Abstract
Purpose The current literature lacks sufficient information about improvements in gait patterns and function after total knee arthroplasty (TKA) and whether patients return to full function. This study evaluated change in gait, performance-based function, and self-reported function 1 year after TKA in patients with symptomatic knee osteoarthritis and how these aspects interrelate.MethodsA total of 28 patients (64 % female) with knee osteoarthritis, with a mean age of 66 (±7) years, and 25 age- and gender-matched controls participated in this prospective cohort study. Three-dimensional gait analysis generated comprehensive measures of kinematic and kinetic gait deviations, respectively. Participants completed the Five Times Sit-to-Stand (5STS) test, and the self-reported questionnaire Knee Injury and Osteoarthritis Outcome Score (KOOS), at baseline prior to surgery and 1 year after TKA.ResultsKinetic gait deviations of both the operated and non-operated limb persisted in patients with knee osteoarthritis at 1 year after surgery, while kinematic gait patterns were comparable to controls. Performance on the 5STS and KOOS scores in patients with knee osteoarthritis improved significantly 1 year after surgery (effect size 0.5–1.5), but did not reach the level of controls. Ten patients with knee osteoarthritis (36 %) exceeded the minimally detectable change on the 5STS.ConclusionMeasures of overall gait patterns and the 5STS revealed improvements in function 1 year after TKA, but were not restored to the level of healthy controls. Based on change in 5STS performance, we identified patients with substantial improvements in gait patterns. Self-reported measures of function could not detect differences between patients improving in 5STS performance and those who did not. These findings highlight the use of the 5STS in clinical practice since improvement on this test seems to follow the reduction in gait pattern deviations.Level of evidenceII.
Highlights
The current literature lacks sufficient information about the degree of functional improvement after total knee arthroplasty (TKA) using objectively measured function including gait patterns [21]
Based on change in 5STS performance, we identified patients with substantial improvements in gait patterns
These findings highlight the use of the 5STS in clinical practice since improvement on this test seems to follow the reduction in gait pattern deviations
Summary
The current literature lacks sufficient information about the degree of functional improvement after total knee arthroplasty (TKA) using objectively measured function including gait patterns [21]. Patients with knee osteoarthritis report decreased pain and improved function following TKA surgery [15, 19], and research indicates patient satisfaction correlates well with both self-reported outcomes and a clinicianbased score [2]. Selfreported measures of function have been found to be largely influenced by pain, and if perceived pain is greatly reduced, the assessment of function may be overestimated or confused with improved function rather than reduced pain [3]. Despite these improvements, 20–30 % of patients report persistent disability, limited function, reduced quality of life, diminished working capacity, and gait deviations after TKA [24, 38]. Detailed knowledge of the relationships between objective measures of function derived from threedimensional (3D) gait analysis and performance-based function would be advantageous when determining which outcome measures to use in clinical practice
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