The contralateral knee may not be a valid control for biomechanical outcomes after unilateral total knee arthroplasty.
Aged
Arthroplasty, Replacement, Knee
Biomechanical Phenomena
Case-Control Studies
Cross-Sectional Studies
Female
Gait
/ physiology
Gait Analysis
/ methods
Humans
Knee Joint
/ physiopathology
Male
Middle Aged
Osteoarthritis, Knee
/ diagnosis
Postoperative Period
Range of Motion, Articular
Treatment Outcome
Gait
Joint replacement
Kinematics
Kinetics
Osteoarthritis
Symmetry
Journal
Gait & posture
ISSN: 1879-2219
Titre abrégé: Gait Posture
Pays: England
ID NLM: 9416830
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
09
05
2018
revised:
03
12
2018
accepted:
18
01
2019
pubmed:
18
3
2019
medline:
4
7
2019
entrez:
18
3
2019
Statut:
ppublish
Résumé
Although unilateral symptoms and unilateral total knee arthroplasty (TKA) are common, many patients have bilateral radiographic osteoarthritis (OA). Because the contralateral (non-operated) limb is often used as a comparison for clinical and biomechanical outcomes, it is important to know if the presence of OA influences movement patterns in either limb. The purpose of this study was to compare bilateral sagittal plane biomechanics between subjects with and without contralateral knee OA after unilateral TKA. Fifty-three subjects who underwent unilateral TKA underwent three-dimensional gait analysis 6-24 months after surgery participated in this cross-sectional study. Kellgren-Lawrence (KL) OA severity in the contralateral limb was measured, and subjects were classified into either a non-OA (KL 0 or 1) or OA (KL 2-4) group. Mixed-model ANOVA tests with factors of group and limb were used to compare biomechanical measures. In the presence of a significant interaction effect, post-hoc comparisons were performed. The OA group had more knee flexion at initial contact, less knee flexion and extension excursions, and less knee extension in the contralateral limb compared to the non-OA group. The non-OA group had significant differences between limbs, with more knee flexion at initial contact, less knee joint excursion, and less peak knee extension on the operated limb compared to the contralateral limb, whereas there were no limb differences for the OA group. Kinetic variables were not different in the ANOVA models. Subjects with contralateral knee OA have more symmetrical gait, although they adopt a more abnormal and stiff-legged gait pattern bilaterally. Researchers and clinicians should consider radiographic disease severity, not just symptoms, in the contralateral limb when identifying appropriate subject samples for unilateral biomechanical studies. Symmetrical movement patterns between limbs after surgery should not be the sole factor upon which movement recovery is based.
Sections du résumé
BACKGROUND
Although unilateral symptoms and unilateral total knee arthroplasty (TKA) are common, many patients have bilateral radiographic osteoarthritis (OA). Because the contralateral (non-operated) limb is often used as a comparison for clinical and biomechanical outcomes, it is important to know if the presence of OA influences movement patterns in either limb.
RESEARCH QUESTION
The purpose of this study was to compare bilateral sagittal plane biomechanics between subjects with and without contralateral knee OA after unilateral TKA.
METHODS
Fifty-three subjects who underwent unilateral TKA underwent three-dimensional gait analysis 6-24 months after surgery participated in this cross-sectional study. Kellgren-Lawrence (KL) OA severity in the contralateral limb was measured, and subjects were classified into either a non-OA (KL 0 or 1) or OA (KL 2-4) group. Mixed-model ANOVA tests with factors of group and limb were used to compare biomechanical measures. In the presence of a significant interaction effect, post-hoc comparisons were performed.
RESULTS
The OA group had more knee flexion at initial contact, less knee flexion and extension excursions, and less knee extension in the contralateral limb compared to the non-OA group. The non-OA group had significant differences between limbs, with more knee flexion at initial contact, less knee joint excursion, and less peak knee extension on the operated limb compared to the contralateral limb, whereas there were no limb differences for the OA group. Kinetic variables were not different in the ANOVA models.
SIGNIFICANCE AND INTERPRETATION
Subjects with contralateral knee OA have more symmetrical gait, although they adopt a more abnormal and stiff-legged gait pattern bilaterally. Researchers and clinicians should consider radiographic disease severity, not just symptoms, in the contralateral limb when identifying appropriate subject samples for unilateral biomechanical studies. Symmetrical movement patterns between limbs after surgery should not be the sole factor upon which movement recovery is based.
Identifiants
pubmed: 30878729
pii: S0966-6362(18)30530-7
doi: 10.1016/j.gaitpost.2019.01.030
pmc: PMC8963525
mid: NIHMS1785612
pii:
doi:
Types de publication
Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
179-184Subventions
Organisme : NCRR NIH HHS
ID : P20 RR016458
Pays : United States
Organisme : NIA NIH HHS
ID : R56 AG048943
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier B.V. All rights reserved.
Références
J Orthop Res. 2011 May;29(5):647-52
pubmed: 21437943
Clin Orthop Relat Res. 2010 Jan;468(1):37-44
pubmed: 19472024
Gait Posture. 2015 Feb;41(2):676-82
pubmed: 25715680
J Orthop Sports Phys Ther. 2012 Feb;42(2):135-44
pubmed: 22333656
Clin Biomech (Bristol, Avon). 2015 Jan;30(1):78-85
pubmed: 25467765
J Orthop Sports Phys Ther. 2005 Jul;35(7):424-36
pubmed: 16108583
J Arthroplasty. 2013 Dec;28(10):1842-5
pubmed: 24238572
Ann Rheum Dis. 1998 Dec;57(12):717-23
pubmed: 10070270
J Orthop Sports Phys Ther. 2013 Oct;43(10):715-26
pubmed: 23892267
J Orthop Sci. 2009 Jan;14(1):114-20
pubmed: 19214698
Clin Biomech (Bristol, Avon). 2010 May;25(4):383-6
pubmed: 20004501
Clin Biomech (Bristol, Avon). 2009 May;24(4):372-8
pubmed: 19285768
J Orthop Traumatol. 2017 Jun;18(2):177-184
pubmed: 28361285
Clin Biomech (Bristol, Avon). 2015 Nov;30(9):889-94
pubmed: 26330122
Arthritis. 2011;2011:454873
pubmed: 22046517
Knee. 2007 Aug;14(4):253-63
pubmed: 17531493
J Orthop Sports Phys Ther. 2012 Dec;42(12):1039-49
pubmed: 23090437
Clin Biomech (Bristol, Avon). 2008 Mar;23(3):320-8
pubmed: 18060669
Ann Rheum Dis. 1957 Dec;16(4):494-502
pubmed: 13498604
Ann Rheum Dis. 1956 Mar;15(1):1-11
pubmed: 13303052
Clin Biomech (Bristol, Avon). 2013 Feb;28(2):205-10
pubmed: 23219062
Clin Biomech (Bristol, Avon). 2004 Jan;19(1):44-9
pubmed: 14659929
Arthritis Care Res (Hoboken). 2010 Jan 15;62(1):38-44
pubmed: 20191489
J Bone Joint Surg Am. 1998 Aug;80(8):1132-45
pubmed: 9730122
Gait Posture. 2012 Jan;35(1):61-5
pubmed: 21903396
J Orthop Sports Phys Ther. 2015 Sep;45(9):647-55
pubmed: 26207975