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Slow gait speed after bilateral total knee arthroplasty is associated with suboptimal improvement of knee biomechanics

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to investigate gait speed changes 2 years after bilateral total knee arthroplasty (TKA) and identify kinetic and kinematic factors associated with such changes by comparing patients with age- and sex-matched controls.

Methods

The study group included 34 female patients with end-stage knee osteoarthritis (OA) who underwent bilateral TKA and 42 age- and sex-matched controls without knee pain or OA. Standard TKA was performed on all arthritic patients with placement of posterior stabilized fixed-bearing implants. Kinetic and kinematic parameters were evaluated using a commercial optoelectric gait analysis system. Gait speed, kinetic and kinematic changes and determinants of speed were assessed via principal component analysis and multiple regression analysis.

Results

The average gait speed of an arthritic patient was 90.2 ± 18.4 cm/s and improved to 96.0 ± 12.3 cm/s after TKA (p = 0.032). However, the speed remained slower than that of controls (111.2 ± 8.2 cm/s, p < 0.001). With regard to kinetics, the peak knee extension moment (KEM) generated by the quadriceps was unchanged after TKA and weaker than that of controls (p < 0.001). The proportions of KEM contributing to the total sagittal moment were also smaller in the pre-/post-operative groups than in the control group (13–14% vs. 19%). On the other hand, the ankle plantar flexion moment (APFM) was increased after TKA (p = 0.007) and its proportion of the total sagittal moment was greater than in controls (46% vs. 42%). With regard to kinematics, knee range of motion (ROM) improved after TKA (p = 0.025), but was smaller than that of controls (p < 0.001). In controls, gait speed was determined principally by hip and knee joint moments. However, in the TKA group, speed was determined by the knee ROM and APFM.

Conclusions

Despite showing improvement, the gait speed of TKA patients remained slower than that of controls. Slow gait speed after bilateral TKA was associated with suboptimal improvement of knee biomechanics. Quadriceps strengthening exercises and the achievement of greater ROM during gait are advised for the further improvement of gait speed.

Level of evidence

Retrospective cohort study, Level III.

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Abbreviations

TKA:

Total knee arthroplasty

OA:

Osteoarthritis

KEM:

Knee extension moment

APFM:

Ankle plantar flexion moment

PC:

Principal component

PCA:

Principal component analysis

ROM:

Range of motion

SLS:

Single leg stance phase

References

  1. Abbasi-Bafghi H, Fallah-Yakhdani HR, Meijer OG, de Vet HC, Bruijn SM, Yang LY et al (2012) The effects of knee arthroplasty on walking speed: a meta-analysis. BMC Musculoskelet Disord 13:66

    Article  PubMed  PubMed Central  Google Scholar 

  2. Abellan van Kan G, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M et al (2009) Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 13:881–889

    Article  PubMed  CAS  Google Scholar 

  3. Artaud F, Singh-Manoux A, Dugravot A, Tzourio C, Elbaz A (2015) Decline in fast gait speed as a predictor of disability in older adults. J Am Geriatr Soc 63:1129–1136

    Article  PubMed  Google Scholar 

  4. Astephen Wilson JL, Dunbar MJ, Hubley-Kozey CL (2015) Knee joint biomechanics and neuromuscular control during gait before and after total knee arthroplasty are sex-specific. J Arthroplast 30:118–125

    Article  Google Scholar 

  5. Bejek Z, Paroczai R, Illyes A, Kiss RM (2006) The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis. Knee Surg Sports Traumatol Arthrosc 14:612–622

    Article  PubMed  Google Scholar 

  6. Benedetti MG, Catani F, Bilotta TW, Marcacci M, Mariani E, Giannini S (2003) Muscle activation pattern and gait biomechanics after total knee replacement. Clin Biomech (Bristol, Avon) 18:871–876

    Article  CAS  Google Scholar 

  7. Bjerke J, Ohberg F, Nilsson KG, Stensdotter AK (2016) Walking on a compliant surface does not enhance kinematic gait asymmetries after unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 24:2606–2613

