Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 6, pp 1671–1680 | Cite as

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

  • Du Hyun Ro
  • Hyuk-Soo Han
  • Dong Yeon Lee
  • Seong Hwan Kim
  • Yoon-Ho Kwak
  • Myung Chul Lee



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.


Biomechanics Gait analysis Motion capture system Total knee arthroplasty 



Total knee arthroplasty




Knee extension moment


Ankle plantar flexion moment


Principal component


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.

Authors’ 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.

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.



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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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • Du Hyun Ro
    • 1
  • Hyuk-Soo Han
    • 1
  • Dong Yeon Lee
    • 1
  • Seong Hwan Kim
    • 2
  • Yoon-Ho Kwak
    • 1
  • Myung Chul Lee
    • 1
    • 3
  1. 1.Department of Orthopaedic SurgerySeoul National University College of MedicineSeoulSouth Korea
  2. 2.Department of Orthopedic SurgeryHanmaeum Changwon HospitalChangwon-SiSouth Korea
  3. 3.Department of Orthopaedic SurgerySeoul National University HospitalSeoulSouth Korea

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