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Does Total Knee Arthroplasty Change Frontal Plane Knee Biomechanics During Gait?

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Clinical Orthopaedics and Related Research®

Abstract

Background

Dynamic knee varus angle and adduction moments have been reported to be reduced after TKA. However, it is unclear whether this reduction is maintained long term.

Questions/purposes

We therefore asked whether (1) the dynamic knee adduction angle and moment remain reduced 1 year after TKA, (2) if changes in adduction moment are related to static alignment and varus angle during gait 6 months and 1 year after TKA, and (3) if these changes in loading pattern are related to changes in Knee Society scores.

Methods

We performed gait analysis on 15 patients (17 TKAs) before surgery and 6 months and 1 year after TKA. Weightbearing radiographs were used to assess coronal plane knee alignment.

Results

TKA corrected static knee alignment from 2.2° (2.5°) varus to 3.5° (2.7°) valgus at 6 months. Peak varus angle during gait was reduced from 9.7° (6.5°) to 3.6° (5.8°) at 6 months and 5.2° (7.6°) at 1 year. Peak adduction moment was reduced to 85% of the preoperative level at 6 months but increased to 94% of the preoperative level at 1 year. We observed a correlation between the increase in dynamic varus angle and increase in adduction moment from the 6-month to 1-year followups.

Conclusions

TKA improves knee adduction moment at 6 months, but this effect is lost with time (1 year).

Clinical Relevance

Despite restoration of static knee alignment, knee adduction moment remains high presumably predisposing to medial polyethylene wear as noted by retrieval studies.

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Acknowledgment

We thank Malachy McHugh, PhD, Director of Research at the Nicholas Institute of Sports Medicine and Athletic Trauma, for assistance with the study design, statistical analysis, and manuscript drafting and editing.

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Authors and Affiliations

  1. Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, 100 E. 77th Street, 2nd Floor, New York, NY, 10075, USA

    Karl F. Orishimo MS, Ian J. Kremenic MEng & Stephen J. Nicholas MD

  2. Lenox Hill Hospital, 130 E. 77th Street, 11th Floor, New York, NY, 10075, USA

    Ajit J. Deshmukh MD & Jose A. Rodriguez MD

Authors
  1. Karl F. Orishimo MS
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  2. Ian J. Kremenic MEng
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  3. Ajit J. Deshmukh MD
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  4. Stephen J. Nicholas MD
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Corresponding author

Correspondence to Karl F. Orishimo MS.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Orishimo, K.F., Kremenic, I.J., Deshmukh, A.J. et al. Does Total Knee Arthroplasty Change Frontal Plane Knee Biomechanics During Gait?. Clin Orthop Relat Res 470, 1171–1176 (2012). https://doi.org/10.1007/s11999-011-2196-0

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  • DOI: https://doi.org/10.1007/s11999-011-2196-0

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