Comparison of spatiotemporal, kinematic, and kinetic gait characteristics in total and unicompartmental knee arthroplasty during level walking: A systematic review and meta-analysis

Early postoperative gait characteristics after unicompartmental knee arthroplasty: results and clinical implications

BACKGROUND AND OBJECTIVE

Despite the established efficacy of unicompartmental knee arthroplasty (UKA), quantitative assessments of early postoperative changes in gait and stability remain limited. This study investigated preoperative and postoperative alterations in gait and stability following UKA.

METHODS

A cohort of 30 patients undergoing unilateral UKA at the Joint Surgery Department of the Affiliated Hospital of Xuzhou Medical University between May 2021 and 2022 was compared with a control group of 15 healthy elderly individuals without a history of hip or knee pathology. Evaluated parameters included Hospital for Special Surgery (HSS) scores, center of pressure path length, 95% confidence ellipse area, pace, stride length, stride frequency, gait cycle, and single support time percentage. Measurements were obtained preoperatively and at 1 and 3 months postoperatively for both groups.

RESULTS

Step frequency remained unchanged between preoperative and 1-month postoperative assessments (p > 0.05). Stability declined at 1 month postoperatively relative to baseline, whereas other gait parameters showed significant improvement (p < 0.05). By 3 months, HSS scores and all gait and stability metrics exhibited substantial enhancement compared to baseline (p < 0.05).

CONCLUSIONS

Early gait recovery following UKA demonstrated a positive trajectory; however, step frequency showed minimal improvement, and stability remained compromised at 1 month postoperatively. Quantitative gait analysis provides a robust framework for monitoring rehabilitation progress after UKA.

Biomechanical and clinical assessments of activities of daily living following unicompartmental knee arthroplasty: A scoping review

BACKGROUND

Unicompartmental knee arthroplasty is an effective treatment for isolated medial or lateral knee osteoarthritis. Evaluating knee joint loading during activities of daily living postoperatively can offer valuable insights about the compensatory mechanisms in unicompartmental knee arthroplasty patients. The aim of this scoping review was to summarize and to synthesize the existing literature on the most performed activities of daily living and their associated biomechanical outcomes following unicompartmental knee arthroplasty.

METHODS

Five databases, including Medline, Embase, CINAHL, Web of Science, and Ergonomics Abstracts were searched based on 3 main concepts: unicompartmental knee arthroplasty, activities of daily living and biomechanical outcomes. Studies were screened based on titles and abstracts, followed by a full text reading conducted by two authors following inclusion and exclusion criteria.

FINDINGS

This scoping review included 17 studies that met the inclusion criteria and focusing on activities of daily living. These activities were categorized into three main subgroups 1) Stair negotiation, 2) Higher degree of knee flexion activities (including squat, lunge and sit-to-stand) and 3) other activities of daily living (including balance, incline and decline walking).

INTERPRETATION

Stair negotiation was the most evaluated task followed by squatting with a main focus on reporting knee joint kinematics and kinetics. The majority of studies did not report the use of Patient Reported Outcome Measures combined with motion analysis outcomes. Furthermore, most studies focused primarily on medial knee arthroplasty with a fixed-bearing design in short-term follow-up which warrants caution when generalizing these findings to all types of unicompartmental knee arthroplasty.

Gradual restoration of gait following unicompartmental knee arthroplasty: a prospective study

BACKGROUND

This study investigates the gait characteristics and clinical outcomes following Unicompartmental Knee Arthroplasty (UKA) to provide scientific evidence for optimizing postoperative rehabilitation and patient management.

METHODS

Between December 2022 and November 2023, 34 patients with unilateral medial compartment knee osteoarthritis (KOA) underwent UKA. Preoperative and postoperative videos of patients in standing, walking (side view), squatting, and supine knee-bending positions were captured using smartphones. Gait parameters including gait cycle, swing time, swing phase, stance time, stance phase, double support time, walking speed, step time, cadence, step length, stride length, stride width, active knee flexion angle, and maximum hip and knee flexion angles during squatting were analyzed using the MediaPipe framework for human pose estimation.

