Three-dimensional Gait Analysis Of Patients Before And In The Early Stage After Total Knee Arthroplasty

BackgroundKnee Osteoarthritis(KOA)is a common degenerative disease,and it mainly affects the middle-aged and elderly population and seriously harms the patients’ quality of life.Total knee arthroplasty(TKA)is currently the most effective treatment for stage IV KOA.However,in clinical rehabilitation after surgery,the approaches of monitoring motor function recovery and quantitatively evaluating motor function improvement of lower limbs are limited.Gait Analysis(GA)has come into our sight as a new approach.This study used GA equipment to measure the indicators including three-dimensional gait parameters and hip flexor muscle strength before and after TKA and conducted comparative analysis.Hospital for Special Surgery(HSS)and The Western Ontario and McMaster Universities Arthritis Index(WOMAC)scores were jointly employed to conduct comprehensive,dynamic,and quantitative evaluation of motor function improvement and recovery of lower limbs.MethodsThe study used a self-contrast paired design.A total of 45 elderly patients(52 sides)undertaking TKA from September 2018 to July 2019 in Orthopedic Medical Center of The Second Hospital of Jilin University were enrolled.The average age was 68.4 years.There were 7 male patients(9 sides),average height 172±7cm,average weight 65±12kg;38 female patients(43 sides),average height 163±8cm,average weight 57±10kg,excluding other factors affecting lower limb motor function.The gait data of every patient was measured and compared with the American MOTION? motion capture device before TKA and at 3 months after TKA.At the same time,Surface EMG(Sur-EMG)was used to measure hip flexor muscle strength during walking.HSS and WOMAC scoring were performed before each gait test for all the patients.In this study,statistical analysis was conducted using SPSS25.0.The quantitative data were expresses as mean and standard deviation((?) ± s).The gait data before TKA and after TKA was compared with paired-sample t-test.An alpha of 0.05 was used as the cutoff for significance.Significance was defined as P<0.05.ResultsGA equipment provided accurate information about the patient’s movement and force in three dimensions(X/Y/Z).The results of post-processing software OT611 showed that,after TKA,the compensatory abnormal gait including short leg gait and pain reduction gait caused by long term KOA improved.The kinematic parameters significantly improved,with the average step length before TKA 0.47±0.05 m,at 3 months after TKA 0.50±0.02m(P=0.004);average velocity before TKA 0.76±0.02m/s,at 3 months after TKA 0.87±0.04m/s(P<0.001);average cadence before TKA 94.38±8.93step/min,at 3 months after TKA 96.96±8.26step/min(P<0.001).The movement angles of lower limb joints significantly improved,with the average peak hip flexion angle during walking before TKA 17.7±2.5°,at 3 months after TKA 24.1±2.8°(P<0.001);the average peak hip extension angle during walking before TKA 10.8±1.9°,at 3 months after TKA 15.3±1.9°(P<0.001);the average peak knee flexion angle during walking before TKA 68.7±3.8°,at 3 months after TKA 59.3±4.1°(P<0.001);the average peak ankle flexion angle during walking before TKA 15.5±2.6°,at 3 months after TKA 14.3±2.1°(P=0.013).After TKA,the stance phase and swing phase of bilateral limbs tended to become balanced.The average HSS score before TKA was 46.42±11.97,and that at 3 months after TKA was 69.91±12.44(P<0.001).The average WOMAC score before TKA was 72.64±15.06,and that at 3 months after TKA was 39.71±12.03(P<0.001).The results of Sur-EMG showed that the hip flexion muscle strength improved after TKA.ConclusionThis study found that TKA was significantly effective in treating stage IV KOA of elderly patients,which improved lower limb motor function and the patients’ quality of life significantly.As a biomechanical research method,GA can dynamically and quantitatively evaluate the lower limb motor function of patients undertaking TKA,and accurately reflect the condition of postoperative recovery,and therefore it can provide reference for guiding surgeries and exploring new rehabilitation methods.