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1.
Clin Biomech (Bristol, Avon) ; 101: 105855, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36563543

RESUMO

BACKGROUND: Both medial knee osteoarthritis and associated varus alignment have been proposed to alter knee joint loading and consequently overloading the medial compartment. Individuals with knee osteoarthritis and varus deformity are candidates for coronal plane corrective surgery, high tibial osteotomy. This study evaluated knee loading and contact location for a control group, a pre-surgery cohort and the same cohort 12 months post-surgery using a musculoskeletal modelling approach. METHODS: Joint kinematics during gait were measured in 30 knee osteoarthritis patients, before and after high tibial osteotomy, and 28 healthy adults. Using a musculoskeletal model that incorporated patient-specific mechanical tibial femoral angle, the resulting muscle, ligament, and contact forces were calculated and the medial - lateral condyle load distribution was analysed. FINDINGS: Surgery changed medial compartment contact force throughout stance relative to pre-surgery. This reduction in medial compartment contact force pre- vs post-HTO is observed despite a significant increase in post-surgery walking speed compared to pre-HTO, where increased speed is typically associated with increased joint loading. INTERPRETATION: This study has estimated the effects of high tibial osteotomy on knee loading using a generic model that incorporates a detailed knee model to better understand tibiofemoral contact loading. The findings support the aim of surgery to unload the medial knee compartment and lateralise joint contact forces.


Assuntos
Osteoartrite do Joelho , Adulto , Humanos , Osteoartrite do Joelho/cirurgia , Articulação do Joelho/cirurgia , Articulação do Joelho/fisiologia , Tíbia/cirurgia , Fêmur , Fenômenos Biomecânicos/fisiologia , Osteotomia/métodos
2.
PLoS One ; 17(1): e0262798, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35051232

RESUMO

The primary role of muscles is to move, and control joints. It is therefore important to understand how degenerative joint disease changes this role with the resulting effect on mechanical joint loading. Muscular control strategies can vary depending on strength and coordination which in turn influences joint control and loading. The purpose of this study was to investigate the variation in neuromuscular control mechanisms and joint biomechanics for three subject groups including those with: uni-compartmental knee osteoarthritis (OA), listed for high tibial osteotomy surgery (pre-HTO, n = 10); multi-compartmental knee OA listed for total knee replacement (pre-TKR, n = 9), and non-pathological knees (NP, n = 11). Lower limb kinematics and electromyography (EMG) data for subjects walking at self-selected speed, were input to an EMG-driven musculoskeletal knee model which was scaled and calibrated to each individual to estimate muscle forces. Compared to NP, the peak gastrocnemius muscle force reduced by 30% and 18% for pre-HTO and pre-TKR respectively, and the peak force estimated for hamstring muscle increased by 25% for pre-HTO. Higher quadriceps and hamstring forces suggest that co-contraction with the gastrocnemius could lead to higher joint contact forces. Combined with the excessive loading due to a high external knee adduction moment this may exacerbate joint destruction. An increased lateral muscle co-contraction reflects the progression from NP to uni-compartmental OA (pre-HTO). Pre-TKR patients adopt a different gait pattern to pre-HTO patients. Increased medial muscle co-activation could potentially differentiate between uni- or multi-compartmental OA.


Assuntos
Marcha/fisiologia , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Adulto , Fenômenos Biomecânicos/fisiologia , Eletromiografia , Feminino , Humanos , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/patologia , Músculo Esquelético/fisiopatologia , Osteoartrite do Joelho/patologia , Caminhada/fisiologia
3.
J Biomech ; 112: 110042, 2020 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-33038749

