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Improved knee biomechanics among patients reporting a good outcome in knee-related quality of life one year after total knee arthroplasty
Department of Women’s and Children’s Health, Karolinska Institutet, MotorikLab, Q2:07, Karolinska University Hospital, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Orebro University Hospital. Department of Orthopedics.
Department of Molecular Medicine and Surgery, Karolinska Institutet, L1:00, Karolinska University Hospital, Stockholm, Sweden.
Department of Women’s and Children’s Health, Karolinska Institutet, MotorikLab, Q2:07, Karolinska University Hospital, Stockholm, Sweden; Department of Physical Therapy, Movement & Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, United States; Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States.
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2017 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, 122Article in journal (Refereed) Published
Abstract [en]

Background: It is not well understood why one in five patients report poor outcomes following knee arthroplasty. This study evaluated changes in knee biomechanics, and perceived pain among patients reporting either a good or a poor outcome in knee-related quality of life after total knee arthroplasty.

Methods: Twenty-eight patients (mean age 66 (SD 7) years) were included in this prospective study. Within one month of knee arthroplasty and one year after surgery, patients underwent three-dimensional (3D) gait analysis, completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), and rated perceived pain using a visual analogue scale. A "good outcome" was defined as a change greater than the minimally detectable change in the KOOS knee-related quality of life, and a "poor outcome" was defined as change below the minimally detectable change. Nineteen patients (68%) were classified as having a good outcome. Groups were analyzed separately and knee biomechanics were compared using a two-way repeated measures ANOVA. Differences in pain between groups were evaluated using Mann Whitney U test.

Results: Patients classified as having a good outcome improved significantly in most knee gait biomechanical outcomes including increased knee flexion-extension range, reduced peak varus angle, increased peak flexion moment, and reduced peak valgus moment. The good outcome group also displayed a significant increase in walking speed, a reduction (normalization) of stance phase duration (% of gait cycle) and increased passive knee extension. Whereas, the only change in knee biomechanics, one year after surgery, for patients classified as having a poor outcome was a significant reduction in peak varus angle. No differences in pain postoperatively were found between groups.

Conclusion: Patients reporting a good outcome in knee-related quality of life improved in knee biomechanics during gait, while patients reporting a poor outcome, despite similar reduction in pain, remained unchanged in knee biomechanics one year after total knee arthroplasty. With regards to surgeon-controlled biomechanical factors, surgery may most successfully address frontal plane knee alignment. However, achieving a good outcome in patient-reported knee-related quality of life may be related to dynamic improvements in the sagittal plane.

Place, publisher, year, edition, pages
BioMed Central, 2017. Vol. 18, 122
Keyword [en]
Gait, Knee, Biomechanics, Joint replacement, Quality of Life, Function, Osteoarthritis
National Category
Orthopedics Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:oru:diva-57015DOI: 10.1186/s12891-017-1479-3ISI: 000397765700008PubMedID: 28327133ScopusID: 2-s2.0-85016029615OAI: oai:DiVA.org:oru-57015DiVA: diva2:1088322
Note

Funding Agencies:

Karolinska Institutet, Stiftelsen Promobilia

Swedish Rheumatism Foundation

Available from: 2017-04-12 Created: 2017-04-12 Last updated: 2017-04-12Bibliographically approved

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CiteExportLink to record
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