Gait mechanics are influenced by quadriceps strength, age, and sex after total knee arthroplasty

Abstract

Although most patients are satisfied with outcomes after total knee arthroplasty (TKA), many retain preoperative altered gait mechanics. Identifying patient characteristics associated with gait mechanics will improve rehabilitation strategies and enhance our understanding of movement disorders. Therefore, the purpose of this study was to identify which patient characteristics are related to gait mechanics in the surgical limb during walking post‐TKA. Patient characteristics included age, body mass, sex, quadriceps strength, self‐reported function, and knee pain. General linear regression was used to compare patient characteristics associated with gait mechanics, after controlling for gait speed, functional capacity and time from surgery. We tested 191 patients cross‐sectionally at 6–24 months after primary, unilateral TKA. Quadriceps weakness in the surgical limb was associated with less peak vertical ground reaction force (PvGRF) (β = .245, p = .044), knee extension moment (β = .283, p = .049), and knee extension excursion (β = .298, p = .038). Older age (β = .168, p = .050) was associated with less PvGRF. Quadriceps strength in the nonsurgical limb (β = −.357, p = .021) was associated with greater knee extension excursion in the surgical limb. Females with TKA (β = −.276, p = .007) had less knee flexion excursion compared to males. Faster gait speed was also associated with greater PvGRF (β = .585, p < .001), knee extensor moment (β = .481, p < .001), and knee flexion excursion (β = .318, p < .001). Statement of Clinical Significance: This study showed quadriceps weakness, slower gait speed, older age and being female were related to altered gait mechanics post‐TKA. These findings will help clinicians better educate patients and develop targeted interventions for improving care in patients post‐TKA.

Maximum knee extension velocity without external load is a stronger determinant of gait function than quadriceps strength in the early postoperative period following total knee arthroplasty

“…Quadriceps strength has been shown to affect the biomechanics (kinematics and kinetics) of the knee joint during gait in patients with TKA [8,9] and has been significantly correlated with gait function [10][11][12][13]. Furthermore, several intervention studies have revealed that the rehabilitation programs focused on quadriceps strength effectively improve gait function in patients who undergo TKA [14][15][16][17].…”

Current applications of gait analysis after total knee arthroplasty: A scoping review

“…A handful of studies do demonstrate gait analysis parameters that are associated with clinical outcomes after total knee arthroplasty. 8,34,35 Quadriceps weakness, 8,10 gait speed, 8,10,36 cadence, 33 step length, 33 have all been identified as related to outcomes after TKA. However, the correlation of 3D kinematic or kinetic data with clinical outcomes after total knee arthroplasty is sparse in the literature.…”

“…6e8 Patients after TKA do exhibit a decreased arc of motion with stair climbing 9 and compensatory changes at the hip and ankle. 10 Thus, the biomechanics of the lower extremity may be altered in patients after TKA.…”

Effect of knee joint weight change on knee function recovery and gait after total knee arthroplasty

“…The lower limb prosthesis was worn much like an article of clothing, and there was almost no difference in muscle strength between the affected limb and the healthy limb. Our research objects were patients who had recently undergone surgical treatment; at this time, the strength of the quadriceps femoris muscles and hamstring muscles of the affected side was significantly lower than that of the healthy side [19]. The difference in postoperative muscle strength may be an important factor affecting the gait changes of patients.…”