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Title: [Analysis of gait and effectiveness after unicompartmental knee arthroplasty].
Author: Hao P, Yang L, He R, Chen H, Sun M, Liang S.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 Nov 15; 34(11):1369-1375. PubMed ID: 33191692.
Abstract:
OBJECTIVE: To explore the gait trajectory characteristics and effectiveness after unicompartmental knee arthroplasty (UKA). METHODS: Thirty patients (30 knees) with anterior medial compartment osteoarthritis who were treated with UKA between January 2017 and December 2018 were selected as subjects (UKA group). According to age, gender, and side, 30 patients (30 knees) with knee osteoarthritis treated with total knee arthroplasty (TKA) were selected as control (TKA group). In addition to the range of motion (ROM) before operation showing significant difference between the two groups ( t=4.25, P=0.00), there was no significant difference in gender, age, disease duration, sides, body mass index, and preoperative hip-knee-ankle angle (HKA), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups ( P>0.05). The incision length, drainage volume within 24 hours after operation, and the changes of hemoglobin and albumin were recorded. The WOMAC score, ROM, and HKA before and after operation were compared between the two groups. At 1 year after operation, the gait trajectory characteristics of two groups were analyzed by Vicon three-dimensional gait capture system, and the absolute symmetry index (ASI) of the lower limbs of the two groups was calculated. RESULTS: The incisions of the two groups healed by first intention, with no complications. The incision length, drainage volume within 24 hours, and the changes of hemoglobin and albumin after operation in the UKA group were significantly smaller than those in the control group ( P<0.05). All patients were followed up completely, the follow-up time ranged from 13 to 20 months of UKA group (mean, 18 months) and 16 to 24 months of control group (mean, 20 months). The imaging review showed that the lower limb alignment of the two groups were restored to a neutral position, and the position of prosthesis was good. At 1 year after operation, the WOMAC score, HKA, and ROM of two groups were significantly improved when compared with those before operation ( P<0.05); the postoperative WOMAC score and ROM of the UKA group were significantly better than those of the control group ( P<0.05), and there was no significant difference in HKA between the two groups ( t=1.54， P=0.13). Gait analysis at 1 year after operation showed that the walking speed, stride length, knee extension at mid-stance, and flexion at swing in the UKA group were significantly better than those in the TKA group ( P<0.05); there was no significant difference in cadence, knee flexion at initial contact, and knee flexion at loading response between the two groups ( P>0.05). The ASI of bilateral knee flexion in the UKA group was significantly greater than that in the TKA group during the initial contact and loading response period ( P<0.05). CONCLUSION: Compared with TKA, UKA has the advantages of small incision, less blood loss, and quicker functional recovery. The early gait after UKA is mainly manifested as the increase in walking speed, stride length, knee flexion at swing, and extension at mid-stance phase. From the analysis of gait symmetry, during the initial contact and loading response phase, the operation side after UKA undertakes more shock absorption and joint stabilization functions than the contralateral side. 目的: 探讨人工单髁关节置换术（unicompartmental knee arthroplasty，UKA）后步态特点及临床疗效。. 方法: 选择 2017 年 1 月—2018 年 12 月接受 UKA 治疗的 30 例（30 膝）膝关节前内侧间室骨关节炎患者为研究对象（UKA 组）。按照年龄、性别及侧别进行 1∶1 配对，选择接受人工全膝关节置换术（total knee arthroplasty，TKA）治疗的 30 例（30 膝）膝关节骨关节炎患者为对照（TKA 组）。两组患者除术前膝关节活动度（range of motion，ROM）比较差异有统计学意义（ t=4.25， P=0.00）外，性别、年龄、病程、侧别、体质量指数及术前髋-膝-踝角（hip-knee-ankle angle，HKA）、美国西部 Ontario 与 McMaster 大学骨关节炎指数评分（WOMAC）等一般资料比较，差异均无统计学意义（ P>0.05）。记录两组手术切口长度、术后 24 h 引流量、血红蛋白和白蛋白变化值；比较两组手术前后 WOMAC 评分、ROM 及 HKA。术后 1 年使用 Vicon 三维步态系统进行分析，比较两组各步态参数，并计算两组患者双下肢各步态参数的绝对对称指数（absolute symmetry index，ASI）。. 结果: 两组患者术后切口均Ⅰ期愈合，无手术相关并发症发生。UKA 组手术切口长度、术后 24 h 引流量及血红蛋白、白蛋白变化值均明显小于 TKA 组（ P<0.05）。患者均获完整随访，UKA 组随访时间 13～20 个月，平均 18 个月；TKA 组 16～24 个月，平均 20 个月。影像学复查示，两组下肢力线均恢复至中立位，假体位置良好。术后 1 年，两组 WOMAC 评分、ROM 及 HKA 均较术前显著改善（ P<0.05）；其中 UKA 组 WOMAC 评分及 ROM 明显优于 TKA 组（ P<0.05），HKA 组间比较差异无统计学意义（ t=1.54， P=0.13）。术后 1 年步态分析显示，UKA 组步速、步幅、支撑相中期膝关节伸直角度及摆动相膝关节屈曲角度均优于 TKA 组（ P<0.05）；步频、初始着地膝关节屈曲角度、承重反应期膝关节屈曲角度比较差异均无统计学意义（ P>0.05）。UKA 组初始着地与承重反应期膝关节屈曲角度 ASI 明显大于 TKA 组（ P<0.05）。. 结论: 与 TKA 相比，UKA 具有切口小、失血量少、功能恢复快的优势；UKA 术后早期步态主要表现为步速、步幅、支撑相中期与摆动相膝关节屈伸角度的增加。从步态对称性分析，UKA 后在初始着地及承重反应期术侧下肢较对侧下肢承担了更多震荡吸收以及维持关节稳定的功能。.

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