Improved knee biomechanics among patients reporting a good outcome in knee-related quality of life one year after total knee arthroplasty

BMC Musculoskeletal Disorders

Research Article

Margareta Hedström¹  Viktor Lindgren²  Per Wretenberg³  Eva W. Broström⁴  Josefine E. Naili⁴  Maura D. Iversen⁵ 

[1] Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, K54, 141 86, Stockholm, Sweden;Department of Molecular Medicine and Surgery, Karolinska Institutet, L1:00, Karolinska University Hospital, 171 76, Stockholm, Sweden;Department of Orthopedics, School of Medical Sciences, Örebro University and Örebro University Hospital, Örebro, Sweden;Department of Women’s and Children’s Health, Karolinska Institutet, MotorikLab, Q2:07, Karolinska University Hospital, 171 76, Stockholm, Sweden;Department of Women’s and Children’s Health, Karolinska Institutet, MotorikLab, Q2:07, Karolinska University Hospital, 171 76, Stockholm, Sweden;Department of Physical Therapy, Movement & Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, 02115, Boston, MA, USA;Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;

关键词: Gait;    Knee;    Biomechanics;    Joint replacement;    Quality of Life;    Function;    Osteoarthritis;   

DOI  :  10.1186/s12891-017-1479-3

 received in 2016-11-30, accepted in 2017-03-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIt is not well understood why one in five patients report poor outcomes following knee arthroplasty. This study evaluated changes in knee biomechanics, and perceived pain among patients reporting either a good or a poor outcome in knee-related quality of life after total knee arthroplasty.MethodsTwenty-eight patients (mean age 66 (SD 7) years) were included in this prospective study. Within one month of knee arthroplasty and one year after surgery, patients underwent three-dimensional (3D) gait analysis, completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), and rated perceived pain using a visual analogue scale. A “good outcome” was defined as a change greater than the minimally detectable change in the KOOS knee-related quality of life, and a “poor outcome” was defined as change below the minimally detectable change. Nineteen patients (68%) were classified as having a good outcome. Groups were analyzed separately and knee biomechanics were compared using a two-way repeated measures ANOVA. Differences in pain between groups were evaluated using Mann Whitney U test.ResultsPatients classified as having a good outcome improved significantly in most knee gait biomechanical outcomes including increased knee flexion-extension range, reduced peak varus angle, increased peak flexion moment, and reduced peak valgus moment. The good outcome group also displayed a significant increase in walking speed, a reduction (normalization) of stance phase duration (% of gait cycle) and increased passive knee extension. Whereas, the only change in knee biomechanics, one year after surgery, for patients classified as having a poor outcome was a significant reduction in peak varus angle. No differences in pain postoperatively were found between groups.ConclusionPatients reporting a good outcome in knee-related quality of life improved in knee biomechanics during gait, while patients reporting a poor outcome, despite similar reduction in pain, remained unchanged in knee biomechanics one year after total knee arthroplasty. With regards to surgeon-controlled biomechanical factors, surgery may most successfully address frontal plane knee alignment. However, achieving a good outcome in patient-reported knee-related quality of life may be related to dynamic improvements in the sagittal plane.

【 授权许可】

CC BY   
© The Author(s). 2017