RESUMO

The purpose of this study was to quantify the effect of total knee replacement (TKR) alignment on in-vivo knee function and loading in a unique patient cohort who have been identified as having a high rate of component mal-alignment. Post-TKR (82.4 ± 6.7 months), gait analysis was performed on 25 patients (27 knees), to calculate knee kinematics and kinetics. For a step activity, video fluoroscopic analysis quantified in-vivo implant kinematics. Frontal plane lower-limb alignment was defined by the Hip-Knee-Ankle angle (HKA) measured on long leg static X-rays. Transverse plane component rotation was calculated from computed tomography scans. Sagittal plane alignment was defined by measuring the flexion angle of the femoral component and the posterior tibial slope angle (PTSA). For gait analysis, a more varus HKA correlated with increased peak and dynamic joint kinetics, predicting 47.6% of Knee Adduction Angular Impulse variance. For the step activity, during step-up and single leg loaded, higher PTSA correlated with a posterior shift in medial compartment Anterior-Posterior (AP) translation. During step-down, higher PTSA correlated with reduced lateral compartment AP translation with a posterior shift in AP translation in both compartments. A more varus HKA correlated with a more posterior medial AP translation and inter-component rotation was related to transverse plan range of motion. This in-vivo study found that frontal plane lower-limb alignment had a significant effect on joint forces during gait but had minimal influence on in-vivo implant kinematics for step activity. PTSA was found to influence in-vivo TKR translations and is therefore an important surgical factor.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular , Tíbia/cirurgia
4.
Knee Surg Sports Traumatol Arthrosc ; 28(9): 2872-2882, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31384981

RESUMO

PURPOSE: The purpose of this study was to quantify changes in knee loading in the three clinical planes, compensatory gait adaptations and patient-reported outcome measures (PROMS) resulting from opening wedge high tibial osteotomy (HTO). METHODS: Gait analysis was performed on 18 participants (19 knees) with medial osteoarthritis (OA) and varus alignment pre- and post-HTO, along with 18 controls, to calculate temporal, kinematic and kinetic measures. Oxford Knee Score, Knee Outcome Survey and visual analogue pain scores were collected. Paired and independent sample tests identified changes following surgery and deviations from controls. RESULTS: HTO restored frontal and transverse plane knee joint loading to that of the control group, while reductions remained in the sagittal plane. Elevated frontal plane trunk sway (p = 0.031) and reduced gait speed (p = 0.042), adopted as compensatory gait changes pre-HTO, were corrected by the surgery. PROMs significantly improved (p ≤ 0.002). Centre of pressure (COP) was lateralised relative to the knee post-HTO (p < 0.001). Energy absorbed in the sagittal plane significantly increased post-HTO (p = 0.007), whilst work done in the transverse plane reduced (p ≤ 0.008). Pre-operative gait deviations from the control group that were retained post-HTO included smaller sagittal (p = 0.003) knee range of motion during gait, greater stance duration (p = 0.008) and altered COP location (anterior to the knee) in early stance (p = 0.025). CONCLUSIONS: HTO surgery restored frontal and transverse plane knee loading to normal levels and improved PROMs. Gait adaptations known to reduce knee loading employed pre-HTO were not retained post-HTO. Some gait features were found to differ between post-HTO subjects and controls. LEVEL OF EVIDENCE: II.


Assuntos
Análise da Marcha , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Medidas de Resultados Relatados pelo Paciente , Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor , Amplitude de Movimento Articular , Velocidade de Caminhada , Adulto Jovem
5.
Clin Biomech (Bristol, Avon) ; 70: 237-244, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31669957

