ReviewGait analysis of patients following total knee replacement: A systematic review
Introduction
Total knee replacement (TKR) is a widely used intervention in the management of knee osteoarthritis. The increasing prevalence of TKR highlights the need to appropriately assess post-operative outcome of this procedure [1]. Gait analysis is a tool that has been used by researchers to measure functional outcome following TKR. It has been proposed that gait analysis is valuable in the clinical management of patients undergoing TKR through its ability to monitor forces through the knee [2]. In particular, the adduction moment across the knee has received attention due to its association with TKR component loosening [3].
Despite the potential usefulness of gait analysis, there are marked discrepancies in the research methods that have been reported. Variations in subject characteristics, prosthetic designs and methodology of gait analysis make comparison of findings between studies difficult. Nonetheless, assessment of TKR patients using gait analysis continues to be reported. It is therefore important to identify discrepancies between studies to allow for more appropriate comparison of findings and potentially to assist in directing future research. To date there has been no attempt to systematically review the findings of gait analysis in patients following TKR. The aim of this systematic review was therefore to identify common themes in the methods of research in the gait analysis of TKR patients and to summarise the findings reported in this literature.
Section snippets
Literature search strategy
A search for articles on gait analysis in patients following TKR was completed in September 2006. The databases of Medline, Cinahl, Embase, Current Contents, Pedro, and The Cochrane Library were searched for full text articles published in English using combinations and variations of the following terms: knee arthroplasty, knee replacement, knee prosthesis, knee implant, gait, locomotion, walking, biomechanics, kinetics, kinematics, angle, moment and torque. These electronic searches were
Results
Eleven studies were accepted for inclusion in this systematic review. Table 1 summarises results from the assessment of methodologic quality for each of these studies. All studies satisfied a similar number of criteria, yet the methodology varied substantially across studies.
Although all studies stated the aim of the research, there were marked differences in the research objectives – four aimed to describe the gait of patients with total knee arthroplasty [10], [11], [12], [13] and six aimed
Discussion
This review showed that TKR patients walked with less total range of knee motion than their control counterparts. Contributing to this reduction in overall motion, TKR patients walked with less knee flexion during the swing phase of gait. The range of flexion during the loading phase of stance was also reduced compared to controls. Consistently large effect sizes across these patient–control comparisons indicated the substantial differences between groups regarding these kinematic gait
Acknowledgements
This project was funded by an Australian Research Council Linkage Grant (LP 0455460).
References (52)
The role of gait analysis in the management of the knee
Knee
(2005)- et al.
Influence of walking speed on gait parameters
J Biomed Eng
(1985) - et al.
Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services
Am J Prev Med
(2000) - et al.
Pre-surgery knee joint loading patterns during walking predict the presence and severity of anterior knee pain after total knee arthroplasty
J Orthop Res
(2004) - et al.
Comprehensive gait analysis in posterior-stabilized knee arthroplasty
J Arthroplasty
(1996) - et al.
A comparison of isokinetic strength testing and gait analysis in patients with posterior cruciate-retaining and substituting knee arthroplasties
J Arthroplasty
(1998) - et al.
A biomechanical evaluation of one-stage vs. two-stage bilateral knee arthroplasty patients
Gait Posture
(1999) - et al.
Functional analysis of cemented medial unicompartmental knee arthroplasty
J Arthroplasty
(1996) - et al.
Clinical and functional comparison of bicondylar sledge prostheses retaining all ligaments and constrained total knee replacement
Clin Biomech
(2004) - et al.
Effects of age on the biomechanics and physiology of gait
Clin Geriatr Med
(1996)
A functional and radiographic analysis of the total condylar knee arthroplasty
J Arthroplasty
Functional biomechanical assessment of the Oxford Meniscal Knee
J Arthroplasty
Dynamics of knee malalignment
Orthop Clin North Am
Kinemax outcomes: G. Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?
J Arthroplasty
Knee joint functional range of movement prior to and following total knee arthroplasty measured using flexible electrogoniometry
Gait Posture
Tractive forces during rolling motion of the knee: implications for wear in total knee replacement
J Biomech
Gait biomechanics and the evolution of total joint replacement
Gait Posture
Enhancing the ability of gait analyses to differentiate between groups: scaling gait data to body size
Gait Posture
Normalization of joint moments during gait: a comparison of two techniques
J Biomech
The PCL significantly affects the functional outcome of total knee arthroplasty
J Arthroplasty
Gait analysis after total knee arthroplasty. Comparison of posterior cruciate retention and substitution
J Orthop Sci
Patellofemoral design influences function following total knee arthroplasty
J Arthroplasty
The influence of femoral rollback on patellofemoral contact loads in total knee arthroplasty
J Arthroplasty
Reduced hip extension in the elderly: dynamic or postural?
Arch Phys Med Rehabil
Quantitative evaluation of gait pattern in patients with osteoarthrosis of the knee and after total knee arthroplasty. Gait analysis using a pressure measuring system
J Orthop Sci
Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002
J Bone Joint Surg
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