Improved knee biomechanics among patients reporting a good outcome in knee-related quality of life one year after total knee arthroplasty.
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.



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.



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.



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.
Department of Women's and Children's Health, Karolinska Institutet, MotorikLab, Q2:07, Karolinska University Hospital, 171 76, Stockholm, Sweden. josefine.naili@ki.se.
Josefine E
JE
Naili
Department of Orthopedics, School of Medical Sciences, Örebro University and Örebro University Hospital, Örebro, Sweden.
Per
P
Wretenberg
Department of Molecular Medicine and Surgery, Karolinska Institutet, L1:00, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Viktor
V
Lindgren
Department of Women's and Children's Health, Karolinska Institutet, MotorikLab, Q2:07, Karolinska University Hospital, 171 76, Stockholm, Sweden.|Department of Physical Therapy, Movement & Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA.|Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Maura D
MD
Iversen
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, K54, 141 86, Stockholm, Sweden.
Margareta
M
Hedström
Department of Women's and Children's Health, Karolinska Institutet, MotorikLab, Q2:07, Karolinska University Hospital, 171 76, Stockholm, Sweden.
Eva W
EW
Broström
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018771:Arthralgia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005260:Female; D005684:Gait; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D000071081:Minimal Clinically Important Difference; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control / Q000523:psychology; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking
Biomechanics; Function; Gait; Joint replacement; Knee; Osteoarthritis; Quality of Life