Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients

Igor Komnik, Markus Peters, Johannes Funken, Sina David, Stefan Weiss, Wolfgang Potthast, Igor Komnik, Markus Peters, Johannes Funken, Sina David, Stefan Weiss, Wolfgang Potthast

Abstract

After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.

Conflict of interest statement

The study was supported by ARCUS Clinics Pforzheim. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The authors have declared that no competing interests exist.

Figures

Fig 1. Knee internal rotation angles during…
Fig 1. Knee internal rotation angles during decline walking.
Values are presented as mean curves (solid lines) ± standard deviations (SD, shaded areas). Positive values indicate internal rotation. Dotted lines represent the non-OP knee of the TKA group (red) and UKA group (blue). The green rectangle indicates significantly different peak values between the TKA-OP knee and the CG (p = 0.012), the TKA-OP knee and TKA non-OP knee (p = 0.002), the UKA-OP knee and UKA non-OP knee (p = 0.007).
Fig 2. Knee internal rotation moments during…
Fig 2. Knee internal rotation moments during decline walking.
Values are presented as mean curves ± standard deviations (SD, shaded areas). Positive values indicate internal rotation moments. Dotted lines represent the non-OP knee of the TKA group (red) and UKA group (blue). The green rectangles indicate significantly different peak values between the TKA-OP knee and TKA non-OP knee, the UKA-OP knee and UKA non-OP knee for the first 50% of the stance phase (TKA: p = 0.002, UKA: p = 0.003) as well as 50%–100% of the stance phase (TKA: p = 0.041, UKA: p = 0.015).
Fig 3. Knee varus angles during decline…
Fig 3. Knee varus angles during decline walking.
Values are presented as mean curves ± standard deviations (SD, shaded areas). Positive values indicate varus alignment. Dotted lines represent the non-OP knee of the TKA group (red) and UKA group (blue). The green rectangle indicates significantly different peak values between the TKA-OP knee and TKA non-OP knee (p = 0.016), the UKA-OP knee and UKA non-OP knee (p = 0.008) for the first 50% of the stance phase.
Fig 4. Knee adduction moments during level…
Fig 4. Knee adduction moments during level walking.
Values are presented as mean curves (solid lines) ± standard deviations (SD, shaded areas). Positive values indicate adduction moments. Dotted lines represent the non-OP knee of the TKA group (red) and UKA group (blue). The green rectangle indicates significantly different peak values between the TKA-OP knee and CG (p = 0.001), the UKA-OP knee and CG (p = 0.007).

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