title: Pre-surgery knee joint loading patterns during walking predict the presence and severity of anterior knee pain after total knee arthroplasty.
abstract: This study tested if abnormal sagittal knee joint loading patterns after total knee arthroplasty (TKA) were present pre-surgery, and if patterns with higher external knee flexion moments were related to the presence and severity of post-surgery anterior knee pain. Gait analysis and clinical evaluation were performed on 34 patients (41 arthroplasties) both before and 12-18 months after TKA, and on 20 healthy age-matched controls at matched velocities. The majority of knees with abnormal flexor or extensor sagittal knee joint loading patterns post-surgery (18 of 26, 69%) also displayed these patterns pre-surgery. Knee joint loading in the early mid-stance phase of walking prior to surgery was identified by stepwise regression as a significant predictor of the presence (exp(beta)=2.9, CI: 1.2-6.8, p=0.017) and severity of post-surgery anterior knee pain (R2=0.314, p=0.019). Therefore, the frequency and severity of anterior knee pain after TKA can be partially explained by retained pre-surgery gait patterns that had higher external flexion moments in the early mid-stance phase, which place higher forces on the patellofemoral joint.
authors.affiliation: School of Surgery and Pathology (Orthopaedics)/Human Movement and Exercise Science, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Smith
authors.forename: D G
authors.initials: DG
authors.lastname: Lloyd
authors.forename: D J
authors.initials: DJ
authors.lastname: Wood
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005684:Gait / Q000502:physiology; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology* / Q000503:physiopathology; D011300:Preoperative Care; D016059:Range of Motion, Articular / Q000502:physiology; D012720:Severity of Illness Index; D016138:Walking; D016474:Weight-Bearing