RESUMO

BACKGROUND: Low back pain (LBP) classification systems are used to deliver targeted treatments matched to an individual profile, however, distinguishing between different subsets of LBP remains a clinical challenge. METHODS: A novel application of the Cardiff Dempster-Shafer Theory Classifier was employed to identify clinical subgroups of LBP on the basis of repositioning accuracy for subjects performing a sitting and standing posture task. 87 LBP subjects, clinically subclassified into flexion (n = 50), passive extension (n = 14), and active extension (n = 23) motor control impairment subgroups and 31 subjects with no LBP were recruited. Thoracic, lumbar and pelvic repositioning errors were quantified. The Classifier then transformed the error variables from each subject into a set of three belief values: (i) consistent with no LBP, (ii) consistent with LBP, (iii) indicating either LBP or no LBP. FINDINGS: In discriminating LBP from no LBP the Classifier accuracy was 96.61%. From no-LBP, subsets of flexion LBP, active extension and passive extension achieved 93.83, 98.15% and 97.62% accuracy, respectively. Classification accuracies of 96.8%, 87.7% and 70.27% were found when discriminating flexion from passive extension, flexion from active extension and active from passive extension subsets, respectively. Sitting lumbar error magnitude best discriminated LBP from no LBP (92.4% accuracy) and the flexion subset from no-LBP (90.1% accuracy). Standing lumbar error best discriminated active and passive extension from no LBP (94.4% and 95.2% accuracy, respectively). INTERPRETATION: Using repositioning accuracy, the Cardiff Dempster-Shafer Theory Classifier distinguishes between subsets of LBP and could assist decision making for targeted exercise in LBP management.


Assuntos
Dor Lombar/diagnóstico , Postura Sentada , Posição Ortostática , Adulto , Pessoas com Deficiência , Feminino , Humanos , Dor Lombar/fisiopatologia , Região Lombossacral/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
6.
Orthop Res Rev ; 11: 129-140, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31572022

RESUMO

OBJECTIVE: To examine functional performance differences using kinematic and kinetic analysis between participants with and without knee osteoarthritis (OA) to determine which outcomes best characterize persons with and without knee OA. METHODS: Participants with unilateral moderate knee OA (Kellgren-Lawrence grades 2 or 3) and controls without knee pain were matched for age, gender, and body mass index. Primary outcomes included temporal parameters, joint rotations and moments, and ground reaction forces assessed via 3D motion capture during walking and ascending/descending stairs. Secondary outcomes included timed functional activities (sit to stand; tying shoelaces), 48 hrs lower limb activity monitoring, and patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, European Quality of Life-5 Dimensions). RESULTS: Eight matched pairs were analyzed. Compared with controls, OA participants exhibited significant reductions in peak frontal hip and sagittal knee moments, and decreased peak anterior ground reaction force with the affected limb while walking. Ascending stairs, OA participants had slower speed, fewer strides per minute, longer cycle and stance times, and increased trunk range of motion (ROM) in assessments of both limbs; longer swing time and reduced ankle ROM in the affected limb; and increased knee frontal ROM in the unaffected limb. Descending stairs, OA participants had fewer strides per minute and decreased trunk transverse ROM in assessments of both limbs; increased knee frontal ROM in the affected limb; and longer strides, shorter stance and cycle times, increased trunk sagittal and decreased knee transverse ROMs in the unaffected limbs vs controls. Compared with controls, OA participants had slower walking cadence (120-130 vs 100-110 steps/min, respectively), took significantly longer on timed functional measures, and had significantly worse scores in patient-reported outcomes. CONCLUSION: Several objectives and patient-reported measures examined in this study could potentially be considered as outcomes in pharmacologic or physical therapy OA trials.

7.
J Hand Surg Eur Vol ; 44(6): 607-613, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30975050

RESUMO

We developed an optoelectronic motion analysis protocol to measure anatomical and functional ranges of wrist motion in Colles'-type and scaphoid-type splints and casts. The protocol was used to study the restriction of wrist motion in casts and splints in ten healthy volunteers. Scaphoid-type casts were no more restrictive to wrist motion than Colles'-type casts, but casts were significantly more restrictive than removable splints. Removable splints were more restrictive than no immobilization. Results suggest there is no benefit in using scaphoid-type casts rather than Colles'-type casts to reduce wrist motion.


