Slow gait speed after bilateral total knee arthroplasty is associated with suboptimal improvement of knee biomechanics
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.
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.
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.
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.
KeywordsBiomechanics Gait analysis Motion capture system Total knee arthroplasty
Total knee arthroplasty
Knee extension moment
Ankle plantar flexion moment
Principal component analysis
Range of motion
Single leg stance phase
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.
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.
Compliance with ethical standards
Conflict of interest
The authors certify that they have no commercial association that might pose a conflict of interest in connection with this article.
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).
- 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 13:881–889CrossRefPubMedGoogle Scholar
- 37.Parcells BW, Tria AJ Jr (2016) The cruciate ligaments in total knee arthroplasty. Am J Orthop (Belle Mead NJ) 45:E153–E160Google 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 22:3135–3141CrossRefPubMedGoogle 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 32:25–31Google Scholar