The Effect of Gait Speed on Pre- and Postoperative Analysis of Gait Parameters after Total Knee Arthroplasty

Author(s):  
Regina Ullmann ◽  
M. Hildebrand ◽  
S. Leuchte
Author(s):  
Daniel Pfeufer ◽  
Priscila Monteiro ◽  
Jeremy Gililland ◽  
Mike B. Anderson ◽  
Wolfgang Böcker ◽  
...  

AbstractTotal knee arthroplasty (TKA) improves the quality of life in those suffering from debilitating arthritis of the knee. However, little is known about the influence of TKA on restoring physical function. Prior studies have used artificial means, such as instrumented treadmills, to assess physical function after TKA. In this study an insole sensor device was used to quantify parameters of gait. The purpose of this study was to evaluate the ability of a wearable insole sensor device to measure immediate postoperative gait parameters at 2 weeks and 6 weeks following primary TKA and to determine if the device was suitable and sensitive enough to identify and measure potentially subtle changes in these measures at these early postoperative time periods. Twenty-nine patients with unilateral TKA, without contralateral knee pain, and aid-free walking before surgery were evaluated. An insole force sensor measured the postoperative parameters while walking a distance of 40 m on level ground at 2 and 6 weeks after TKA. The loading rate of the operated lower extremity was an average of 68.7% of the contralateral side at 2 weeks post-surgery and increased to 82.1% at 6 weeks post-surgery (p < 0.001). The mean gait speed increased from 0.75 to 1.02 m/s, (p < 0.001) and cadence increased from 82.9 to 99.9 steps/min (p < 0.001), while the numeric pain scale at rest decreased from 3.5/10 to 2.2/10, (p < 0.001) and the pain while walking from 3.9/10 to 2.4/10, (p < 0.001) from 2 to 6 weeks post-surgery. A significant improvement in gait parameters is detectable in the first 6 weeks after surgery with the use of a wearable insole device. As the gait speed and cadence increase and the VAS pain level decreases, the loading rate and average peak force begin to normalize. This device may allow for early gait analysis and have potential clinical utility in detecting early differences in patients' functional status following TKA.


TRAUMA ◽  
2021 ◽  
Vol 22 (3) ◽  
pp. 5-11
Author(s):  
Khaled Obeidat ◽  
O.D. Karpinska

According to epidemiological studies, osteoarthritis accounts for 10–12 % of all cases of musculoskeletal diseases. In the general structure of knee pathology, degenerative diseases make up 57.8 %. The urgency of the problems of gonarthrosis is due to not only its widespread prevalence, but also the high risk of developing knee dysfunction, accompanied by a significant reduction in the quality of life of patients and often leading to partial or permanent disability of patients. Gonarthrosis has significant gender features. Women account for about 70 % of the number of patients, while men had this disease almost 2 times less often, but other data indicate that the incidence of gonarthrosis in men under 60 years of age is higher, and in women it begins to increase after 65 years. Knee replacement is a leading method in the treatment of knee osteoarthritis stages III–IV. The tendency towards an increase in the total number of surgeries leads to an increase in the frequency of complications and unsatisfactory results: according to some authors, from 3.3 to 13.2 % of patients complain of knee replacement outcomes. Studies of long-term complaints after arthroplasty have shown that in addition to pain reduction, some patients had an increase in varus angle when bending the knee while walking but they didn’t mark an improvement in gait parameters compared to preoperative examination. After unilateral total knee arthroplasty, the load patterns of the frontal plane in the operated knee remain pathological in the long run. After knee arthroplasty, there is muscle weakness, and studies have shown changes in all muscles of the lower extremity. Weakening of some muscles led to compensatory strengthening of others. Studies of the effect of preoperative rehabilitation on the outcome of knee arthroplasty have shown its low efficiency. Many studies have studied motor activity of patients after total knee arthroplasty in recent years. Not only gait features, but also movements of the pelvis, trunk and upper extremities are studied. Modern methods of diagnosing spatial oscillations of the body when walking have shown that disorders of body movements — excessive hand movements, pelvic loosening, asymmetrical flexion of the knee joints, etc., after arthroplasty are preserved in patients and restore slowly, and some disorders remain forever. Conclusions. Knee arthroplasty relieves pain, improves quality of life, but according to many authors, patients complain of incomplete restoration of the functionality of the prosthetic limb. According to the researchers, the main cause for incomplete reco-very of gait parameters is the difference in the frontal angles of the knee joint flexion and the difference in the length of the steps. Special training exercises can reduce the asymmetry of the steps, but it is difficult to completely restore the symmetry of the steps within 2 years. Studies of the effect of preoperative rehabilitation on the outcome of knee arthroplasty have shown its low effectiveness.


