Comparison of the Kinematics Following Gait Perturbation in Individuals Who Did or Did Not Undergo Total Knee Replacement

Vicktoria Elkarif,Isabella Schwartz,Rivkin Gurion,Sigal Portnoy,Alexander Greenberg,Leonid Kandel,Debbie Rand

doi:10.3390/app11167453

Vicktoria Elkarif, Isabella Schwartz + Show 5 more

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https://doi.org/10.3390/app11167453

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Abstract

We aimed to compare the spatiotemporal parameters and joint kinematics during unperturbed and perturbed gait between individuals with osteoarthritis (OA) who did or did not undergo total knee replacement (TKR) one year post a baseline evaluation. OA subjects scheduled for TKR (TKR group; n = 14) and not scheduled for TKR (NTKR group; n = 17) were age-matched. Outcome measures included: joint range of motion, timed up and go, joint pain levels, Oxford score, and the Activities-specific Balance Confidence Scale. In addition, spatiotemporal gait parameters and joint kinematics were recorded during perturbed and unperturbed gait. After one year, most of the TKR group (71%), but only 41% of the NTKR group, increased their gait velocity by more than 0.1m/sec, which is the meaningful clinical important difference for gait velocity. After perturbation of the contralateral limb, the TKR group showed a greater decrease in the maximal extension of the OA hip compared to the NTKR group (p = 0.031). After perturbation of the OA limb, more subjects decreased their OA knee flexion–extension range in the NTKR group compared to the TKR group (p = 0.011) and more subjects decreased their maximal ankle plantar flexion in the TKR group (p = 0.049). Although the surgery was successful in terms of pain reduction and increased functionality, individuals following TKR exhibited unique compensatory strategies in response to the perturbation of both limbs. These findings might suggest that balance deficits remain in individuals following TKR and therefore are associated with a risk of falls.

Highlights

Osteoarthritis (OA) is a degenerative disease that is comprised of biological, structural, and biomechanical components [1,2,3,4]
We compared the gait patterns during a unperturbed and perturbed gait in individuals with OA who did or did not undergo total knee replacement (TKR) one year post a baseline evaluation. This is the first report of gait characteristics and perturbation change in the recovery strategy of subjects with OA over one year
Our main findings show a decrease in pain levels and Oxford scores in most subjects following TKR, coupled with increased gait velocity and reduced pelvic tilt, as well as a different perturbation recovery strategy compared to the NTKR group

Summary

Introduction

Osteoarthritis (OA) is a degenerative disease that is comprised of biological, structural, and biomechanical components [1,2,3,4]. Abnormality of the spatiotemporal gait parameters such as gait velocity [14,15], swing [15], and stance durations, in addition to step length [14] and toe clearance [15,16] were correlated with the incidence of falls. Another factor that may affect the outcome of tripping is the strategy of recovery following perturbation [17]. This possible factor was not thoroughly explored in individuals with OA, those who underwent surgical treatment

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