A pilot study of post-total knee replacement gait rehabilitation using lower limbs robot-assisted training system

  • Jianhua LiEmail author
  • Tao Wu
  • Zhisheng Xu
  • Xudong Gu
Original Article


The aim of this study was to explore the application value of the lower limbs robot-assisted training system for post-total knee replacement (TKR) gait rehabilitation. A total of 60 patients with osteoarthritis of the knee were equally randomized into the traditional and robot-assisted rehabilitation training groups within 1 week after TKR. All patients received 2-week training. Scores of hospital for special surgery (HSS), knee kinesthesia grades, knee proprioception grades, functional ambulation (FAC) scores, Berg balance scores, 10-m sitting–standing time, and 6-min walking distances were compared between the groups. The HSS score, Berg score, 10-m sitting–standing time, and 6-min walking distance of the robot-assisted training group were significantly higher than the control group (P < 0.05). Its knee kinesthesia grade, knee proprioception grade, and FAC score were better than the control group but not significantly (P > 0.05). Lower limbs robot-assisted rehabilitation training improves post-TKR patients’ knee proprioception and stability more effectively compared with the traditional method. It improves patients’ gait and symptoms, increases their walking speed, and prolongs their walking distances, which benefit their return to family and society.


Total knee replacement Robot Rehabilitation 



This study was supported by the Health Bureau of Zhejiang Province (YH200805).

Conflict of interest



  1. 1.
    Muiesan ML, Boni E, Castellano M et al (1993) Effects of transdermal nitroglycerin in combination with an ACE inhibitor in patients with chronic stable angina pectoris. Eur Heart J 14:1701–1708PubMedCrossRefGoogle Scholar
  2. 2.
    Genêt F, Gouin F, Coudeyre E, Revel M, Rannou F (2007) The benefits of ambulatory physiotherapy after total hip replacement. Clinical practice recommendations. Ann Readapt Med Phys 50:776–782PubMedCrossRefGoogle Scholar
  3. 3.
    Al-Zahrani KS, Bakheit AM (2002) A study of gait characteristic of patients with chronic osteoarthritis of the knee. Disabil Rehabil 24:275–280PubMedCrossRefGoogle Scholar
  4. 4.
    Gök H, Ergin S, Yavuzer G (2002) Kinetic and kinematic characteristic of gait in patients with medial knee arthrosis. Acta Orthop Scan 73:647–652CrossRefGoogle Scholar
  5. 5.
    Chen B, Zimmerman JR, Soulen L, DeLisa JA (2000) Continuous passive motion after total knee arthroplasty: a prospective study. Am J Phys Med Rehabil 79:421–426PubMedCrossRefGoogle Scholar
  6. 6.
    Kehelt H, Wilmore DW (2002) Multi-modal strategies to improve surgical outcome. Am J Surg 183:630–641CrossRefGoogle Scholar
  7. 7.
    Viton JM, Atlani L, Mesure S (2002) Reorganization of equilibrium and movement control strategies after total knee arthroplasty. J Rehabil Med 34:12–19PubMedCrossRefGoogle Scholar
  8. 8.
    Dietz V, Gollhofer A, Kleiber M, Trippel M (1992) Regulation of bipedal stance: dependency on “load” receptors. Exp Brain Res 89:229–231PubMedCrossRefGoogle Scholar
  9. 9.
    Sehutte MJ, Dabezias EJ, Zimn y ML, Happel LT (1987) Neural anatomy of the human anterior cruciate ligament. J Bone Joint Surg 69:243–247Google Scholar
  10. 10.
    Mouchnino L, Gueguen N, Blanchard C, Boulay C, Gimet G, Viton JM, Franceschi JP, Delarque A (2005) Sensori-motor adaptation to knee osteoarthritis during stepping-down before and after total knee replacement. BMC Musculoskelet Disord 6:21PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Mac Donald PB, Hedden D, Pacin O, Sutherland K (1996) Proprioception in anterior cruciate ligament-deficient and reconstructed knees. Am J Sports Med 24:774–778CrossRefGoogle Scholar
  12. 12.
    Jerosch J, Prymka M (1996) Knee joint proprioception in normal volunteers and patients with anterior cruciate ligaments tears, taking special account of the effect of a knee bandage. Arch Orthop Tranma Surg 115:162–166CrossRefGoogle Scholar
  13. 13.
    Johnson MJ (2006) Recent trends in robot-assisted therapy environments to improve real-life functional performance after stroke. J Neuroeng Rehabil 18:29CrossRefGoogle Scholar
  14. 14.
    Amirabdollahian F, Loureiro R, Gradwell E, Collin C, Harwin W, Johnson G (2007) Multivariate analysis of the Fugl-Meyer outcome measures assessing the effectiveness of GENTLE/S robot-mediated stroke therapy. J Neuroeng Rehabil 19:44Google Scholar
  15. 15.
    Müller F, Heller S, Krewer C, Husemann B, Koenig E (2004) Effective gait training on the treadmill and the Lokomat: comparison of achievable training time and speed. Neurol Rehabil 4:27Google Scholar
  16. 16.
    Aoyagi D, Ichinose WE, Harkema SJ, Reinkensmeyer DJ, Bobrow JE (2007) A robot and control algorithm that can synchronously assist in naturalistic motion during body-weight-supported gait training following neurologic injury. IEEE Trans Neural Syst Rehabil Eng 15:387–400PubMedCrossRefGoogle Scholar
  17. 17.
    Ferris DP, Sawicki GS, Domingo A (2005) Powered lower limb orthoses for gait rehabilitation. Top Spinal Cord Inj Rehabil 11:34–49PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Husemann B, Müller F, Krewer C, Heller S, Koenig E (2007) Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: a randomized controlled pilot study. Stroke 38:349–354PubMedCrossRefGoogle Scholar
  19. 19.
    Dietz V, Müller R, Colombo G (2002) Locomotor activity in spinal man: significance of afferent input from joint and load receptors. Brain 125:2626–2634PubMedCrossRefGoogle Scholar
  20. 20.
    Sharma L (1999) Proprioceptive impairment in knee osteoarthritis. Rheum Dis Clin North Am 25:299–314PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Department of Rehabilitation Medicine, Sir Run Shaw Hospital, College of MedicineZhejiang UniversityHangzhouChina
  2. 2.Department of Rehabilitation MedicineThe Second Hospital of JiaxingJiaxingChina

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