Effect of total knee replacement surgery and postoperative 12 month home exercise program on gait parameters
A Heikkilä1, N Sevander-Kreus1, A Häkkinen2
1Department of Health Sciences, University of Jyväskylä, Keskussairaalantie 4, 40620 Jyväskylä, Finland; Department of Orthopaedic Surgery, Central Finland Central Hospital, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
Objective:
To evaluate the effects of surgery and a postoperative progressive home exercise program on gait parameters among individuals operated with total knee arthroplasty.
Design:
Single blinded randomized controlled trial.
Subjects:
108 patients (84 females, 24 males, mean age 69 years).
Interventions:
Patients were equally randomized into an exercise group (EG) and control group (CG). The 12-months progressive home exercise program starting two months postoperatively was compared to usual care.
Methods:
Gait analysis was performed using the Gaitrite electronic walkway system. In addition, knee extension and flexion strength were measured by a dynamometer preoperatively, and pain on visual analog scale (VAS) at two months and 14 months postoperatively.
Results:
At the 12-month follow-up, maximal gait velocity (p=0.006), cadence (p=0.003) and stance time (p=0.039) showed a greater increase among EG than CG. All the other gait parameters improved among both groups, but with not statistically discernible difference between groups. Weak correlations were found between changes in maximal gait velocity and the knee extension (r=-0.31, p=0.002), flexion strength (r=0.28, p=0.004) and pain during loading (r=-0.27, p=0.005) values.
Conclusion:
The intervention produced statistically significant changes in maximal gait velocity, cadence and stance times in the exercise group compared to controls. Although the average change was small it is of importance that biggest changes occurred in those with low performance.
