Evaluation of gait performance of knee osteoarthritis patients after total knee arthroplasty with different assistive devices

Tereso, Ana; Martins, Maria Manuel; Santos, Cristina Peixoto

doi:10.1590/2446-4740.0729

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Research on Biomedical Engineering

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Sumário

Original articles • Res. Biomed. Eng. 31 (3) • Jul-Sep 2015 • https://doi.org/10.1590/2446-4740.0729 copy

Evaluation of gait performance of knee osteoarthritis patients after total knee arthroplasty with different assistive devices

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction

Nowadays Knee Osteoarthritis (KOA) affects a large percentage of the elderly, and one solution is to perform a Total Knee Arthroplasty (TKA). In this paper, one intends to study the gait and posture of these patients after the TKA, while walking with three assistive devices (ADs) (crutches, standard walker (SW) and rollator with forearm supports (RFS)).

Methods

Eleven patients were evaluated in 2 phases: 5 days and 15 days after surgery. This evaluation was conducted with two inertial sensors, one attached to the operated leg ankle, to measure spatiotemporal parameters, and the other at the sacrum, to measure posture and fall risk-related parameters. Multivariate analysis of variance (MANOVA) with repeated measures was performed to detect group differences.

Results

The MANOVA results show that all spatiotemporal parameters are significantly different (p<0.05) between the two phases of study. So, time has a significant influence on such parameters. In relation to the ADs, one observes that there are statistical significant effects on all spatiotemporal parameters, except for swing duration and step length (p>0.05). The interaction between time and ADs only affects significantly the velocity (p<0.05). In terms of fall risk parameters, time only significantly affects the antero-posterior direction (p<0.05) and ADs affects significantly root mean square in medio-lateral direction (p<0.05). In terms of interaction between time and ADs, there are no statistical significant differences.

Conclusion

This study concludes that depending on the state of recovery of the patient, different ADs should be prescribed. On the overall, standard walker is good to give stability to the patient and RFS allows the patient to present a gait pattern closer to a natural gait.

Knee osteoarthritis; Total knee arthroplasty; Assistive devices; Elderly; Walkers

Variables	Time					Factor (ADs)					*TimeFactor**					Tukey post hoc
Variables	p-value	df	Error	F	sig	p-value	df	Error	F	sig	p-value	df	Error	F	sig	Tukey post hoc
Tstride (s)	0.000	1	30	21.440	0.000	0.001	2	30	8.519	0.001	0.193	2	30	1.739	0.193	RFS: Crutches, SW
Tswing (s)	0.000	1	30	86.272	0.000	0.469	2	30	0.776	0.469	0.818	2	30	0.202	0.818	-
Tstance (s)	0.001	1	30	14.031	0.001	0.001	2	30	8.936	0.001	0.350	2	30	1.086	0.350	RFS: Crutches, SW
Velocity (m/s)	0.000	1	30	316.488	0.000	0.008	2	30	5.773	0.008	0.048	2	30	3.359	0.048	RFS - SW
Cadence (step/min)	0.000	1	30	49.354	0.000	0.000	2	30	14.444	0.000	0.897	2	30	0.109	0.897	RFS - SW
SL (m)	0.000	1	30	1316.144	0.000	0.100	2	30	2.487	0.100	0.399	2	30	0.947	0.399	-

Variables	Time					Factor					*TimeFactor**					Tukey post hoc
Variables	p-value	df	Error	F	sig	p-value	df	Error	F	sig	p-value	df	Error	F	sig
ROMAP (m/s²)	0.000	1	18	38.276	0.000	0.118	2	18	2.408	0.118	0.413	2	18	0.929	0.413	-
RMSAP (m/s²)	0.000	1	18	239.991	0.000	0.463	2	18	0.803	0.463	0.216	2	18	1.670	0.216	-
RMSML (m/s²)	0.126	1	18	2.571	0.126	0.005	2	18	7.131	0.005	0.097	2	18	2.658	0.097	RFS: Crutches, SW
DCOM (m)	0.913	1	18	0.012	0.913	0.100	2	18	2.618	0.100	0.121	2	18	2.379	0.121	-

Parameters	Crutches	SW	RFS	Healthy elderly (free walking)
TStride_5 [s]	3.555 ± 1.385	3.264 ± 1.093	2.043 ± 0.565	1.08
TStride_15 [s]	2.147 ± 0.624	2.370 ± 0.773	1.551 ± 0.599	1.08
TSwing_5 [s]	1.152 ± 0.570 (32.42%)	1.155 ± 0.559 (35.40%)	0.948 ± 0.385 (46.42%)	0.39 (36.11%)
TSwing_15 [s]	0.793 ± 0.282 (36.92%)	0.820 ± 0.343 (34.60%)	0.734 ± 0.241 (47.35%)	0.39 (36.11%)
TStance_5 [s]	2.727 ± 2.046 (67.58%)	2.092 ± 0.991 (64.60%)	1.102 ± 0.415 (53.58%)	0.69 (63.89%)
TStance_15 [s]	1.164 ± 0.383 (63.08%)	1.476 ± 0.844 (65.40%)	0.874 ± 0.430 (52.65%)	0.69 (63.89%)
Velocity_5 [m/s]	0.169 ± 0.102	0.127 ± 0.074	0.220 ± 0.066	1.16
Velocity_15 [m/s]	0.396 ± 0.110	0.302 ± 0.101	0.531 ± 0.261	1.16
Cadence_5 [step/min]	33.466 ± 11.674	34.170 ± 10.302	55.132 ± 17.509	112
Cadence_15 [step/min]	55.521 ± 10.899	53.149 ± 11.029	76.908 ± 19.607	112
SL_5 [m]	0.280 ± 0.074	0.230 ± 0.086	0.274 ± 0.075	0.61
SL_15 [m]	0.422 ± 0.073	0.344 ± 0.069	0.398 ± 0.052	0.61

Parameters	Crutches	SW	RFS	Healthy subjects (free walking)
ROM ML_5 [m/s²]	0.864 ± 0.257	0.741 ± 0.268	0.539 ± 0.176	0.468 ± 0.218
ROM ML_15 [m/s²]	0.445 ± 0.093	0.444 ± 0.080	0.978 ± 0.540	0.468 ± 0.218
ROM AP_5 [m/s²]	2.005 ± 0.859	1.457 ± 0.536	1.556 ± 0.907	0.447 ± 0.195
ROM AP_15 [m/s²]	1.833 ± 0.775	1.081 ± 0.728	2.365 ± 1.368	0.447 ± 0.195
RMS AP_5 [m/s²]	0.716 ± 0.162	0.726 ± 0.252	0.603 ± 0.213	0.316 ± 0.053
RMS AP_15 [m/s²]	0.649 ± 0.271	0.434 ± 0.088	0.589 ± 0.343	0.316 ± 0.053
RMS ML_5 [m/s²]	0.333 ± 0.081	0.447 ± 0.137	0.287 ± 0.029	0.212 ± 0.004
RMS ML_15 [m/s²]	0.408 ± 0.181	0.318 ± 0.044	0.232 ± 0.089	0.212 ± 0.004
DCOM_5 [m]	1.189 ± 0.421	0.879 ± 0.372	0.951 ± 0.600	0.385 ± 0.001
DCOM_15 [m]	0.981 ± 0.430	0.612 ± 0.384	1.379 ± 0.664	0.385 ± 0.001

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