    Article  PubMed  Google Scholar 

  8. Bohannon RW (1997) Comfortable and maximum walking speed of adults aged 20–79 years: reference values and determinants. Age Ageing 26:15–19

    Article  PubMed  CAS  Google Scholar 

  9. Bohannon RW (2008) Population representative gait speed and its determinants. J Geriatr Phys Ther 31:49–52

    Article  PubMed  Google Scholar 

  10. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD (2010) Patient satisfaction after total knee arthroplasty: who is satisfied and who is not? Clin Orthop Relat Res 468:57–63

    Article  PubMed  Google Scholar 

  11. Boyer KA, Beaupre GS, Andriacchi TP (2008) Gender differences exist in the hip joint moments of healthy older walkers. J Biomech 41:3360–3365

    Article  PubMed  Google Scholar 

  12. Callisaya ML, Blizzard L, Schmidt MD, McGinley JL, Lord SR, Srikanth VK (2009) A population-based study of sensorimotor factors affecting gait in older people. Age Ageing 38:290–295

    Article  PubMed  Google Scholar 

  13. Cho SH, Park JM, Kwon OY (2004) Gender differences in three dimensional gait analysis data from 98 healthy Korean adults. Clin Biomech (Bristol, Avon) 19:145–152

    Article  CAS  Google Scholar 

  14. Clark DJ, Manini TM, Fielding RA, Patten C (2013) Neuromuscular determinants of maximum walking speed in well-functioning older adults. Exp Gerontol 48:358–363

    Article  PubMed  PubMed Central  Google Scholar 

  15. Del Valle ME, Harwin SF, Maestro A, Murcia A, Vega JA (1998) Immunohistochemical analysis of mechanoreceptors in the human posterior cruciate ligament: a demonstration of its proprioceptive role and clinical relevance. J Arthroplast 13:916–922

    Article  Google Scholar 

  16. Deluzio KJ, Astephen JL (2007) Biomechanical features of gait waveform data associated with knee osteoarthritis: an application of principal component analysis. Gait Posture 25:86–93

    Article  PubMed  CAS  Google Scholar 

  17. Dennis DA, Komistek RD, Hoff WA, Gabriel SM (1996) In vivo knee kinematics derived using an inverse perspective technique. Clin Orthop Relat Res 331:107–117

    Article  Google Scholar 

  18. Dunbar MJ, Robertsson O, Ryd L, Lidgren L (2001) Appropriate questionnaires for knee arthroplasty. Results of a survey of 3600 patients from the Swedish knee arthroplasty registry. J Bone Joint Surg Br 83:339–344

    Article  PubMed  CAS  Google Scholar 

  19. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191

    Article  PubMed  Google Scholar 

  20. Fitzpatrick CK, Clary CW, Rullkoetter PJ (2012) The role of patient, surgical, and implant design variation in total knee replacement performance. J Biomech 45:2092–2102

    Article  PubMed  Google Scholar 

  21. Hausdorff JM (2005) Gait variability: methods, modeling and meaning. J Neuroeng Rehabil 2:19

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hayashida I, Tanimoto Y, Takahashi Y, Kusabiraki T, Tamaki J (2014) Correlation between muscle strength and muscle mass, and their association with walking speed, in community-dwelling elderly Japanese individuals. PLoS One 9:e111810

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Inoue W, Ikezoe T, Tsuboyama T, Sato I, Malinowska KB, Kawaguchi T et al (2017) Are there different factors affecting walking speed and gait cycle variability between men and women in community-dwelling older adults? Aging Clin Exp Res 29:215–221

    Article  PubMed  Google Scholar 

  24. Kadaba MP, Ramakrishnan HK, Wootten ME (1990) Measurement of lower extremity kinematics during level walking. J Orthop Res 8:383–392

    Article  PubMed  CAS  Google Scholar 

  25. Kim S (2008) Changes in surgical loads and economic burden of hip and knee replacements in the US: 1997–2004. Arthritis Rheum 59:481–488