Assuntos
Moldes Cirúrgicos , Fraturas Ósseas/terapia , Pronação/fisiologia , Contenções , Supinação/fisiologia , Articulação do Punho/fisiologia , Adolescente , Adulto , Voluntários Saudáveis , Humanos , Pessoa de Meia-Idade , Dispositivos Ópticos , Óptica e Fotônica , Osso Escafoide/lesões , Adulto Jovem
8.
PLoS One ; 14(1): e0203417, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30682010

RESUMO

BACKGROUND: Gait analysis can be used to measure variations in joint function in patients with knee osteoarthritis (OA), and is useful when observing longitudinal biomechanical changes following Total Knee Replacement (TKR) surgery. The Cardiff Classifier is an objective classification tool applied previously to examine the extent of biomechanical recovery following TKR. In this study, it is further developed to reveal the salient features that contribute to recovery towards healthy function. METHODS: Gait analysis was performed on 30 patients before and after TKR surgery, and 30 healthy controls. Median TKR follow-up time was 13 months. The combined application of principal component analysis (PCA) and the Cardiff Classifier defined 18 biomechanical features that discriminated OA from healthy gait. Statistical analysis tested whether these features were affected by TKR surgery and, if so, whether they recovered to values found for the controls. RESULTS: The Cardiff Classifier successfully discriminated between OA and healthy gait in all 60 cases. Of the 18 discriminatory features, only six (33%) were significantly affected by surgery, including features in all three planes of the ground reaction force (p<0.001), ankle dorsiflexion moment (p<0.001), hip adduction moment (p = 0.003), and transverse hip angle (p = 0.007). All but two (89%) of these features remained significantly different to those of the control group after surgery. CONCLUSIONS: This approach was able to discriminate gait biomechanics associated with knee OA. The ground reaction force provided the strongest discriminatory features. Despite increased gait velocity and improvements in self-reported pain and function, which would normally be clinical indicators of recovery, the majority of features were not affected by TKR surgery. This TKR cohort retained pre-operative gait patterns; reduced sagittal hip and knee moments, decreased knee flexion, increased hip flexion, and reduced hip adduction. The changes that were associated with surgery were predominantly found at the ankle and hip, rather than at the knee.


Assuntos
Artroplastia do Joelho , Marcha , Articulação do Joelho , Osteoartrite do Joelho , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia
9.
Arch Rehabil Res Clin Transl ; 1(3-4): 100022, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33543053

RESUMO

OBJECTIVES: To review the literature regarding gait retraining to reduce knee adduction moments and their effects on hip and ankle biomechanics. DATA SOURCES: Twelve academic databases were searched from inception to January 2019. Key words "walk*" OR "gait," "knee" OR "adduction moment," "osteoarthriti*" OR "arthriti*" OR "osteo arthriti*" OR "OA," and "hip" OR "ankle" were combined with conjunction "and" in all fields. STUDY SELECTION: Abstracts and full-text articles were assessed by 2 individuals against a predefined criterion. DATA SYNTHESIS: Of the 11 studies, sample sizes varied from 8-40 participants. Eight different gait retraining styles were evaluated: hip internal rotation, lateral trunk lean, toe-in, toe-out, increased step width, medial thrust, contralateral pelvic drop, and medial foot weight transfer. Using the Black and Downs tool, the methodological quality of the included studies was fair to moderate ranging between 12 of 25 to 18 of 28. Trunk lean and medial thrust produced the biggest reductions in first peak knee adduction moment. Studies lacked collective sagittal and frontal plane hip and ankle joint biomechanics. Generally, studies had a low sample size of healthy participants with no osteoarthritis and assessed gait retraining during 1 laboratory visit while not documenting the difficulty of the gait retraining style. CONCLUSIONS: Gait retraining techniques may reduce knee joint loading; however, the biomechanical effects to the pelvis, hip, and ankle is unknown, and there is a lack of understanding for the ease of application of the gait retraining styles.

