Comprehensive gait analysis in posterior-stabilized knee arthroplasty

Sixteen patients implanted with a posterior-stabilized prosthesis (Insall-Burstein PS II, Zimmer, Warsaw, IN) and 32 age-matched control subjects were evaluated by isokinetic muscle testing and comprehensive gait analysis at a mean 46 months following the index arthroplasty. The contralateral knee was normal in 13 patients and an asymptomatic total knee arthroplasty in 3 patients. No significant differences (P > .05) were found between the study and control groups in spatiotemporal gait parameters nor were there isokinetic strength deficits. A prolonged firing of the vastus medialis was observed in some patients. Knee range of motion during level walking and stair descent was decreased significantly (P < .05) in the study group. There was no significant difference for knee range of motion between the study and control groups during stair ascent. Spatiotemporal gait parameters in the total knee arthroplasty patients show no significant differences from the control subject at nearly 4 years after surgery. However, other gait abnormalities are present and cannot be accounted for on the basis of muscle weakness, abnormal phasic muscle activity, or inadequate knee range of motion. With reference to historic control subjects, the persistent gait abnormalities of patients implanted with posterior-stabilized prostheses (posterior cruciate substituting) are comparable to those of patients implanted with cruciate-retaining prostheses and superior to cruciate-sacrificing prostheses.