Investigating pre-operative joint-level biomechanics in partial versus total knee arthroplasty

While knee osteoarthritis (OA) is incurable, end-stage OA can be managed surgically with partial knee arthroplasty (PKA) or total knee arthroplasty (TKA). Most studies that compare PKA and TKA cohorts rely on patient-reported outcome measures (PROMs) and lack objective joint-level biomechanics. The purpose of this study was to examine preoperative joint-level kinematics during multiple functional tasks including preferred-pace walking, fast-paced walking, and sit-to-stand alongside self-reported outcomes in patients that received partial versus total knee arthroplasty.

Participants with end-stage knee osteoarthritis were recruited from St. Joseph's Healthcare Hamilton. Self-reported measures included the Oxford knee score, pain ratings, quality of life, and depression. Functional tasks were recorded using markerless motion capture, and joint-level kinematics were analyzed with linear mixed models to test main and interaction effects of surgery type and task condition.

The study included 15 patients that received partial knee arthroplasty and 56 patients that received total knee arthroplasty. No significant differences were observed in self-reported outcomes, nor in single-speed gait or sit-to-stand performance. However, differences emerged when examining walking patterns across speeds. Compared to the total knee arthroplasty group, patients that received partial knee arthroplasty demonstrated greater changes in stride length, peak stance and swing knee flexion, knee excursion, peak stance hip flexion, and overall hip range of motion when going from preferred- to fast-paced walking.

These findings suggest that multi-speed gait assessments may provide a more sensitive approach to detecting kinematic differences in osteoarthritis patients and may be valuable in other clinical contexts.