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中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 712 -717. doi: 10.3877/cma.j.issn.1674-134X.2021.06.010

综述

全膝关节置换术后运动学变化特征的研究进展
林博夫1, 李梦远2, 郑秋坚2,()   
  1. 1. 510000 广州,广东省人民医院(广东省医学科学院)关节骨病与创伤科;515041 汕头大学医学院
    2. 510000 广州,广东省人民医院(广东省医学科学院)关节骨病与创伤科
  • 收稿日期:2020-06-19 出版日期:2021-12-01
  • 通信作者: 郑秋坚
  • 基金资助:
    广东省医学科学技术研究基金项目(A2020023); 广州市科技计划基础与应用基础研究项目(博士青年科技人员类)(202102020427)

Progresses of kinematic characteristics after total knee arthroplasty

Bofu Lin1, Mengyuan Li2, Qiujian Zheng2,()   

  1. 1. Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China; Shantou University Medical College, Shantou 515041, China
    2. Department of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, China
  • Received:2020-06-19 Published:2021-12-01
  • Corresponding author: Qiujian Zheng
引用本文:

林博夫, 李梦远, 郑秋坚. 全膝关节置换术后运动学变化特征的研究进展[J/OL]. 中华关节外科杂志(电子版), 2021, 15(06): 712-717.

Bofu Lin, Mengyuan Li, Qiujian Zheng. Progresses of kinematic characteristics after total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(06): 712-717.

全膝关节置换术是治疗终末期膝关节骨关节炎的有效方法之一,然而,仍有患者在膝关节置换术后表现出步速下降、膝关节不稳定等异常运动学改变。膝关节的运动学对膝关节的运动状态进行了量化描述,有助于更加客观、精确地评估患者术后膝关节的功能。本文主要介绍了全膝关节置换术后患者膝关节的运动学变化及其影响因素。通过文献整理分析发现,尽管患者在全膝关节置换术后步速、步长、膝关节活动度等步态参数较术前改善,但是与正常人相比仍存在一定差距,患者的膝关节运动也受到假体设计、手术方式和对线方法等因素的影响。运动分析系统可用于采集患者术前、术后的运动学数据,分析患者出现术后运动学异常的病理变化机制,为个体化制定术后快速康复方案、提高患者满意度提供理论依据。

Total knee arthroplasty (TKA) is one of the effective procedures in treating terminal stage knee osteoarthritis. However, some patients continue to report abnormal kinematic changes such as decreased step velocity, instability after TKA. The kinematics of the knee quantitatively describe the motion of the knee, which can help better assess the function of the knee more precisely and objectively. This article aimed at introducing kinematic changes of patients’ knee and factors that influence patients’ kinematics after TKA. According to the documented data, although better gait parameters are achieved after TKA, some defects are still noticed in patients compared to normal people. In addition, patients’ kinematics is affected by prosthesis design, operation method, and lower extremity alignment, etc. The pre- and post-operative kinematic data of patients collected by motion analysis system would be helpful in exploring the mechanism of pathological changes in patients with postoperative kinematic abnormalities, thus providing theoretical basis for the guideline of individualized post-operative rapid rehabilitation and improving patients’ satisfaction.

