Modifications de la marche associées à la présence d’une prothèse totale de genou conservant ou sacrifiant le ligament croisé postérieur

Abstract

Purpose of the study We wanted to check whether the differences in joint kinematics between the normal and prosthesis knee, with or without preservation of the posterior cruciate ligament, have an effect on knee flexion-extension during gait and on gait performance. Material and methods A control group of nine subjects was compared with two groups of subjects with total knee prostheses, with (n = 10 patients) or without (n = 6 patients) preservation of the posterior cruciate ligament. Gait was studied on flat ground at three different walking speeds. We measured the principal temporospatial gait parameters as well as knee flexion and extension angles using continuous electrogoniometry. Non-parametric statistical tests were used to analyze data due to the small number of subjects in each group. Results The flexion-extension cycles were different between the control group and the prostheses groups, but there was no difference between the two prostheses groups. Measurements made during gait confirmed this result, demonstrating a modification of the temporospatial parameters and a decrease in knee flexion during weight bearing in the prostheses groups compared with the control group. The statistical analysis demonstrated a correlation between these two results. Discussion The individual nature of gait parameters hindered data analysis. Indeed, there are many different ways to walk “normally”. We were however able to demonstrate the following points. The theoretical differences in joint kinematics between prostheses with or without preservation of the posterior cruciate ligament did not have any effect on gait. There were however significant differences between the control group and the prostheses groups, and these differences depended on walking speed. The most interesting results concerned the changes in the weight-bearing phase. Flexion during this phase was related to walking speed and was decreased in amplitude in both prostheses groups. This lesser amplitude in knee flexion probably affected the quality of gait because it was correlated with decreased temporospatial parameters related to gait performance. Conclusion This decreased amplitude of flexion during gait, which cannot be expected from motion measurements without weight bearing, can be explained by an interaction between joint kinematics, the musculoligamentary system and the locomotor schema.