10.
PLoS One ; 12(4): e0174670, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28369104

RESUMO

This study aims to examine alternative methods of normalization that effectively reflect muscle activity as compared to Maximal Voluntary Contraction (MVC). EMG data recorded from knee flexion-extension muscles in 10 control subjects during the stance phase of the gait cycle were examined by adopting different approaches of normalization: MVC, Mean and Peak Dynamic during gait cycles, (MDM and PDM, respectively), Peak Dynamic during activities of daily living (ADLs), (*PDM), and a combination of ADLs and MVC(**PDM). Intra- and inter-individual variability were calculated to determine reliability and similarity to MCV. **PDM showed excellent reliability across subjects in comparison to MVC, where variance ratio ranged from 0.43-0.99 for **PDM and 0.79-1.08 for MVC. Coefficient of variability showed a similar trend to Variance Ratio, ranging from 0.60-1.25 for **PDM and 1.97-3.92 for MVC. Both MVC and **PDM, and to some extent *PDM, demonstrated good-to-excellent relative amplitude's matching; i.e. root mean square difference and absolute difference were both around 0.08 for Vastus medialis to about 4 for Medial gastrocnemius. It was concluded that **PDM and *PDM were reliable, **PDM mirrored MVC and thus could be used as an alternative to MVC for subjects who are unable to provide the required effort for MVC testing. Where MVC testing is not possible, *PDM is the next preferred option.


Assuntos
Atividades Cotidianas , Eletromiografia/métodos , Marcha/fisiologia , Contração Isométrica/fisiologia , Contração Muscular/fisiologia , Músculo Esquelético/fisiologia , Caminhada/fisiologia , Humanos , Articulação do Joelho/fisiologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-25898862

RESUMO

The purpose of this study is to assess changes in subjective and objective function from pre- to post-knee arthroplasty (KA) using a combined classifier technique. Twenty healthy adults (50-80 years) and 31 KA patients (39-81 years) were studied (4 weeks pre- and 6 months post-KA). Questionnaire measures of subjective pain, joint stability, activity and function were collected. Objective functional assessment included goniometry, ultrasound imaging and 3-D motion analysis/inverse modelling of gait and sit-stand. An optimal set of variables were used to classify function using the Cardiff Dempster-Shafer theory (DST) method. Out of sample accuracy of the classifiers ranged between 90% and 94% for segregating healthy individuals and pre-KA patients. Post-KA subjective function improved with 74% classified as healthy. However, there was minimal improvement in objective measures (23% classified as healthy). The novel use of Cardiff DST segregated KA patients from healthy individuals and estimated changes in function from pre- to post-surgery. KA patients had improved pain and function post-operation but objective knee joint measures remained different to healthy individuals.


Assuntos
Artroplastia do Joelho/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Antropometria , Análise Discriminante , Feminino , Marcha , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Análise de Componente Principal
12.
Ann Biomed Eng ; 43(2): 363-75, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25613485

RESUMO

This paper compares the frontal plane hip function of subject's known to have had hip arthroplasty via either the lateral (LA) or posterior (PA) surgical approaches and a group of subjects associated with no pathology (NP). This is investigated through the Trendelenburg test using 3D motion analysis and classification. Here, a recent development on the Classification and Ranking Belief Simplex (CaRBS) technique, able to undertake n-state classification, so termed NCaRBS is employed. The relationship between post-operative hip function measured during a Trendelenburg Test using three patient characteristics (pelvic obliquity, frontal plane hip moment and frontal plane hip power) of LA, PA and NP subjects are modelled together. Using these characteristics, the classification accuracy was 93.75% for NP, 57.14% for LA, 38.46% for PA. There was a clear distinction between NP and post-surgical function. 3/6 LA subjects and 6/8 PA subjects were misclassified as having NP function, implying that greater function is restored following the PA to surgery. NCaRBS achieved a higher accuracy (65.116%) than through a linear discriminant analysis (48.837%). A Neural Network with two-nodes achieved the same accuracy (65.116%) and as expected was further improved with three-nodes (69.767%). A valuable benefit to the employment of the NCaRBS technique is the graphical exposition of the contribution of patient characteristics to the classification analysis.


