Factors associated with gait speed recovery after total knee arthroplasty: A longitudinal study

Abstract

Gait speed limitations can remain significant issues after a total knee arthroplasty (TKA) but their associated factors are not well understood. This study aimed to identify the factors associated with acute gait speed recovery post-TKA. We performed a prospective longitudinal study of 1765 patients who underwent primary TKA between July 2013 and July 2015. At 4, 8, 12, and 16 weeks postsurgery, fast gait speed was measured. The factors associated with gait speed over time since TKA were identified using multivariable generalized least squares modeling. Lower postoperative quadriceps strength and knee flexion range of motion were closely associated with lower gait speed over time (0.084m/s, 0.064m/s, and 0.055m/s change in gait speed per interquartile range change in ipsilateral quadriceps strength, contralateral quadriceps strength, and knee flexion range of motion, respectively). Additional strong predictors of lower gait speed included older age (0.11m/s), lower levels of preoperative Short Form 36 physical function (0.066m/s), greater body mass (0.046m/s), and the preoperative use of a walking aid (overall P < 0.001). Patients who reported that they limited their daily activities due to a fear of falling also had poorer gait speed (0.033m/s and 0.054m/s slower gait speed for "Occasional" and "Often" categories, respectively, vs. "None"). Gait speed recovery post-TKA is driven by both physical and psychological factors, suggesting that identifying and treating the underlying physical and cognitive causes of gait speed limitations may be crucial to optimize functional recovery.