2018 ◽  
Vol 32 (09) ◽  
pp. 891-896
Author(s):  
Jarosław Jabłoński ◽  
Marcin Sibiński ◽  
Michał Polguj ◽  
Jacek Kowalczewski ◽  
Dariusz Marczak ◽  
...  

AbstractThe aim of the study was to evaluate the impact of implant component alignment on objective and subjective outcomes after total knee arthroplasty (TKA). The rotation of the femoral component and its influence on the final results were also examined. After exclusion, the study examined 102 patients (mean age, 66.28 years; range, 51–79 years) who had undergone unilateral TKA. All of the operative procedures were performed by one surgeon with one type of implant. One year after the operation, improvements in Knee Society's Knee Scoring System, functional score, Western Ontario and McMaster Universities Osteoarthritis Index, and Visual Analog Scale were observed; however, none showed a significant correlation with any of the parameters analyzed by X-ray or computed tomography (CT) (α, β, γ, δ angles and posterior condylar angle [PCA]). Significant improvements were found for the vast majority of the parameters used for gate analysis at the final follow-up. Significant correlations were found between PCA angle and differences in stance phase, swing phase of the operated limb, and step width (all p = 0.03). No other significant relationships were found between gait parameters and indicators measured by X-ray and CT. None of the analyzed radiographic parameters, including rotation of the femoral component, correlated with final clinical results. Neither femoral internal rotation of 3° to 6°, nor rotation of 0° ± 3° or 0° ± 6° influenced the outcome. One year after TKA, a significant improvement was observed in both functional and gait parameters.


2017 ◽  
Vol 32 (8) ◽  
pp. 2404-2410 ◽  
Author(s):  
Alice Bonnefoy-Mazure ◽  
Pierre Martz ◽  
Stéphane Armand ◽  
Yoshimasa Sagawa ◽  
Domizio Suva ◽  
...  

2017 ◽  
Vol 46 (5) ◽  
pp. 544-551 ◽  
Author(s):  
Yong-Hao Pua ◽  
Felicia Jie-Ting Seah ◽  
Ross Allan Clark ◽  
Cheryl Lian-Li Poon ◽  
John Wei-Ming Tan ◽  
...  

2012 ◽  
Vol 20 (7) ◽  
pp. 1252-1260 ◽  
Author(s):  
Rita M. Kiss ◽  
Zoltán Bejek ◽  
Miklós Szendrői

2021 ◽  
Vol 8 (6) ◽  
pp. 245-259
Author(s):  
Jyotsna Amod Thosar ◽  
Miti Parikh ◽  
Mohan Madhav Desai

Introduction: In acute phase after Total Knee Arthroplasty (TKA), physiotherapy, aims at reducing pain, local edema and muscle weakness. Among treatment techniques, cryotherapy increases pain tolerance, helping in uninhibited motor recruitment of quadriceps. Intermittent muscle fiber contraction with Neuromuscular Electrical Stimulation (NMES) improves blood flow, reduces pain and decreases quadriceps arthrogenic muscle inhibition. Exercise therapy causes muscle strengthening. Effects of perioperative cold therapy have conflicting evidences. Early NMES use, post TKA for pain and swelling reduction has shown paucity of literature. Hence, this study aims to compare the effectiveness of these techniques in improving function. Method: Interventional study was conducted with 30 subjects randomly allocated into two groups (Group A- cryotherapy and Group B- NMES). Both received standardized exercise therapy. On 2nd postoperative day- pain (using Visual Analog Scale), Range Of Motion (using universal goniometer) and gait speed (using 4 metre walk test) was measured. Treatment was given for 5 days according to allocated group. Post-treatment outcome measures were taken. Results: Out of 30 participants, both groups showed statistically significant (p<0.05) improvement in all outcomes. Comparing effectiveness between the groups, NMES showed statistically significant improvement for knee flexion ROM. Other outcome measures showed no statistically significant difference. Conclusion: Rehabilitation in acute phase is essential for improving patient’s strength in long term. Along with exercise therapy, both cryotherapy and NMES showed improved function. On comparison, NMES showed better results for improvement in knee flexion ROM. Keywords: Total Knee Arthroplasty, cryotherapy, neuromuscular electrical stimulation, exercise therapy, visual analog scale, range of motion, gait speed.