    Article  PubMed  Google Scholar 

  26. Koh IJ, Kim MW, Kim JH, Han SY, In Y (2015) Trends in high tibial osteotomy and knee arthroplasty utilizations and demographics in Korea from 2009 to 2013. J Arthroplast. doi:10.1016/j.arth.2015.01.002

    Article  Google Scholar 

  27. Lattanzio PJ, Chess DG, MacDermid JC (1998) Effect of the posterior cruciate ligament in knee-joint proprioception in total knee arthroplasty. J Arthroplast 13:580–585

    Article  CAS  Google Scholar 

  28. Lee DC, Shon OJ, Kwack BH, Lee SJ (2013) Proprioception and clinical results of anterolateral single-bundle posterior cruciate ligament reconstruction with remnant preservation. Knee Surg Relat Res 25:126–132

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lelas JL, Merriman GJ, Riley PO, Kerrigan DC (2003) Predicting peak kinematic and kinetic parameters from gait speed. Gait Posture 17:106–112

    Article  PubMed  Google Scholar 

  30. Lundberg HJ, Rojas IL, Foucher KC, Wimmer MA (2016) Comparison of antagonist muscle activity during walking between total knee replacement and control subjects using unnormalized electromyography. J Arthroplast 31:1331–1339

    Article  Google Scholar 

  31. Matsuda K, Ikeda S, Nakahara M, Ikeda T, Okamoto R, Kurosawa K et al (2015) Factors affecting the coefficient of variation of stride time of the elderly without falling history: a prospective study. J Phys Ther Sci 27:1087–1090

    Article  PubMed  PubMed Central  Google Scholar 

  32. Nakahara H, Okazaki K, Mizu-Uchi H, Hamai S, Tashiro Y, Matsuda S et al (2015) Correlations between patient satisfaction and ability to perform daily activities after total knee arthroplasty: why aren’t patients satisfied? J Orthop Sci 20:87–92

    Article  PubMed  Google Scholar 

  33. Nielsen JB (2003) How we walk: central control of muscle activity during human walking. Neuroscientist 9:195–204

    Article  PubMed  Google Scholar 

  34. Noble PC, Gordon MJ, Weiss JM, Reddix RN, Conditt MA, Mathis KB (2005) Does total knee replacement restore normal knee function? Clin Orthop Relat Res 431:157–165

    Article  Google Scholar 

  35. Okita Y, Tatematsu N, Nagai K, Nakayama T, Nakamata T, Okamoto T et al (2014) The effect of walking speed on gait kinematics and kinetics after endoprosthetic knee replacement following bone tumor resection. Gait Posture 40:622–627

    Article  PubMed  Google Scholar 

  36. Pamoukdjian F, Paillaud E, Zelek L, Laurent M, Levy V, Landre T et al (2015) Measurement of gait speed in older adults to identify complications associated with frailty: a systematic review. J Geriatr Oncol 6:484–496

    Article  PubMed  Google Scholar 

  37. Parcells BW, Tria AJ Jr (2016) The cruciate ligaments in total knee arthroplasty. Am J Orthop (Belle Mead NJ) 45:E153–E160

    Google Scholar 

  38. Pua YH, Seah FJ, Clark RA, Lian-Li Poon C, Tan JW, Chong HC (2017) Factors associated with gait speed recovery after total knee arthroplasty: a longitudinal study. Semin Arthritis Rheum 46:544–551

    Article  PubMed  Google Scholar 

  39. Ro DH, Lee DY, Moon G, Lee S, Seo SG, Kim SH et al (2017) Sex differences in knee joint loading: cross-sectional study in geriatric population. J Orthop Res 35:1283–1289

    Article  PubMed  Google Scholar 

  40. Robertsson O, Dunbar M, Pehrsson T, Knutson K, Lidgren L (2000) Patient satisfaction after knee arthroplasty: a report on 27,372 knees operated on between 1981 and 1995 in Sweden. Acta Orthop Scand 71:262–267

    Article  PubMed  CAS  Google Scholar 

  41. Scott CE, Howie CR, MacDonald D, Biant LC (2010) Predicting dissatisfaction following total knee replacement: a prospective study of 1217 patients. J Bone Joint Surg Br 92:1253–1258

