Gait Analysis 1 Year after Primary TKA: No Difference between Gap Balancing and Measured Resection Technique

No clinical relevant differences in early clinical outcomes, patient satisfaction and objective gait and posture analysis between a custom versus off-the-shelf total knee arthroplasty: a prospective controlled study

Osteoarthritis is one of the most frequent joint diseases in the world. Therefore, it is critical to develop sufficient therapy strategies to improve a patient's quality of life. The aim of this study was to evaluate the influence of an individualized (custTKA) vs. a conventional (convTKA) total knee arthroplasty (TKA) in regard to gait, posture and clinical outcome. Seventy-three patients (male: n = 32, female: n = 41; age: 66.5 ± 8.64 years; BMI: 32.2 ± 5.68 kg/m2; axis pre-operative: 174 ± 4.65°) were included in this prospective controlled trial study (examinations 1, 2 and 3: preoperative, 3 and 12 months postoperative). Two experienced senior surgeons performed the surgeries. Clinical results were measured using the Forgotten Knee Joint Score (FKJS) and Knee Society Score (KSS). Additionally, gait was measured with inertial sensor based mobile and treadmill based systems, while posture was measured with a posturographic system in order to assess gait patterns and postural stability, regulation and weight distribution. Radiographic evaluation was measured of the hip knee ankle (HKA)) at 3 and 12 months postoperative. There were no clinically significant interaction effects (time x group) for posture (e.g., stability indicator, postural subsystems) or gait (e.g., stride length, walking speed, double support). However, time effects were observed for the somatosensory system (p = 0.005, ηp2 = 0.08), medio-lateral weight distribution (p < 0.001, ηp2 = 0.31), stride length (p < 0.001, ηp2 = 0.21), walking speed (p < 0.001, ηp2 = 0.21), cadence (p < 0.001, ηp2 = 0.18), stance phase (p < 0.001, ηp2 = 0.20) and maximum toe force (p < 0.001, ηp2 = 0.24). No significant differences were found for KSS or FJS 3 and 12 months postoperative (custTKA/convTKA: KSS examination 2 179/189, p = 0.153; KSS examination 3 206/198, p = 0.246; FKJS examination 2 41.4/40.7, p = 0.900; FKJS examination 3 54.9/45.8, p = 0.149). Similarly, no significant differences were noted for flexion at 3 (113/119°, p = 0.062) and 12 months postoperative (121/122°, p = 0.615). Radiographic diagnostic (HKA) also displayed no significant-relevant interaction effects. In this prospective controlled study no clinical significant-relevant interaction effects (group x time) were found between both techniques regarding biomechanical and clinical parameters. Therefore, it can be concluded that custTKA provides no substantial clinical benefits compared to convTKA.

Long-term gait analysis in patients after total knee arthroplasty: A systematic review and meta-analysis

BACKGROUND

Gait abnormalities have been described in patients after total knee arthroplasty (TKA), leading to the development of inter-joint coordination abnormalities and increased risk of falling. Such impairments have been reported to persist in the long-term, although the majority of studies assessed gait pattern especially in the first months after TKA.

RESEARCH QUESTION

What are the long-term gait impairments in patients after TKA compared to healthy age-matched subjects?

METHODS

A systematic search was conducted on MEDLINE/PubMed, EMBASE, CENTRAL and Scopus databases. Observational studies or randomized controlled trials investigating gait spatial-temporal, kinematic and kinetics parameters in a time-window longer than 6 months in patients with TKA compared to healthy age-matched subjects were included. Methodological quality was assessed using the modified Downs and Black (D&B) checklist and participants' characteristics, surgical procedures details and outcome measures were extracted. Pooled or un-pooled findings were categorized into "6 months - 1 year" and "more than 1 year" timepoint categories.

RESULTS

Twenty-eight studies (976 patients) were included. Overall quality was fair with a mean modified D&B score of 63.5 %. Reduced speed, stride length, cadence and longer stance phase were found in patients when compared to healthy individuals at "6 months - 1 year" follow-up. Spatial-temporal parameters deficits were also found at more than 1 year after TKA, where lower single-limb support and longer double-limb support durations were detected. These impairments occurred in concomitance with decreased knee range of motion along the sagittal and frontal planes and altered kinetic parameters. Hip kinematic and kinetic long-term impairments were also detected after TKA.