2020 ◽  
Vol 4 (s1) ◽  
pp. 143-143
Author(s):  
Vesta Nwankwo ◽  
Janet Bettger ◽  
Cindy L. Green ◽  
Thomas Risoli

OBJECTIVES/GOALS: Patient beliefs and goals can facilitate discussion of recovery expectations, patient-provider collaboration and maximization of goal achievement. In this study, we sought to address an evidence gap and examine the association of preoperative self-assessment of goals with preoperative and 6-week knee function and gait speed among total knee arthroplasty (TKA) patients. METHODS/STUDY POPULATION: We conducted a secondary analysis of data from the VERITAS randomized, controlled trial conducted from 11/2016-03/2018 that included adults age ≥ 18 years with scheduled and completed unilateral TKA followed by post-surgical physical therapy. Patients rated their ability to perform various activities of daily living goals scaled from 0 (unable to perform) to 10 (full performance). Patients were categorized by pre-surgical (baseline) goal rating: low = 0-2, intermediate = 3-4, and high = 5-10. Outcomes including gait speed and the KOOS were assessed within 10 days prior to surgery and 6-weeks post-surgery. Descriptive statistics and outcomes were compared for patients by preoperative goal rating using Chi-square or Fisher’s exact tests and ANOVA or Kruskal-Wallis tests as appropriate. RESULTS/ANTICIPATED RESULTS: Of 288 patients (mean age 65±8; 62.5% women; 82% white), 102 had a low goal rating (GR), 86 intermediate, and 99 high. Patients with low GR preoperatively generally had lower baseline mean scores than intermediate and high GR patients, respectively, on the KOOS (33.9/35.6/39.8; p<0.001) and lower gait speed (m/s) compared to intermediate and high GR patients at baseline (0.9/1.1/1.0; p = 0.009). The low, intermediate, and high GR groups, respectively, showed no difference across mean KOOS scores (61.0/61.2/61.9; p = 0.63) or gait speed (m/s) (1.0/1.0/1.0, p = 0.33) at 6 weeks postoperative. DISCUSSION/SIGNIFICANCE OF IMPACT: In this study, adults who perceived greater difficulty with a pre-selected activity goal, exhibited lower function prior to TKA but showed no differences in function 6-weeks after surgery. Follow-up studies will describe the association between goal-setting preoperatively and patient goal attainment and satisfaction following surgery.


2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Maolin Sun ◽  
Ying Zhang ◽  
Yang Peng ◽  
Dejie Fu ◽  
Huaquan Fan ◽  
...  

Background. With the development of three-dimensional printing (3DP) technology, the patient-specific instrumentation (PSI) has been widely applied in total knee arthroplasty (TKA). The purpose of this study was to compare the gait parameters of patients with 3DP personalized guide-assisted and standard TKA. Methods. Retrospective analysis of the advanced knee OA cases in our hospital between June 2017 and June 2018 was conducted. 30 cases received 3DP personalized guide-assisted TKA (group A), and 60 patients who underwent standard TKA during the same period were in group B and group C according to the computed tomography (CT) measurement results, each with 30 cases. Hip–knee–ankle angle (HKA), patella transverse axis-femoral transepicondylar axis angle (PFA), and gait parameters were statistically analyzed. The function was assessed by Hospital for Specific Surgery (HSS) and Knee Society Score (KSS). Results. The mean follow-up period was 12.3 months in the three groups. The knee max flexion angle at the swing phase of group A was larger than group B and group C (P<0.05), there was no statistically significant difference in other gait parameters. The mean PFA of group A was smaller than that of group B and group C (P<0.05). While, the HKA, HSS, and KSS scores of three groups showed no significant difference. Conclusion. 3DP personalized guide technology could improve the gait parameters after surgery, specifically reflected in the knee max flexion angle at the swing phase. It could also assist in the reconstruction of more accurate patellar tracking and rotational alignment in TKA, avoiding the occurrence of insufficient or excessive extorsion.


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