Abstract
BackgroundIt is not well understood why one in five patients report poor outcomes following knee arthroplasty. This study evaluated changes in knee biomechanics, and perceived pain among patients reporting either a good or a poor outcome in knee-related quality of life after total knee arthroplasty.MethodsTwenty-eight patients (mean age 66 (SD 7) years) were included in this prospective study. Within one month of knee arthroplasty and one year after surgery, patients underwent three-dimensional (3D) gait analysis, completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), and rated perceived pain using a visual analogue scale. A “good outcome” was defined as a change greater than the minimally detectable change in the KOOS knee-related quality of life, and a “poor outcome” was defined as change below the minimally detectable change. Nineteen patients (68%) were classified as having a good outcome. Groups were analyzed separately and knee biomechanics were compared using a two-way repeated measures ANOVA. Differences in pain between groups were evaluated using Mann Whitney U test.ResultsPatients classified as having a good outcome improved significantly in most knee gait biomechanical outcomes including increased knee flexion-extension range, reduced peak varus angle, increased peak flexion moment, and reduced peak valgus moment. The good outcome group also displayed a significant increase in walking speed, a reduction (normalization) of stance phase duration (% of gait cycle) and increased passive knee extension. Whereas, the only change in knee biomechanics, one year after surgery, for patients classified as having a poor outcome was a significant reduction in peak varus angle. No differences in pain postoperatively were found between groups.ConclusionPatients reporting a good outcome in knee-related quality of life improved in knee biomechanics during gait, while patients reporting a poor outcome, despite similar reduction in pain, remained unchanged in knee biomechanics one year after total knee arthroplasty. With regards to surgeon-controlled biomechanical factors, surgery may most successfully address frontal plane knee alignment. However, achieving a good outcome in patient-reported knee-related quality of life may be related to dynamic improvements in the sagittal plane.
Highlights
It is not well understood why one in five patients report poor outcomes following knee arthroplasty
Preoperative differences between groups The good outcome group presented with significantly less knee flexion-extension range (5°) during gait preoperatively (Fig. 2), compared to the poor outcome group (p = 0.004) (Table 2)
This study evaluated change in knee biomechanics during gait among total knee arthroplasty (TKA) patients classified as having a good or a poor outcome based on postoperative change in kneerelated quality of life (QoL)
Summary
It is not well understood why one in five patients report poor outcomes following knee arthroplasty. This study evaluated changes in knee biomechanics, and perceived pain among patients reporting either a good or a poor outcome in knee-related quality of life after total knee arthroplasty. The knee-related QoL subscale evaluates knee-specific mental and social aspects of function and requires patients to reflect upon the impact of knee symptoms on their QoL [7]. This subscale may be considered the most emotionally sensitive part of the questionnaire as it evaluates awareness and lifestyle changes related to the knee [7]. 90% of patients with TKA consider this subscale to be extremely or very important [8]
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