SIGNIFICANCE

These findings highlighted long-term gait pattern alterations in patients with TKA compared to age-matched healthy subjects. Future studies should identify interventions able to reduce long-term gait pattern alterations and improve function in patients after TKA.

Current applications of gait analysis after total knee arthroplasty: A scoping review

Introduction

The biomechanics of the knee do not return to normal after knee replacement. The purpose of this scoping review is to summarize the current use of gait analysis in total knee arthroplasty and to identify the preoperative motion analysis parameters for which a systematic review aimed at determining the reliability and validity may be warranted.

Materials and methods

This IRB-exempt scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The 279 articles from the five search engines underwent a title/abstract and full-text screening. Included articles were categorized as either: the role of gait analysis as a research tool for operative decisions, other research applications for motion analysis in total knee arthroplasty, gait analysis as a tool in predicting radiologic outcomes, or gait analysis as a tool in predicting clinical outcomes.

Results

Eleven articles studied gait analysis as a research tool in studying operative decisions. Five articles studied other research applications for motion analysis in total knee arthroplasty. Other research applications for motion analysis currently include studying the role of the unicompartmental knee arthroplasty and novel physical therapy protocols aimed at optimizing post-operative care. Two articles studied motion analysis as a tool for predicting radiographic outcomes. 15 articles studied motion analysis in conjunction with clinical scores.

Conclusions

There is a broad range of research applications for motion analysis in knee reconstruction. Current limitations include vague definitions of 'gait analysis' or 'motion analysis' and a limited number of articles with preoperative and postoperative outcomes. Knee adduction moment, knee adduction impulse, total knee range of motion, varus angle, cadence, stride length, and velocity have the potential for integration into composite clinical scores. A systematic review to determine the psychometric properties of these variables is warranted.

Similar postoperative outcomes after total knee arthroplasty with measured resection and gap balancing techniques using a contemporary knee system: a randomized controlled trial

PURPOSE

The Attune® Knee System provides new instrumentation to achieve symmetric flexion/extension gaps in total knee arthroplasty (TKA). However, there is limited information on the optimal TKA technique using this system. The aim of this randomised controlled trial was to determine which surgical technique results in better postoperative clinical outcomes after TKA using the contemporary Attune^® Knee System: the measured resection or gap balancing technique.

METHODS

A prospective randomized controlled trial was conducted with 100 patients undergoing TKA using measured resection (n = 50) or gap balancing (n = 50) technique. The measured femoral sizer was used in the measured resection group, while the balanced femoral sizer was used in the gap balancing group. Functional outcomes and quality of life were assessed preoperatively and at 6 months and 2 years post-surgery, using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), the Physical Component Score (PCS) and Mental Component Score (MCS) of Short-Form 36 (SF-36). Using weight-bearing coronal radiographs, the hip-knee-ankle angle (HKA), coronal femoral component angle (CFA), coronal tibial component angle (CTA) and joint line height were also evaluated for each patient.

RESULTS

There were no significant differences in the functional scores or the proportion of patients from each group who were satisfied or had their expectations fulfilled at 6 months or 2 years post-surgery. There was also no significant difference in the number of patients who attained minimum clinically important difference (MCID) postoperatively between the groups. Postoperatively, there was no significant difference in the number of HKA outliers between the groups (p = 0.202). The postoperative CFA (p = 0.265) and CTA (p = 0.479) were similar between the groups. There was also no significant difference in the absolute change (p = 0.447) or proportion of outliers (p = 0.611) for joint line height between the groups.

CONCLUSION

Both measured resection and gap balancing techniques resulted in comparable functional and quality of life outcomes up to 2 years post-surgery. Both techniques appear to be equally effective in achieving excellent outcomes with the Attune^® Knee System.

LEVEL OF EVIDENCE

I.