| BackgroundThere is little literature report on the dynamic changes and trends of knee prosthesis kinematics after posterior cruciate retaining total knee arthroplasty(CR-TKA).Whether the posterior cruciate ligament preserved during total knee arthroplasty can perform its proper kinematic function after surgery has also been questioned.Three-dimensional gait analysis can accurately present the tiny changes of knee joint motion and realize the accurate quantification of six-degrees-of-freedom(6DOF)knee kinematic alterations.Gait analysis performed in patients with CR-TKA before and after operation,exploring the changes and trends of gait kinematics after TKA,clarifying the correlation between key gait kinematics parameters and clinical efficacy,can help clinicians better understand the kinematic changes brought about by CR-TKA,and further understand the role of posterior cruciate ligament in TKA,the role of gait analysis in preoperative/postoperative kinematic evaluation of TKA.The clinical significance of relevant kinematic parameters can be more clearly defined by gait analysis.Objectives1.To compare the gait kinematics of patients with CR-TKA before and after operation,the changes and trends of gait kinematics after CR-TKA were analyzed,and the role and clinical significance of posterior cruciate ligament in the changes of relevant gait parameters were also analyzed.2.To compare WOMAC and KSS 2011 before and after CR-TKA,to analyze the correlation between gait kinematic parameters and clinical scores at different time points,to explore the short-term clinical efficacy of CR-TKA and the clinical significance of gait analysis and its role in the evaluation of postoperative effect.MethodsSubjects enrolled: A total of 30 patients with advanced knee osteoarthritis were selected from the Department of Orthopedics,Changhai Hospital from June 2021 to December 2021.Methods and follow-up time: all patients were operated with posterior cruciate retaining total knee arthroplasty by the same team of senior surgeons,the patients were followed up at 3 months,6 months and 1 year after operation.Gait kinematic evaluation: patients were evaluated at 1 day before operation,3months,6 months and 1 year after operation respectively.Opti＿knee,infrared motion capture system,was used to collect the gait kinematic parameters of the affected knee when walking on flat ground.At the same time,knee kinematics data of 30 healthy subjects,matched age and sex,were collected as the normal control group.Anterior-posterior displacement of tibia relative to femur,internal and external rotation of tibia relative to femur,flexion/extension angle of knee were compared before and after operation.The correlation between gait parameters and clinical efficacy after CR-TKA: all patients completed WOMAC and KSS 2011 scales on the same day performing gait analysis.The correlation between gait parameters and scores were analyzed at the same time.Results1.Comparison of gait kinematics before and after CR-TKAFrom preoperative,postoperative 3 months,postoperative 6 months to postoperative 1year,the minimum extension angle of knee in standing phase decreased gradually,but ROM of knee flexion/extension in gait cycle,the maximum internal rotation angle of tibia in standing/swinging phase,ROM of tibial internal/external rotation in standing/swinging phase,ROM of tibial internal/external rotation in gait cycle increased gradually,the difference was statistically significant(p<0.05)between each time points.The maximum flexion angle of the swing phase of the knee gradually increased with the time after operation,except for no significant difference between preoperation and 3 months after operation(p>0.05),the difference was statistically significant between each time points(p< 0.05).The maximum anterior displacement of tibia in standing and swinging phase,ROM of anterior-posterior displacement of tibia in standing and swinging phase,ROM of total anterior-posterior displacement of tibia in the whole gait cycle,which at each time point after operation,was larger than it before operation,but they showed a trend of decreasing gradually with the passage of time after operation,the difference was statistically significant(p<0.05).The maximum posterior displacement of tibia in standing and swinging phase at each time point after operation was less than it before operation,and the difference was statistically significant(p<0.05).One year after operation,compared with the normal control group,there were no significant differences in all gait kinematics(p>0.05),except for the maximum posterior displacement in swing phase.The maximum posterior displacement in swing phase was less than that in control group at 1 year after operation,and the difference was statistically significant(p<0.05).2.The correlation between gait kinematics and clinical efficacy before and after CR-TKAThe minimum extension angle in standing phase,the maximum flexion angle in swing phase,and the range of motion of knee flexion/extension were closely related to patient-reported outcome measures(PROMs).The minimum extension angle in standing phase,the maximum flexion angle in swing phase and the ROM of knee flexion/extension showed moderate to strong correlations with the satisfaction score of patients before surgery,3 months after surgery,6 months after surgery,or 1 year after surgery.However,the KSS 2011 knee objective index score only showed moderate positive correlations with the satisfaction score of patients at 1 year after operation.ConclusionPatients after CR-TKA can gradually recovered to near-normal knee kinematics.PCL preserved during surgery can maintain the posterior stability of the artificial knee and play a normal role in guiding the rotation of the tibia.The gait parameters closely related to clinical efficacy after TKA were the minimum extension angle in standing phase,the maximum flexion angle in swing phase and ROM of knee flexion/extension during gait cycle.The smaller minimum extension angle in standing phase,the larger maximum flexion angle in swing phase and the larger ROM of knee flexion/extension during gait cycle,the better the subjective clinical efficacy of patients.Gait kinematic parameters were more correlated and consistent with patient satisfaction within 1 year after surgery compared with objective clinical indexes,such as alignment of lower limbs,stability of knee and passive angle of knee flexion and extension,which were measured by doctors. |
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