RESULTS

Postoperative WOMAC scores were significantly lower than preoperative scores (P < 0.001), while postoperative KSS scores were significantly higher than preoperative scores (P < 0.001).Compared to preoperatively, postoperative affected-side gait speed, step length, step width, and active knee flexion angle all increased (P < 0.05). Additionally, postoperative gait cycle time and double-limb support time were reduced compared to preoperative values (P < 0.05). Among the 17 patients who could perform squats preoperatively and postoperatively, the maximum knee flexion angle and hip flexion angle in the squat position increased from preoperative values of (96.41 ± 20.65)° and (113.77 ± 22.56)° to postoperative values of (110.15 ± 20.79)° and (124.84 ± 21.13)°.

CONCLUSIONS

UKA significantly enhances knee joint kinematics, facilitating the transition from basic to advanced functional activities.

Comparison of the clinical efficacy of patellar lateral retraction and patellar eversion in total knee arthroplasty: a systematic review and meta-analysis

BACKGROUND

According to the mobilization technique of the intraoperative patella, total knee arthroplasty (TKA) can be categorized into patellar eversion (PE) and patellar lateral retraction (PLR). Comparisons between the two procedures are inconclusive; therefore, the study purpose was to assess the postoperative clinical efficacy to identify the most suitable procedure.

METHODS

Electronic databases were searched, including Web of Science, ScienceDirect, PubMed, Embase, OVID, the Cochrane Library, CINAHL, CNKI, and WANFANG, to identify clinical trials of PLR versus PE from inception to May 2023. The statistical software Stata 15.0 and Review Manager 5.4 were applied to the data analysis.

RESULTS

Fifteen studies evaluating a total of 1349 patients and 1409 knees were ultimately included. Statistically significant differences emerged between the PLR and PE groups with respect to blood loss (P = 0.02), incision length (P < 0.001), operation time (P = 0.01), straight leg raise (P < 0.001), knee range of motion (ROM; P < 0.05), the Knee Society Score (KSS) functional score (P = 0.0003), the visual analogue scale (VAS) score (1 and 3 months, both P < 0.05), and operative complications (P = 0.02). Furthermore, the PLR and PE groups had similar clinical efficacy in terms of quadriceps strength, VAS score (1 week and 1 year), Hospital for Special Surgery score, KSS pain score, Insall-Salvati ratio, and the occurrence of patella baja (all P ≥ 0.05).

CONCLUSIONS

The PLR procedure is superior to PE in terms of blood loss, incision length, straight leg raise, knee ROM, VAS score (1 and 3 months), KSS functional score, and operative complications, although PE could decrease the operation time. PLR could achieve better postoperative clinical outcomes than could PE. Therefore, it is recommended that experienced surgeons prioritize PLR in TKA.

REGISTRATION

This study was registered in the PROSPERO international registry (Registration ID: CRD42023440722).

Differences in kinematics and kinetics during gait between total knee arthroplasty implant designs

BACKGROUND

Implant design is important for achieving proper knee biomechanics during gait following knee arthroplasty. Bicruciate-stabilized total knee arthroplasty attempts to replicate anterior stability and rotational facilitation. However, its detailed gait biomechanics compared with other implant designs have not been analyzed. The purpose of this study is to compare knee kinematics and kinetics between bicruciate-stabilized total knee arthroplasty, posterior-stabilized total knee arthroplasty, unicompartmental knee arthroplasty, and normal knees.

METHODS

Ten healthy subjects, 16 who underwent posterior stabilized total knee arthroplasty, 12 who underwent bicruciate-stabilized total knee arthroplasty, and 13 who underwent unicompartmental knee arthroplasty were recruited. The mean follow-up period after arthroplasty was 11.0 months. Three-dimensional kinematics and kinetics were assessed using a motion capture system with subjects walking on a 5-m walkway. Comparisons between groups were conducted using the Kruskal-Wallis test, and post hoc analysis was performed for those parameters that differed significantly.

FINDINGS

The bicruciate-stabilized total knee arthroplasty group showed decreased internal rotation compared to the unicompartmental knee arthroplasty group. Compared to the control group, the posterior-stabilized total knee arthroplasty group exhibited reduced knee extension and internal rotation moment.

