomech 24:372–378CrossRef

Titel: Variability of gait parameters in patients with total knee arthroplasty
verfasst von: Rita M. Kiss
Zoltán Bejek
Miklós Szendrői
Publikationsdatum: 01.07.2012
Verlag: Springer-Verlag
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 7/2012
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-1965-y

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2012

A biomechanical comparison of the primary stability of two minimally invasive techniques for repair of ruptured Achilles tendon

Potential of healing a transected anterior cruciate ligament with genetically modified extracellular matrix bioscaffolds in a goat model

A CT-based classification of prior ACL femoral tunnel location for planning revision ACL surgery

The forgotten joint

Arthroscopic extraarticular reconstruction of the medial patellofemoral ligament with gracilis tendon autograft - surgical technique