Gait and functional status analysis before and after total knee arthroplasty.

BACKGROUND: Among the procedures for severe gonarthrosis, total knee arthroplasty (TKA) is considered a successful method patient satisfaction and functional improvement; however, TKA is commonly associated with incompletely recovered gait function. The aim of this study was to evaluate the influence of TKA and physiotherapy programmes on gait features and patient-reported functional status and the relationship between them, leading to broader knowledge of the origins of long-term gait disturbances. METHODS: Walking speed, step length and single support time were analysed by GAITRite system in 60 healthy controls and 21 TKA patients analysed at four time points: one day before and five days after surgery and before and after a three-week rehabilitation (12 and 15 weeks after surgery). Functional status was assessed using the Western Ontario and McMaster Osteoarthritis Index (WOMAC). RESULTS: At all time points, the TKA subjects walked significantly slower than the controls, but walking speed continuously increased after surgery. Gait asymmetries were observed in single support time (before surgery) and step length (after surgery). Partial restoration of gait function was observed 12 weeks after surgery and completion of the rehabilitation programme. An indirect correlation between gait velocity and function WOMAC subscores was found. CONCLUSIONS: Patients after TKA were characterised by significant improvements in self-reported functionality and progressive reduction of gait abnormalities, probably related to pain reduction. However, at 15 weeks after surgery, patients exhibited step length asymmetry, which could be considered as an effect of habits of three-point crutch gait in the early postoperative period.

Effects of Viscosupplementation on Knee Joint Arthrokinematics - Pilot Study.

BACKGROUND: Osteoarthritis is one of the most common dysfunctions of the musculoskeletal system and viscosup-plementation is becoming an increasingly popular treatment in OA. However, current knowledge regarding biomechanical changes in synovial joints reveals many discrepancies. Therefore, the aim of our study was to evaluate the effect of visco-supplementation on knee joint arthrokinematics as analyzed by vibroarthrography. MATERIAL AND METHODS: Seventeen individuals diagnosed with moderate knee osteoarthritis (VSC) were examined before and after a single injection of hyaluronate. A control group consisted of 30 asymptomatic individuals. During alter-nating extension/flexion of the knee joint, a 6-second vibroarthrographic signal was recorded using an accelerometer. The following parameters were calculated: variance (VMS), amplitude (R4), and spectral power density in the 50-250 Hz (P1) and 250-450 Hz (P2) bands. RESULTS: Statistical analysis showed significant differences (p<0.05) in the values of R4 and P2, which were higher in the VSC group than among the controls. After viscosupplementation, the values of R4, P1 and P2 in the VSC group de-creased to a level not significantly different from that seen among the controls. CONCLUSIONS: 1. After a single intra-articular HA injection, joint motion-related vibrations were reduced, which was recorded as a decreased intensity of vibroacoustic emission. 2. This suggests that the use of viscosupplementation in pa-tients with moderate knee osteoarthritis may improve qualitative aspects of arthrokinematics.