Dmitry Skvortsov1,2, Sergey Kaurkin3,4, Alexey Prizov5,6, Alyona Altukhova3, Evgeny Goncharov7, Artem Nikitin5,6. 1. Scientific Department, Federal Research and Clinical Centre of Russia's Federal Medical-Biological Agency (FNKC FMBA), Orekhoviy bulvar, 28, 115682, Moscow, Russia. skvortsov.biom@gmail.com. 2. Medical Rehabilitation Chair, Pirogov Russian National Research Medical University (RNRMU), ul. Ostrovitianova, 1, 117997, Moscow, Russia. skvortsov.biom@gmail.com. 3. Scientific Department, Federal Research and Clinical Centre of Russia's Federal Medical-Biological Agency (FNKC FMBA), Orekhoviy bulvar, 28, 115682, Moscow, Russia. 4. Medical Rehabilitation Chair, Pirogov Russian National Research Medical University (RNRMU), ul. Ostrovitianova, 1, 117997, Moscow, Russia. 5. Orthopedic Department, Buyanov V.M. Moscow City Clinical Hospital, ul. Bakinskaya, 26, bild. 10, 115516, Moscow, Russia. 6. Ortopedic Chair, Peoples Friendship University of Russia (RUDN University), ul. Miklukho-Maklaya, 6, 117198, Moscow, Russia. 7. Central Clinical Hospital of the Russian Academy of Sciences, Litovskiy blvd., 1a, Moscow, Russia, 117593.
Abstract
PURPOSE: A varus deformity (VD) of the lower limbs results in greater loading of the medial compartment of the knee joint (KJ), leading to its degenerative changes and, eventually, to progressive osteoarthritis (OA) of the joint. The aim of the study was to investigate the mid-term changes in gait biomechanics and clinical symptoms in patients with VD of KJ and OA before and six months after surgical correction. METHODS: The study enrolled 25 patients with medial OA of grade 2-3 according to Kellgren-Lawrence and a VD of > 3°, who underwent arthroscopic lavage and debridement of the knee joint followed by corrective osteotomy. The control group included 20 healthy adults. Clinical and biomechanical assessments were done twice: immediately prior to and six months after the surgical treatment. Biomechanical parameters of gait were recorded using an inertial sensor system. RESULTS: According to our findings, there was a statistically significant post-operative increase in the knee extension amplitude by 1.4° in female patients and an insignificant extension increase in male patients. The mean postoperative KOOS score was 66.7 points (46 to 91) in the patient group, 67.1 points (54 to 91) in males, and 59.5 points (46 to 64) in females. As early as six months after a valgus osteotomy, we already observed improved biomechanics of the KJ motions compared to pre-operative data. By that time, the swing flexion amplitude of the affected KJ had increased and became symmetrical, which had not been the case before surgery. We observed a total of three changes in the KJ kinematics after surgery: increased swing flexion amplitudes in both KJs, a decreased extension amplitude in the affected KJ, and increased first flexion amplitudes in both KJs. CONCLUSION: According to our study, the midterm outcomes after a valgus osteotomy showed clinical improvements based on the VAS and KOOS scores, which were however less pronounced than in similar studies with a longer assessment term after surgery. We also found a significant increase in the amplitude of joint extension, but only in females. As the function of the operated joint is concerned, valgus osteotomy restored the kinematics of walking movements to a nearly normal gait with increased first and second flexion amplitudes. The function of KJ becomes symmetric though the non-operative side. Thus, the healthy and functionally more capable side is copying the movement pattern of the affected side. Hence, the non-operative leg is functioning less efficiently than it is required by the walking pace.
PURPOSE: A varus deformity (VD) of the lower limbs results in greater loading of the medial compartment of the knee joint (KJ), leading to its degenerative changes and, eventually, to progressive osteoarthritis (OA) of the joint. The aim of the study was to investigate the mid-term changes in gait biomechanics and clinical symptoms in patients with VD of KJ and OA before and six months after surgical correction. METHODS: The study enrolled 25 patients with medial OA of grade 2-3 according to Kellgren-Lawrence and a VD of > 3°, who underwent arthroscopic lavage and debridement of the knee joint followed by corrective osteotomy. The control group included 20 healthy adults. Clinical and biomechanical assessments were done twice: immediately prior to and six months after the surgical treatment. Biomechanical parameters of gait were recorded using an inertial sensor system. RESULTS: According to our findings, there was a statistically significant post-operative increase in the knee extension amplitude by 1.4° in female patients and an insignificant extension increase in male patients. The mean postoperative KOOS score was 66.7 points (46 to 91) in the patient group, 67.1 points (54 to 91) in males, and 59.5 points (46 to 64) in females. As early as six months after a valgus osteotomy, we already observed improved biomechanics of the KJ motions compared to pre-operative data. By that time, the swing flexion amplitude of the affected KJ had increased and became symmetrical, which had not been the case before surgery. We observed a total of three changes in the KJ kinematics after surgery: increased swing flexion amplitudes in both KJs, a decreased extension amplitude in the affected KJ, and increased first flexion amplitudes in both KJs. CONCLUSION: According to our study, the midterm outcomes after a valgus osteotomy showed clinical improvements based on the VAS and KOOS scores, which were however less pronounced than in similar studies with a longer assessment term after surgery. We also found a significant increase in the amplitude of joint extension, but only in females. As the function of the operated joint is concerned, valgus osteotomy restored the kinematics of walking movements to a nearly normal gait with increased first and second flexion amplitudes. The function of KJ becomes symmetric though the non-operative side. Thus, the healthy and functionally more capable side is copying the movement pattern of the affected side. Hence, the non-operative leg is functioning less efficiently than it is required by the walking pace.
Authors: Kristin Briem; Dan K Ramsey; William Newcomb; Katherine S Rudolph; Lynn Snyder-Mackler Journal: J Orthop Res Date: 2007-03 Impact factor: 3.494
Authors: H C Davis; B A Luc-Harkey; M K Seeley; J Troy Blackburn; B Pietrosimone Journal: Osteoarthritis Cartilage Date: 2019-01-18 Impact factor: 6.576
Authors: Liang Gao; Henning Madry; Dmitrii V Chugaev; Matteo Denti; Aleksandr Frolov; Mikhail Burtsev; Nina Magnitskaya; Victor Mukhanov; Philippe Neyret; Leonid N Solomin; Evgeniy Sorokin; Alex E Staubli; Kevin R Stone; Viktor Vilenskiy; Vitaliy Zayats; Dietrich Pape; Andrey Korolev Journal: J Exp Orthop Date: 2019-02-25