Dataset Information

Gait comparison of unicompartmental knee arthroplasty and total knee arthroplasty during level walking.

ABSTRACT: This meta-analysis compared the gait patterns of unicompartmental knee arthroplasty (UKA) patients and total knee arthroplasty (TKA) patients during level walking by evaluating the kinetics, kinematics, and spatiotemporal parameters. Studies were included in the meta-analysis if they assessed the vertical ground reaction force (GRF), joint moment at stance, flexion at initial contact, flexion at swing, overall range of motion (ROM), coronal knee angle at stance, walking speed, cadence, and stride length in UKA patients or TKA patients. Seven non-randomized studies met the criteria for inclusion in this meta-analysis. UKA patients and TKA patients were similar in terms of vertical GRF (95% CI: -0.36 to 0.20; P = 0.60), joint moment (95% CI: -0.55 to 0.63; P = 0.90), kinematic outcomes (95% CI: -0.72 to 1.02; P = 0.74), walking speed (95% CI: -0.27 to 0.81; P = 0.32), and cadence (95% CI: -0.14 to 0.68; P = 0.20). In contrast, the stride length (95% CI: 0.01 to 0.80; P = 0.04) differed significantly between groups. Subgroup analyses revealed that the pooled data were similar between the groups: 1st maximum (heel strike), -0.18 BW (P = 0.53); 1st minimum (mid-stance), -0.43 BW (P = 0.08); and 2nd maximum (toe off), -0.03 BW (P = 0.87). On gait analysis, there were no significant differences in vertical GRF, joint moment at stance, overall kinematics, walking speed, or cadence between UKA patients and TKA patients during level walking. However, the TKA group had significantly shorter stride length than UKA patients. Although the comparison was inconclusive in determining which types of knee arthroplasty offered the closest approximation to normal gait, we consider it important to provide better rehabilitation programs to reduce the abnormal stride length in TKA patients compared to UKA patients.

SUBMITTER: Nha KW

PROVIDER: S-EPMC6117028 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Gait comparison of unicompartmental knee arthroplasty and total knee arthroplasty during level walking.

Nha Kyung-Wook KW Shon Oog-Jin OJ Kong Byung-Sic BS Shin Young-Soo YS

PloS one 20180830 8

This meta-analysis compared the gait patterns of unicompartmental knee arthroplasty (UKA) patients and total knee arthroplasty (TKA) patients during level walking by evaluating the kinetics, kinematics, and spatiotemporal parameters. Studies were included in the meta-analysis if they assessed the vertical ground reaction force (GRF), joint moment at stance, flexion at initial contact, flexion at swing, overall range of motion (ROM), coronal knee angle at stance, walking speed, cadence, and strid ...[more]

PMID: 30161216

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Project description:Background/objectiveAccording to previous studies, physiological gait pattern was found in unicompartmental knee arthroplasty (UKA) as compared to total knee arthroplasty (TKA) concerning the gait parameters including gait speed, cadence, and step length. However, little attention had been paid to the detailed kinematic and kinetic differences during gait between TKAs and UKAs. The aim of the present study was to investigate and to clarify the biomechanical differences between posterior stabilized TKAs and fixed bearing UKAs during walking.MethodsA total of 28 patients participated in the present study. Fifteen patients who underwent TKA and thirteen patients who underwent UKA were enrolled. Gait analysis was done at an average of 12.9 months after surgery. The subjects performed level walking at a preferred speed. For each subject, three-dimensional kinematic, kinetic and ground reaction force data were recorded as well as clinical data including range of motion at the knee joint and plain radiographs. Differences of knee kinematics or kinetics were compared between TKAs and UKAs using two-tailed Mann Whitney U-test.ResultsOn physical examination, passive range motion was significantly smaller in TKAs than in UKAs, while femorotibial angle on plain radiographs was not significantly different on plain radiographs. In terms of kinematics, TKAs were more flexed at heel contact and less extended in mid-stance phase compared to UKAs in the sagittal plane, and total excursion of TKAs were also smaller than UKAs. Regarding knee kinetics, TKA patients had significantly less peak tibial internal rotation moment in terminal stance phase. In addition, peak knee adduction moment was significantly larger in UKAs than in TKAs, while peak knee flexion moment was not significantly different.ConclusionPosterior stabilized TKAs exhibited less peak tibial internal rotation moment, which is known as pivot shift avoidance gait, in the present study, compared to fixed bearing UKAs. TKAs had similar gait pattern to anterior cruciate ligament deficient knees, compared to UKAs even if patients with TKAs had no subjective pain during walking.

Project description:BackgroundUnicompartmental knee arthroplasty (UKA) is an established treatment option for patients with unicompartmental osteoarthritis (OA). However, strict patient selection is crucial for its success. The proposed advantages include nearly natural knee kinematics, faster rehabilitation and better functional outcomes. Despite the aforementioned facts and it's proven cost-effectiveness, there are still hesitations for the use of UKA as an alternative to total knee arthroplasty (TKA). Key objectives of this study were therefore to assess clinical and patient-reported outcome (PRO) as well as patient's satisfaction after medial UKA in comparison to TKA.MethodsTo assess the outcome after UKA we conducted a prospective multi-center study. 116 patients with unicompartmental OA and indication for UKA were included. Overall 54 females and 62 males with an average age of 62.7 years (±9.8) and an average body mass index (BMI) of 29.2 (± 3.7) were recruited. Clinical results and PRO were assessed using the Knee Society Score (KSS). Follow-ups took place 3 months, 1 and 2 years after surgery including clinical examination, radiographs, assessment of PRO and adverse events. Pain and satisfaction was evaluated using a visual analog scale (VAS, 0 (worst) to 10 (best)). For comparison with TKA a propensity score matched-pair analysis was performed to eliminate confounders. Matching criteria were gender, patient's age, BMI and comorbidities. A total of 116 matched-pairs were analysed.ResultsThere was no revision in the UKA group until 2 years after surgery. Revision rates were higher in the TKA group (0.6%). Preoperative KSS-Scores were higher within the UKA cohort (p < 0.001). After surgical treatment, PROMs displayed a significant improvement (p < 0,001) in both cohorts. Regarding the Knee-Score (Pain, Alignment, ROM) we observed no differences between cohorts after 12 months. The Function-Score demonstrated significantly better results in the UKA cohort (UKA vs. TKA 95 vs 80, p < 0.001). Patient satisfaction was also higher in UKA patients (UKA vs TKA 9.0 vs 8.8, p = 0.019).ConclusionPatients of both cohorts showed high satisfaction after knee arthroplasty. UKA resulted in higher function scores compared to TKA without increased revision rate during short-term follow-up. Therefore, UKA is a good treatment option for unicompartmental OA.Trial registrationClinicaltrials.gov, NCT04598568 . Registered 22 October 2020 - Retrospectively registered.

Dataset Information

Gait comparison of unicompartmental knee arthroplasty and total knee arthroplasty during level walking.

Publications

Gait comparison of unicompartmental knee arthroplasty and total knee arthroplasty during level walking.

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