INTERPRETATION

Bicruciate-stabilized total knee arthroplasties exhibited different biomechanical characteristics compared to unicompartmental knee arthroplasties during terminal stance. Postoperative total knee arthroplasty rehabilitation should focus on relieving stiffness owing to insufficient knee flexion-extension motion observed in both bicruciate-stabilized and posterior-stabilized total knee arthroplasties compared with unicompartmental knee arthroplasty, which may be due to a lack of knee rotational motion during gait.

A systematic comparative analysis of gait characteristics in patients undergoing total knee arthroplasty and unicompartmental knee arthroplasty: a review study

BACKGROUND

This study systematically reviews recent research comparing clinical outcomes and gait function changes in patients undergoing total knee arthroplasty (TKA) versus unicompartmental knee arthroplasty (UKA).

METHODS

A systematic search of the Web of Science, PubMed, and Embase databases was conducted, covering publications from January 2013 to September 2024, to identify studies evaluating changes in clinical scores and gait parameters in patients undergoing TKA or UKA. Following stringent selection criteria, data were synthesized from studies involving 171 TKA and 148 UKA patients, focusing on reported gait outcomes and aggregating findings for comprehensive analysis. Direct comparisons between TKA and UKA were performed to assess differences in clinical scores and gait parameters, aiming to elucidate the relative efficacy of each surgical approach and provide robust evidence for clinical decision-making.

RESULTS

Ten studies met the inclusion criteria for post-operative gait outcome comparisons between TKA and UKA, with seven studies also addressing clinical scores. One study reported greater improvement in WOMAC scores for the UKA group at 6 months post-operation (P < 0.05), while another found superior EQ-5D scores for UKA patients at 1 year post-surgery (P < 0.05). Conversely, five studies found no significant differences in clinical scores between groups at 1 year (P > 0.05). All ten studies assessed gait parameter recovery, with three studies showing no significant differences at 1 year (P > 0.05). However, seven studies identified superior gait recovery in the UKA group across various parameters, including walking speed, step and stride length, single support time, heel strike force, knee joint range of motion, knee flexion angles during different gait phases, peak knee adduction moment, peak tibial internal rotation moment, gait symmetry, and stride length symmetry (P < 0.05).

CONCLUSIONS

The analysis indicates that UKA offers certain advantages in post-operative gait improvements compared to TKA, though these do not translate into significant differences in conventional clinical scoring systems. To enhance the reliability and generalizability of these findings, future studies should involve larger-scale, prospective randomized controlled trials.

Comparison of clinical efficacy of 3D-printed artificial vertebral body and conventional titanium mesh cage in spinal reconstruction after total en bloc spondylectomy for spinal tumors: a systematic review and meta-analysis

Propose

This meta-analysis aimed to determine whether 3D-printed artificial vertebral bodies (AVBs) have superior clinical efficacy compared to conventional titanium mesh cages (TMCs) for spinal reconstruction after total en bloc spondylectomy (TES) for spinal tumors.

Methods

Electronic databases, including PubMed, OVID, ScienceDirect, Embase, CINAHL, Web of Science, Cochrane Library, WANFANG, and CNKI, were searched to identify clinical trials investigating 3D-printed AVB versus conventional TMC from inception to August 2023. Data on the operation time, intraoperative blood loss, preoperative and postoperative visual analogue scale (VAS) scores, preoperative and postoperative Frankel classification of spinal cord injury, vertebral body subsidence, and early complications were collected from eligible studies for a meta-analysis. Data were analyzed using Review Manager 5.4 and Stata 14.0.

Results

Nine studies assessing 374 patients were included. The results revealed significant differences between the 3D-printed AVB and conventional TMC groups with regard to operation time (P = 0.04), intraoperative blood loss (P = 0.004), postoperative VAS score (P = 0.02), vertebral body subsidence (P < 0.0001), and early complications (P = 0.02). Conversely, the remaining preoperative VAS score and Frankel classifications (pre-and postoperative) did not differ significantly between the groups.

Conclusion

The 3D-printed AVB in spinal reconstruction after TES for spinal tumors has the advantages of a short operative time, little intraoperative blood loss, weak postoperative pain, low occurrence of vertebral body subsidence and early complications, and a significant curative effect. This could provide a strong basis for physicians to make clinical decisions.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441521, identifier CRD42023441521.