Assuntos
Artroplastia de Quadril , Modelos Biológicos , Postura , Análise Discriminante , Humanos , Redes Neurais de Computação
13.
Artigo em Inglês | MEDLINE | ID: mdl-24156508

RESUMO

The aim of this study was to assess the potential of employing a classification tool to objectively classify participants with clinically assessed movement faults (MFs) of the scapula. Six participants with a history of shoulder pain with MFs of the scapula and 12 healthy participants with no movement faults (NMFs) performed a flexion movement control test of the scapula, while scapular kinematic data were collected. Principal component scores and discrete kinematic variables were used as input into a classifier. Five out of the six participants with a history of pain were successfully classified as having scapular MFs with an accuracy of 72%. Variables related to the upward rotation of the scapula had the most influence on the classification. The results of the study demonstrate the potential of adopting a multivariate approach in objective classification of participants with altered scapular kinematics in pathological groups.


Assuntos
Transtornos dos Movimentos/classificação , Movimento/fisiologia , Amplitude de Movimento Articular/fisiologia , Escápula/fisiologia , Articulação do Ombro/fisiologia , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Análise de Componente Principal , Rotação
14.
Eur Spine J ; 22 Suppl 1: S10-5, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23288458

RESUMO

OBJECTIVE: To compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars at restricting cervical spine movement in the sagittal, coronal and axial planes. METHODS: Nineteen healthy volunteers (12 female, 7 male) were recruited to the study. Collars were fitted by an approved physiotherapist. Eight ProReflex (Qualisys, Sweden) infrared cameras were used to track the movement of retro-reflective marker clusters placed in predetermined positions on the head and trunk. 3D kinematic data were collected during forward flexion, extension, lateral bending and axial rotation from uncollared to collared subjects. The physiological range of motion in the three planes was analysed using the Qualisys Track Manager System. RESULTS: The Aspen and Philadelphia were significantly more effective at restricting flexion/extension than the Vista (p < 0.001), Miami-J (p < 0.001 and p < 0.01) and Miami-J Advanced (p < 0.01 and p < 0.05). The Aspen was significantly more effective at restricting rotation than the Vista (p < 0.001) and the Miami-J (p < 0.05). The Vista was significantly the least effective collar at restricting lateral bending (p < 0.001). CONCLUSION: Our motion analysis study found the Aspen collar to be superior to the other collars when measuring restriction of movement of the cervical spine in all planes, particularly the sagittal and transverse planes, while the Aspen Vista was the least effective collar.


Assuntos
Vértebras Cervicais/fisiologia , Aparelhos Ortopédicos , Adolescente , Adulto , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Adulto Jovem
15.
Gait Posture ; 37(1): 32-6, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22841587

RESUMO

Knee osteoarthritis is common and patients frequently complain that they are 'overloading' the joints of the opposite leg when they walk. However, it is unknown whether moments or co-contractions are abnormal in the unaffected joints of patients with single joint knee osteoarthritis, or how they change following treatment of the affected knee. Twenty patients with single joint medial compartment knee osteoarthritis were compared to 20 asymptomatic control subjects. Gait analysis was performed for normal level gait and surface EMG recordings of the medial and lateral quadriceps and hamstrings were used to investigate co-contraction. Patients were followed up 12 months post-operatively and the analysis was repeated. Results are presented for the first 14 patients who have attended follow-up. Pre-operatively, adduction moment impulses were elevated at both knees and the contra-lateral hip compared to controls. Co-contraction of hamstrings and quadriceps was elevated bilaterally. Post-operatively, moment waveforms returned to near-normal levels at the affected knee and co-contraction fell in the majority of patients. However, abnormalities persisted in the contra-lateral limb with partial or no recovery of both moment waveforms and co-contraction in the majority. Patients with knee osteoarthritis do experience abnormal loads of their major weight bearing joints bilaterally, and abnormalities persist despite treatment of the affected limb. Further treatment may be required if we are to protect the other major joints following joint arthroplasty.


Assuntos
Artroplastia do Joelho/reabilitação , Marcha , Articulações/fisiopatologia , Músculo Esquelético/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Estudos de Casos e Controles , Eletromiografia , Feminino , Articulação do Quadril , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/reabilitação , Suporte de Carga
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