LONG-TERM GAIT ANALYSIS IN PATIENTS AFTER TOTAL KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS

G. Marino¹, F. Temporiti^1,2, F. De Capitani¹, L. Bolzoni¹, R. Gatti^1,2

¹IRCCS Humanitas Clinical and Research Center, Physiotherapy Unit, Milano, Italy, ²Humanitas University, Department of Biomedical Sciences, Milano, Italy

Background: Total knee arthroplasty (TKA) represents a successful surgical procedure in subjects with end-stage knee osteoarthritis, relieving patients’ symptoms and restoring functional independence.Gait analysis may provide objective indications on walking pattern restoration, which is essential for re-establishing functional independence and a satisfactory quality of life. Gait abnormalities have been reported in patients after TKA, leading to development of inter-joint coordination abnormalities and increased risk of falling. However, the presence of such impairments in the long-term has been poorly analyzed, since the majority of studies investigated gait pattern especially in the subacute phase after TKA.

Purpose: To assess the presence of long-term gait impairments in patients after TKA compared to healthy individuals.

Methods: A systematic literature review including observational studies or randomized controlled trials investigating gait features in a time-window longer than 6 months through an optoelectronic system in TKA patients compared to healthy subjects was performed. Spatial-temporal, kinematic and kinetic parameter were extracted, pooled using a random-effect model and expressed as mean difference (MD) or standardized mean difference (SMD) with 95% confidence interval (CI₉₅). Risk of bias was assessed using the Downs and Black checklist, heterogeneity was evaluated through the I², and outcomes were categorized into “6 months - 1 year” and “more than 1 year” timepoint categories.

Results: Twenty-seven studies with a total of 934 patients were included. Overall quality was moderate (mean 15.6 points), with risk of bias scores ranged from 11 to 20 out of 28 points. At “6months-1year” timepoint, reduced speed (MD: -0.18 m/s, CI95: -0.22, -0.14, I²:73%), stride length (MD: -0.17 meters, CI95: -0.21, -0.13, I²:67%), cadence (MD: -9.05 step/s, CI95: -12.74, -5.36, I²:53%) and longer stance phase (SMD: 0.94, CI₉₅: 0.70, 1.18, I²:0%) were observed in patients compared to healthy individuals. These impairments persisted at more than 1 year (walking speed: MD: -0.16 m/s, CI₉₅: -0.21, -0.11, I²:97%; stride length: MD: -0.16 meters, CI₉₅: -0.28, -0.04, I²:91%; cadence: MD: -7.9 step/s, CI₉₅: -13.0, -2.7, I²:87%; stance phase: SMD: 0.89, CI₉₅: 0.28, 1.50, I²:73%). At more than 1 year, patients demonstrated deficits for knee extension (MD: 6.1°, CI₉₅: 3.9°, 8.4°,I²:0%) and flexion-extension range (MD: -5.1°, CI₉₅: -7.9°, -2.2°,I²:80%) during gait cycle, and for knee maximum angle in stance (MD: -4.8°, CI₉₅: -9.2°, -0.4, I²:82%) and swing (MD: -6.57°, CI95: -9.14°, -4.01°, I²:81%) phases compared to healthy subjects. Reduced knee flexion (SMD: -0.5, CI₉₅: -0.8, -0.3, I²:51%) and knee adduction moment (SMD: -0.6, CI₉₅: -0.9, -0.3, I²:72%) at more than 1 year were also detected in patients when compared to healthy subjects.

Conclusions: Long-term gait impairments were found in patients after TKA compared to healthy individuals. In particular, patients’ walking speed, stride length, cadence and stance phase are reduced at more than 1 year, along with knee sagittal plane kinematics and several knee kinetic parameters.

Implications: These findings may help clinicians to develop adequate long-term rehabilitation program addressed to restore a physiological gait pattern in patients after TKA, and reduce the incidence of musculoskeletal conditions related to gait adaptations persistence.

Funding acknowledgements: The authors did not receive any funding.

Keywords:
Total knee arthroplasty
Gait analysis
Long-term walking impairments

Topics:
Orthopaedics
Musculoskeletal: lower limb
Musculoskeletal

Did this work require ethics approval? No

Reason: The scientific work consists of a systematic review with meta-analysis.