Gait analysis after total knee replacement for degenerative arthritis

Prior research has shown that total knee replacement (TKR) improves function in patients with degenerative arthritis. However, the specific effects of different prosthetic designs on gait remain unclear. Established knowledge includes the general benefits of TKR, but the impact of cemented versus cementless prostheses is less understood. No prior work had resolved how posterior cruciate ligament preservation affects gait mechanics. This gap motivated a study comparing two common TKR designs. The need for detailed kinetic and kinematic data is evident in the field. Researchers seek to understand how prosthetic choices influence walking patterns. The role of quadriceps function and soft tissue balance is also under investigation. This paper addresses these uncertainties by analyzing gait outcomes after TKR.

The aim of this study was to compare the functional and gait outcomes of two TKR designs in patients with osteoarthritis. The specific problem addressed is the lack of detailed biomechanical data on cemented versus cementless prostheses. The motivation stems from the need to understand how surgical choices influence postoperative gait. The study focuses on the Insall-Burnstein and Miller-Galante prostheses. Each group had nine knees replaced, allowing for a direct comparison. The researchers sought to evaluate both clinical scores and gait mechanics. The study's design included a follow-up period of up to 77 months. This timeframe enabled an assessment of long-term functional outcomes.

The study used quantitative gait analysis and clinical evaluation to assess outcomes. Participants included 13 patients with 18 TKRs, divided into two groups. One group received cemented Insall-Burnstein prostheses, while the other had cementless Miller-Galante prostheses. The VICON system with three cameras and two force plates captured gait data. Kinetic and kinematic data were collected during level walking. The data were compared to the non-operated side and to younger control subjects. Clinical scores included the overall functional knee score and knee flexion angles. The gait analysis focused on velocity, step length, cadence, and limb support durations.

The overall functional knee score was 94.1 points, with 95.0 for I/B and 92.2 for M/G. Average active knee flexion was 109.7 degrees, with 116.4 for I/B and 102.9 for M/G. Patients showed slower walking velocity and shorter step lengths. They also exhibited reduced cadence and altered limb support phases. The M/G group had longer double-limb support and shorter single-limb support. Both prosthetic groups had narrower knee flexion-extension angles. Ground reaction forces were higher in vertical and medio-lateral directions. These findings suggest quadriceps dysfunction and soft tissue imbalance.

The authors reported that both TKR designs improved function but altered gait mechanics. The functional knee scores were high in both groups, indicating good outcomes. However, gait patterns deviated from normal controls. Slower velocity and shorter step lengths were observed. Altered limb support phases suggest compensatory mechanisms. The M/G group showed distinct gait adaptations. Higher ground reaction forces may indicate quadriceps dysfunction. The authors propose that soft tissue balance influences gait outcomes.