A kinematic and kinetic analysis of walking after total knee arthroplasty with and without patellar resurfacing.
BACKGROUND
Clarification of the indications for patellar resurfacing in total knee arthroplasty (TKA) is still necessary. Few studies of adequate power have evaluated functional differences between total knee arthroplasty with and without patellar resurfacing, in particular walking gait. This study aimed to identify clinically relevant differences in knee kinematic or kinetic parameters during level walking between total knee arthroplasty with and without patellar resurfacing, after controlling for pre-surgery gait parameters.


METHODS
Kinematic and kinetic gait analysis of level walking was performed on 34 subjects (41 knees) before and 12-18 months after total knee arthroplasty with patellar resurfacing performed randomly. Linear regression analysis was used to examine the influence of patellar resurfacing upon gait variables whilst controlling for the corresponding pre-surgery measure.


RESULTS
The pre-surgery value was a moderate to strong significant predictor of all post-surgery temporal-spatial and kinetic gait parameters (p < 0.001-0.008), and most kinematic parameters (p < 0.001-0.066). The addition of patellar resurfacing to the regression models did not improve the predictive power in any case. Only one parameter, knee flexion at heel-strike, displayed a difference near statistical significance between total knee arthroplasty with and without patellar resurfacing (10 degrees versus 7 degrees respectively, p = 0.023).


CONCLUSIONS
Pre-surgery gait patterns are an important determinant of post-surgery gait. There are no clinically relevant differences in walking gait between total knee arthroplasty performed with or without patellar resurfacing, using the Profix design.
Smith
Anne J
AJ
School of Surgery and Pathology (Orthopaedics)/Human Movement and Exercise Science, University of Western Australia, Perth Orthopaedic Institute, Nedlands. asmith@cyllene.uwa.edu.au
Lloyd
David G
DG
Wood
David J
DJ
D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001696:Biomechanical Phenomena / Q000379:methods; D003198:Computer Simulation; D005260:Female; D005684:Gait; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D007700:Kinetics; D008297:Male; D008954:Models, Biological; D010329:Patella / Q000503:physiopathology* / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013499:Surface Properties; D016896:Treatment Outcome; D016138:Walking