    Article  PubMed  CAS  Google Scholar 

  42. Tamaki M, Tomita T, Yamazaki T, Yoshikawa H, Sugamoto K (2013) Factors in high-flex posterior stabilized fixed-bearing total knee arthroplasty affecting in vivo kinematics and anterior tibial post impingement during gait. J Arthroplast 28:1722–1727

    Article  Google Scholar 

  43. Tibesku CO, Daniilidis K, Skwara A, Dierkes T, Rosenbaum D, Fuchs-Winkelmann S (2011) Gait analysis and electromyography in fixed- and mobile-bearing total knee replacement: a prospective, comparative study. Knee Surg Sports Traumatol Arthrosc 19:2052–2059

    Article  PubMed  Google Scholar 

  44. Turcot K, Sagawa Y Jr, Fritschy D, Hoffmeyer P, Suva D, Armand S (2013) How gait and clinical outcomes contribute to patients’ satisfaction three months following a total knee arthroplasty. J Arthroplast 28:1297–1300

    Article  Google Scholar 

  45. van den Boom LG, Halbertsma JP, van Raaij JJ, Brouwer RW, Bulstra SK, van den Akker-Scheek I (2014) No difference in gait between posterior cruciate retention and the posterior stabilized design after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22:3135–3141

    Article  PubMed  Google Scholar 

  46. von Schroeder HP, Coutts RD, Lyden PD, Billings E Jr, Nickel VL (1995) Gait parameters following stroke: a practical assessment. J Rehabil Res Dev 32:25–31

    Google Scholar 

  47. Wu Y, Li Y, Chen B (2013) Effect of posterior cruciate ligament retaining or not on knee-joint proprioception. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 27:851–854

    PubMed  Google Scholar 

  48. Yoshida Y, Mizner RL, Ramsey DK, Snyder-Mackler L (2008) Examining outcomes from total knee arthroplasty and the relationship between quadriceps strength and knee function over time. Clin Biomech (Bristol, Avon) 23:320–328

    Article  Google Scholar 

  49. Zingde SM, Leszko F, Sharma A, Mahfouz MR, Komistek RD, Dennis DA (2014) In vivo determination of cam-post engagement in fixed and mobile-bearing TKA. Clin Orthop Relat Res 472:254–262

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Seong Hyun Kim, Hye Sun Park and Hyo Jeong Yoo for providing technical support in collecting and analysing the kinematic data from the participants. The authors appreciate the statistical consultation provided by the Medical Research Collaborating Center at the Seoul National University College of Medicine. The authors also thank Eun Soo Ahn for helping to proofread and correct the manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea

    Du Hyun Ro, Hyuk-Soo Han, Dong Yeon Lee, Yoon-Ho Kwak & Myung Chul Lee

  2. Department of Orthopedic Surgery, Hanmaeum Changwon Hospital, Changwon-Si, South Korea

    Seong Hwan Kim

  3. Department of Orthopaedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea

    Myung Chul Lee

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Contributions

DHR was involved in design, data acquisition, analysis and drafting manuscript; HSH helped in design, data acquisition and interpretation and drafting manuscript; DYLwas involved in data acquisition and analysis; SHK helped in data acquisition; YHK helped in data acquisition; MCL was involved in design, data acquisition, data interpretation and manuscript revision.

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Correspondence to Myung Chul Lee.

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The authors certify that they have no commercial association that might pose a conflict of interest in connection with this article.

Funding

None.

Ethical approval

This study was approved by the Institutional Review Board of Seoul National University College of Medicine, Seoul National University Hospital (no. H-1501-109-644).

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Ro, D.H., Han, HS., Lee, D.Y. et al. Slow gait speed after bilateral total knee arthroplasty is associated with suboptimal improvement of knee biomechanics. Knee Surg Sports Traumatol Arthrosc 26, 1671–1680 (2018). https://doi.org/10.1007/s00167-017-4682-8

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