Deficits in functional performance and gait one year after total knee arthroplasty despite improved self-reported function

Josefine E Naili; Maura D Iversen; Anna-Clara Esbjörnsson; Margareta Hedström; Michael H Schwartz; Charlotte K Häger; Eva W Broström

doi:10.1007/s00167-016-4234-7

Deficits in functional performance and gait one year after total knee arthroplasty despite improved self-reported function

Knee Surg Sports Traumatol Arthrosc. 2017 Nov;25(11):3378-3386. doi: 10.1007/s00167-016-4234-7. Epub 2016 Jul 19.

Authors

Josefine E Naili¹, Maura D Iversen^{2

3

4}, Anna-Clara Esbjörnsson², Margareta Hedström^{5

6}, Michael H Schwartz^{7

8

9}, Charlotte K Häger¹⁰, Eva W Broström²

Affiliations

¹ Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. josefine.naili@ki.se.
² Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
³ Department of Physical Therapy, Movement & Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.
⁴ Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
⁶ Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
⁷ Gillette Children's Specialty Healthcare, St Paul, MN, USA.
⁸ Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.
⁹ Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
¹⁰ Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

Abstract

Purpose: The current literature lacks sufficient information about improvements in gait patterns and function after total knee arthroplasty (TKA) and whether patients return to full function. This study evaluated change in gait, performance-based function, and self-reported function 1 year after TKA in patients with symptomatic knee osteoarthritis and how these aspects interrelate.

Methods: A total of 28 patients (64 % female) with knee osteoarthritis, with a mean age of 66 (±7) years, and 25 age- and gender-matched controls participated in this prospective cohort study. Three-dimensional gait analysis generated comprehensive measures of kinematic and kinetic gait deviations, respectively. Participants completed the Five Times Sit-to-Stand (5STS) test, and the self-reported questionnaire Knee Injury and Osteoarthritis Outcome Score (KOOS), at baseline prior to surgery and 1 year after TKA.

Results: Kinetic gait deviations of both the operated and non-operated limb persisted in patients with knee osteoarthritis at 1 year after surgery, while kinematic gait patterns were comparable to controls. Performance on the 5STS and KOOS scores in patients with knee osteoarthritis improved significantly 1 year after surgery (effect size 0.5-1.5), but did not reach the level of controls. Ten patients with knee osteoarthritis (36 %) exceeded the minimally detectable change on the 5STS.

Conclusion: Measures of overall gait patterns and the 5STS revealed improvements in function 1 year after TKA, but were not restored to the level of healthy controls. Based on change in 5STS performance, we identified patients with substantial improvements in gait patterns. Self-reported measures of function could not detect differences between patients improving in 5STS performance and those who did not. These findings highlight the use of the 5STS in clinical practice since improvement on this test seems to follow the reduction in gait pattern deviations.

Level of evidence: II.

Keywords: Arthroplasty; Biomechanics; Function; Gait; Knee osteoarthritis; Mobile bearing; Outcome; Patient-reported outcome.

MeSH terms

Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee / adverse effects
Arthroplasty, Replacement, Knee / methods
Arthroplasty, Replacement, Knee / rehabilitation*
Female
Gait
Humans
Male
Middle Aged
Mobility Limitation
Osteoarthritis, Knee / surgery*
Prospective Studies
Recovery of Function
Self Report