Moiyad Aljehani1, Kathleen Madara2, Lynn Snyder-Mackler2, Cory Christiansen3, Joseph A Zeni4. 1. University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA; Umm Al-Qura University, Department of Physical Therapy, P.O. Box 715, Makkah, 21421, Saudi Arabia. Electronic address: aljehani@udel.edu. 2. University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE, 19713, USA. 3. Physical Medicine and Rehabilitation Department, University of Colorado Denver, Mailstop C244, 13121 East 17th Avenue, Aurora, CO, 80045, USA. 4. Rutgers, The State University of New Jersey, School of Health Professions, Department of Rehabilitation and Movement Sciences, Physical Therapy Program North, 65 Bergen Street - Office 714A, Newark, NJ, 07107, USA.
Abstract
BACKGROUND: Although unilateral symptoms and unilateral total knee arthroplasty (TKA) are common, many patients have bilateral radiographic osteoarthritis (OA). Because the contralateral (non-operated) limb is often used as a comparison for clinical and biomechanical outcomes, it is important to know if the presence of OA influences movement patterns in either limb. RESEARCH QUESTION: The purpose of this study was to compare bilateral sagittal plane biomechanics between subjects with and without contralateral knee OA after unilateral TKA. METHODS: Fifty-three subjects who underwent unilateral TKA underwent three-dimensional gait analysis 6-24 months after surgery participated in this cross-sectional study. Kellgren-Lawrence (KL) OA severity in the contralateral limb was measured, and subjects were classified into either a non-OA (KL 0 or 1) or OA (KL 2-4) group. Mixed-model ANOVA tests with factors of group and limb were used to compare biomechanical measures. In the presence of a significant interaction effect, post-hoc comparisons were performed. RESULTS: The OA group had more knee flexion at initial contact, less knee flexion and extension excursions, and less knee extension in the contralateral limb compared to the non-OA group. The non-OA group had significant differences between limbs, with more knee flexion at initial contact, less knee joint excursion, and less peak knee extension on the operated limb compared to the contralateral limb, whereas there were no limb differences for the OA group. Kinetic variables were not different in the ANOVA models. SIGNIFICANCE AND INTERPRETATION: Subjects with contralateral knee OA have more symmetrical gait, although they adopt a more abnormal and stiff-legged gait pattern bilaterally. Researchers and clinicians should consider radiographic disease severity, not just symptoms, in the contralateral limb when identifying appropriate subject samples for unilateral biomechanical studies. Symmetrical movement patterns between limbs after surgery should not be the sole factor upon which movement recovery is based.
BACKGROUND: Although unilateral symptoms and unilateral total knee arthroplasty (TKA) are common, many patients have bilateral radiographic osteoarthritis (OA). Because the contralateral (non-operated) limb is often used as a comparison for clinical and biomechanical outcomes, it is important to know if the presence of OA influences movement patterns in either limb. RESEARCH QUESTION: The purpose of this study was to compare bilateral sagittal plane biomechanics between subjects with and without contralateral knee OA after unilateral TKA. METHODS: Fifty-three subjects who underwent unilateral TKA underwent three-dimensional gait analysis 6-24 months after surgery participated in this cross-sectional study. Kellgren-Lawrence (KL) OA severity in the contralateral limb was measured, and subjects were classified into either a non-OA (KL 0 or 1) or OA (KL 2-4) group. Mixed-model ANOVA tests with factors of group and limb were used to compare biomechanical measures. In the presence of a significant interaction effect, post-hoc comparisons were performed. RESULTS: The OA group had more knee flexion at initial contact, less knee flexion and extension excursions, and less knee extension in the contralateral limb compared to the non-OA group. The non-OA group had significant differences between limbs, with more knee flexion at initial contact, less knee joint excursion, and less peak knee extension on the operated limb compared to the contralateral limb, whereas there were no limb differences for the OA group. Kinetic variables were not different in the ANOVA models. SIGNIFICANCE AND INTERPRETATION: Subjects with contralateral knee OA have more symmetrical gait, although they adopt a more abnormal and stiff-legged gait pattern bilaterally. Researchers and clinicians should consider radiographic disease severity, not just symptoms, in the contralateral limb when identifying appropriate subject samples for unilateral biomechanical studies. Symmetrical movement patterns between limbs after surgery should not be the sole factor upon which movement recovery is based.
Authors: Yunchao Shao; Chi Zhang; Kory D Charron; Steven J Macdonald; Richard W McCalden; Robert B Bourne Journal: J Arthroplasty Date: 2013-12 Impact factor: 4.757
Authors: K P Günther; T Stürmer; S Sauerland; I Zeissig; Y Sun; S Kessler; H P Scharf; H Brenner; W Puhl Journal: Ann Rheum Dis Date: 1998-12 Impact factor: 19.103