图1 文献筛选流程图
[1]
Kaufman KR, Hughes C, Morrey BF, et al. Gait characteristics of patients with knee osteoarthritis[J]. J Biomech, 2001, 34(7): 907-915.
[2]
Safiri S, Kolahi AA, Smith E, et al. Global, regional and National burden of osteoarthritis 1990-2017: a systematic analysis of the Global Burden of Disease Study 2017[J]. Ann Rheum Dis, 2020, 79(6): 819-828.
[3]
Maier MW, Aschauer S, Wolf SI, et al. Three dimensional gait analysis in patients with symptomatic component mal-rotation after total knee arthroplasty[J]. Int Orthop, 2019, 43(6): 1371-1378.
[4]
Ro DH, Han HS, Lee DY, et al. Slow gait speed after bilateral total knee arthroplasty is associated with suboptimal improvement of knee biomechanics[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1671-1680.
[5]
Mcclelland JA, Webster KE, Feller JA, et al. Knee kinetics during walking at different speeds in people who have undergone total knee replacement[J]. Gait Posture, 2010, 32(2): 205-210.
[6]
Ro DH, Han HS, Kim SH, et al. Baseline varus deformity is associated with increased joint loading and pain of non-operated knee two years after unilateral total knee arthroplasty[J]. Knee, 2018, 25(2): 249-255.
[7]
Kuwahara W, Nakanishi K, Kurumadani H, et al. Total knee arthroplasty for patients with medial knee osteoarthritis improves trunk movement during gait[J]. J Back Musculoskelet Rehabil, 2020, 33(5): 727-734.
[8]
Bonnefoy-Mazure A, Armand S, Sagawa YJ, et al. Knee kinematic and clinical outcomes evolution before, 3 months, and 1 year after total knee arthroplasty[J]. J Arthroplasty, 2017, 32(3): 793-800.
[9]
Nakahara H, Okazaki K, Mizu-Uchi H, et al. Correlations between patient satisfaction and ability to perform daily activities after total knee arthroplasty: why aren′t patients satisfied?[J]. J Orthop Sci, 2015, 20(1): 87-92.
[10]
Moon YW, Kim HJ, Ahn HS, et al. Serial changes of quadriceps and hamstring muscle strength following total knee arthroplasty: a meta-analysis[J/OL]. PLoS One, 2016, 11(2): e0148193. DOI: 10.1371/journal.pone.0148193.
[11]
Gaffney BM, Harris MD, Davidson BS, et al. Multi-joint compensatory effects of unilateral total knee arthroplasty during high-demand tasks[J]. Ann Biomed Eng, 2016, 44(8): 2529-2541.
[12]
Yoshida Y, Zeni J, Snyder-Mackler L. Do patients achieve normal gait patterns 3 years after total knee arthroplasty?[J]. J Orthop Sports Phys Ther, 2012, 42(12): 1039-1049.
[13]
Mcclelland JA, Webster KE, Feller JA. Variability of walking and other daily activities in patients with total knee replacement[J]. Gait Posture, 2009, 30(3): 288-295.
[14]
Fenner VU, Behrend H, Kuster MS. Joint mechanics after total knee arthroplasty while descending stairs[J]. J Arthroplasty, 2017, 32(2): 575-580.
[15]
Naili JE, Iversen MD, Esbjörnsson AC, et al. Deficits in functional performance and gait one year after total knee arthroplasty despite improved self-reported function[J]. Knee Surg Sports Traumatol Arthrosc, 2017, 25(11): 3378-3386.
[16]
Sumner B, Mccamley JD, Jacofsky DJ, et al. Comparison of knee kinematics and kinetics during stair ascent in single-radius and multiradius total knee arthroplasty[J]. J Knee Surg, 2019, 32(9): 872-878.
[17]
Sumner B, Mccamley J, Jacofsky DJ, et al. Comparison of knee kinematics and kinetics during stair descent in single- and multi-radius total knee arthroplasty[J]. J Knee Surg, 2020, 33(10): 1020-1028.
[18]
Larsen B, Jacofsky MC, Jacofsky DJ. Quantitative, comparative assessment of gait between single-radius and multi-radius total knee arthroplasty designs[J]. J Arthroplasty, 2015, 30(6): 1062-1067.
[19]
Buechel FF, Pappas MJ. Long-term survivorship analysis of cruciate-sparing versus cruciate-sacrificing knee prostheses using meniscal bearings[J]. Clin Orthop Relat Res, 1990, (260): 162-169.
