Improved knee biomechanics among patients reporting a good outcome in knee-related quality of life one year after total knee arthroplasty
2017 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, 122Article in journal (Refereed) Published
Naili, Josefine E.
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.
Iversen, Maura D.
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.
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
Gait, Knee, Biomechanics, Joint replacement, Quality of Life, Function, Osteoarthritis
Orthopedics Rheumatology and Autoimmunity
IdentifiersURN: 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
Karolinska Institutet, Stiftelsen Promobilia
Swedish Rheumatism Foundation2017-04-122017-04-122017-04-12Bibliographically approved