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Knee replacement does not affect contralateral knee loading at early follow-up
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MANCHESTER – Patients with single joint knee osteoarthritis had abnormal gait with a higher adduction moment compared to age-matched controls in a recent gait analysis study presented here.
Total knee replacement surgery, however, did not improve the overall gait and lower extremity joint loading in the patients with osteoarthritis, according to investigators.
“Final gait resulted in elevated moments and elevated co-contractions bilaterally, and this analysis persists despite the index joint having been replaced,” Andrew J. Metcalfe, said in a presentation at the British Orthopaedic Association Congress 2012. “We feel these joints are at risk for abnormal loading.”
Andrew J. Metcalfe
Metcalfe and colleagues at the University Hospital of Wales in Cardiff, Wales, conducted the gait analysis study to confirm if patients with knee osteoarthritis loaded joints in their lower limbs not affected by osteoarthritis any differently, and if knee arthroplasty can “treat” that problem.
“This is an important question. In previous work we found 80% of patients with single joint knee [osteoarthritis] OA will develop bilateral disease over a longer period,” he said.
Metcalfe and colleagues studied the gait and took electromyography measurements in 20 patients 69 years old with unilateral knee osteoarthritis and performed the same studies in 20 patients aged 68 years who served as controls. They had 12-month follow-up data for 15 patients in the active group.
In the study group, the investigators saw “a significant increase in co-contraction bilaterally and that was [with] increased joint action forces with co-contractures and combined contractures of quadriceps and hamstrings, and that increases joint action forces,” Metcalfe said.
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Resolving this problem may involve providing patients with gait training, “although that’s a subject for future study,” he said.
Metcalfe noted that despite the few patients in the study, the gait results were statistically significant.
Reference:
Metcalfe A, Stewart C, Postans N, et al. Abnormal loading of the other joints in patient with knee osteoarthritis, and the response to knee replacement. Presented at the British Orthopaedic Association Congress 2012. Sept. 11-14. Manchester.