[20]
Amaro JT, Novaretti JV, Astur DC, et al. Higher axial tibiofemoral rotation and functional outcomes with mobile-bearing compared with fixed-bearing total knee arthroplasty at 1- but not at 2-year follow-up-a randomized clinical trial[J]. J Knee Surg, 2020, 33(5): 474-480.
[21]
Kim YH, Park JW, Kim JS. The long-term results of simultaneous high-flexion mobile-bearing and fixed-bearing total knee arthroplasties performed in the same patients[J]. J Arthroplasty, 2019, 34(3): 501-507.
[22]
Urwin SG, Kader DF, Caplan N, et al. Gait analysis of fixed bearing and mobile bearing total knee prostheses during walking: do Mobile bearings offer functional advantages?[J]. Knee, 2014, 21(2): 391-395.
[23]
Zeng YM, Yan MN, Li HW, et al. Does mobile-bearing have better flexion and axial rotation than fixed-bearing in total knee arthroplasty? A randomised controlled study based on gait[J]. J Orthop Translat, 2020, 20(20): 86-93.
[24]
Murakami K, Hamai S, Okazaki K, et al. Kinematic analysis of stair climbing in rotating platform cruciate-retaining and posterior-stabilized mobile-bearing total knee arthroplasties[J]. Arch Orthop Trauma Surg, 2017, 137(5): 701-711.
[25]
Gray HA, Guan S, Young TJ, et al. Comparison of posterior-stabilized, cruciate-retaining, and medial-stabilized knee implant motion during gait[J]. J Orthop Res, 2020, 38(8): 1753-1768.
[26]
Wiik AV, Aqil A, Tankard S, et al. Downhill walking gait pattern discriminates between types of knee arthroplasty: improved physiological knee functionality in UKA versus TKA[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(6): 1748-1755.
[27]
Agarwal A, Miller S, Hadden W, et al. Comparison of gait kinematics in total and unicondylar knee replacement surgery[J]. Ann R Coll Surg Engl, 2019, 101(6): 391-398.
[28]
Braito M, Giesinger JM, Fischler S, et al. Knee extensor strength and gait characteristics after minimally invasive unicondylar knee arthroplasty vs minimally invasive total knee arthroplasty: a nonrandomized controlled trial[J]. J Arthroplasty, 2016, 31(8): 1711-1716.
[29]
Bejek Z, Paróczai R, Szendröi M, et al. Gait analysis following TKA: comparison of conventional technique, computer-assisted navigation and minimally invasive technique combined with computer-assisted navigation[J]. Knee Surg Sports Traumatol Arthrosc, 2011, 19(2): 285-291.
[30]
Wegrzyn J, Parratte S, Coleman-Wood K, et al. The John Insall Award: no benefit of minimally invasive TKA on gait and strength outcomes: a randomized controlled trial[J]. Clin Orthop Relat Res, 2013, 471(1): 46-55.
[31]
Luo Z, Zhou K, Peng L, et al. Similar results with kinematic and mechanical alignment applied in total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(6): 1720-1735.
[32]
Mcewen PJ, Dlaska CE, Jovanovic IA, et al. Computer-assisted kinematic and mechanical axis total knee arthroplasty: a prospective randomized controlled trial of bilateral simultaneous surgery[J]. J Arthroplasty, 2020, 35(2): 443-450.
[33]
Koh IJ, Lin CC, Patel NA, et al. Kinematically aligned total knee arthroplasty reproduces more native rollback and laxity than mechanically aligned total knee arthroplasty: a matched pair cadaveric study[J]. Orthop Traumatol Surg Res, 2019, 105(4): 605-611.
[34]
Yeo JH, Seon JK, Lee DH, et al. No difference in outcomes and gait analysis between mechanical and kinematic knee alignment methods using robotic total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1142-1147.
[35]
Mcnair PJ, Boocock MG, Dominick ND, et al. A comparison of walking gait following mechanical and kinematic alignment in total knee joint replacement[J]. J Arthroplasty, 2018, 33(2): 560-564.
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