Abstract
Total knee arthroplasty (TKA) is recognised as an effective treatment for end-staged knee osteoarthritis. Up to 20% of these patients is unfortunately unsatisfied due to anterior knee pain from unknown origin (Bourne and al. 2010). The aim of this study is to compare knee 3D kinematics during gait of patients with anterior knee pain after TKA to an asymptomatic TKA group. Our hypothesis is that the painful TKA group would exhibit known kinematics characteristics during gait that increase patellofemoral (PF) stresses (i.e. dynamic flexion contracture, valgus alignment, valgus collapse or a quick internal tibial rotation movement) compared to the TKA asymptomatic group.
Thirty-eight patients (45 knees) were recruited 12–24 months post-surgery done by one of three experienced orthopaedic surgeons (31 unilateral TKA and seven bilateral TKA, all using the same knee implant). Patients were divided according to their KOOS pain score (with a cut-off at 6/20 to be included in the painful group). The KOOS questionnaire was also used to assess activities of daily living, symptoms, sports and quality of life. A complete clinical and radiological work up was done on the painful group to exclude those with known explanation for pain (i.e. loosening, malrotation, infection and clinical instability). 3D knee kinematics during treadmill walking was captured and computed using the KneeKGTM system.
For the painful and asymptomatic groups, demographic results show respectively: age of 64.4 ± 7.6 and 69.8 ± 8.3 years, BMI of 31.9 ± 5.0 and 28.1 ± 3.6 kg.m−2, speed of 1.8 ± 0.6 and 1.67 ± 0.5 miles/h., and 50% of women in each group. Only age and BMI showed to be statistically different between groups. The painful TKA group exhibited a valgus alignment when walking (at initial contact and during stance, p<0.001). No significant difference has been put forward for the flexion/extension and internal/external tibial rotation.
Since a higher valgus alignment increases the Q angle, which lateralise the patella and increases PF stresses, results provide new insight on origin of symptoms. Conservative treatments for PF pain syndrome have shown to address the valgus alignment and improve symptoms, therefore the next step will be to assess the impact on pain level and alignment during gait of a personalised conservative management for the painful TKA group. Additionally, a study assessing the change in the radiological and dynamic alignment from pre to post surgery could bring valuable insight on the impact of surgical procedure on anterior knee pain.
