J Korean Orthop Assoc.  2007 Aug;42(4):505-514. 10.4055/jkoa.2007.42.4.505.

A Comparison of Gait Analysis after Total Knee Arthroplasty and Unicompartmental Knee Arthroplasty in the Same Patient

• Choy WS
• Kim HY
• Kim KJ
• Kam BS

• KMID: 2186513
• DOI: http://doi.org/10.4055/jkoa.2007.42.4.505

Abstract

PURPOSE: To compare the gait characteristics of unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) performed on the same patient.
MATERIALS AND METHODS
Twelve female patients with advanced degenerative arthritis of both knee joints were enrolled for the study group. The mean age was 70.3 (64-74) years old. One side of the knee joint had been replaced with UKA and the other side with TKA. The mean follow-up period was 11.8 months for the UKA side and 14.8 months for TKA side. The clinical and radiographic evaluations were performed. The gait features of the study group were assessed using computerized gait analysis. Seven age-matched healthy female volunteers (14 knees) were included as the normal control group.
RESULTS
The clinical and radiographic results improved after joint replacement in both groups. The postoperative gait was almost normalized regardless of the type of surgery performed, with the exception of some parameters including the walking speed, mean pelvic tilt, knee flexion at initial contact, peak knee flexion, knee flexion between initial contact and loading response, knee flexion between initial swing phase and mid-stance phase and ankle 3rd rocker. Knee flexion at the initial contact of UKA and TKA groups was similar, and was different from that of the normal control group. At the loading response, the amount of knee flexion was similar between the three groups. Kinetic data of the first peak vertical ground reaction force and hip extension moment at loading response were better in the UKA group.
CONCLUSION
The gait features were normalized in both groups. The UKA group was better normalized than the TKA group in terms of the aspect of the gait features, whereas TKA group showed better correction of deformities.

Keyword

Knee; Arthritis; Gait analysis; TKA; UKA

MeSH Terms

Ankle
Arthritis
Arthroplasty*
Congenital Abnormalities
Female
Follow-Up Studies
Gait*
Hip
Humans
Joints
Knee Joint
Knee*
Osteoarthritis
Volunteers
Walking

Figure

• 

  Fig. 1 Pelvic kinematics of the UKA and TKA groups. The pelvic motions of both groups showed a normal sinusoidal pattern.

• 

  Fig. 2 Kinematic and kinetic results of the hip joint in the sagittal plane. The hip motion in the sagittal plane (A) were normalized in both UKA and TKA groups. The amount of extensor moment (B) and power generation (C) at the loading response were still less than those in the normal control group.

• 

  Fig. 3 Knee joint kinematics of the UKA and TKA group. The knee joints of the UKA and TKA groups were not fully extended at the initial contact compared with the normal control group, but rather flexed about 14° (A). Knee joint alignment in the coronal plane was corrected in the TKA group (B). The knee joint of the UKA group still shows slight varus alignment (B). Tibial external torsion was well corrected in the TKA side than in the UKA side (C).

• 

  Fig. 4 Kinematic and kinetic results of the ankle joint in the sagittal plane. The first and second rockers were quite similar in the three groups, but the third rockers of the UKA and TKA group were less than the normal control group (A). The ankle push off moment (B) and power generation (C) of TKA group were ≤UKA group.

• 

  Fig. 5 Ground Reaction Force (GRF) of the UKA and TKA groups. The vertical GRF (A) showed two peaks during the loading response and push-off period. The first peak of the vertical GRF was almost normalized in the UKA side. The second peak of the vertical GRF was similar in both groups.

Reference

1. Andriacchi TP. Functional analysis of pre and post-knee surgery: total knee arthroplasty and ACL reconstruction. J Biomech Eng. 1993. 115:575–581.

2. Argenson JN, Chevrol-Benkeddache Y, Aubaniac JM. Modern unicompartmental knee arthroplasty with cement: a three to ten-year follow-up study. J Bone Joint Surg Am. 2002. 84:2235–2239.

3. Barrett DS, Cobb AG, Bentley G. Joint proprioception in normal, osteoarthritic and replaced knees. J Bone Joint Surg Br. 1991. 73:53–56.

4. Berman AT, Zarro VJ, Bosacco SJ, Israelite C. Quantitative gait analysis after unilateral or bilateral total knee replacement. J Bone Joint Surg Am. 1987. 69:1340–1345.

5. Cameron HU, Jung YB. A comparison of unicompartmental knee replacement with total knee replacement. Orthop Rev. 1988. 17:983–988.

6. Chassin EP, Mikosz RP, Andriacchi TP, Rosenberg AG. Functional analysis of cemented medial unicompartmental knee arthroplasty. J Arthroplasty. 1996. 11:553–559.

7. Chung CY, Seong SC, Lee MC, Moon YW, Kim TG, Lim ST. Gait analysis after total knee arthroplasty. J Korean Orthop Assoc. 1997. 32:1290–1301.

8. Chung CY, Park MS, Choi IH, Cho TJ, Yoo WJ, Kim JY. Three dimensional gait analysis in normal Korean: a preliminary report. J Korean Orthop Assoc. 2005. 40:83–88.

9. Collopy MC, Murray MP, Gardenr GM, DiUlio RA, Gore DR. Kinesiologic measurements of functional performance before and after geometric total knee replacement: one-year follow-up of twenty cases. Clin Orthop Relat Res. 1977. 126:196–202.

10. Dennis D, Komistek R, Scuderi G, et al. In vivo three-dimensional determination of kinematics for subjects with a normal knee or a unicompartmental or total knee replacement. J Bone Joint Surg Am. 2001. 83:Suppl 2. (Pt 2):104–115.

11. Dorr LD, Ochsner JL, Gronley J, Perry J. Functional comparison of posterior cruciate-retained versus cruciate-sacrificed total knee arthroplasty. Clin Orthop Relat Res. 1988. 236:36–43.

12. Ferkul D, Peat M, Woodbury MG. Changes in temporal characteristics and knee joint angles in total knee arthroplasty patients. Physiotherapy Canada. 1982. 34:313–318.

13. Insall J, Walker P. Unicondylar knee replacement. Clin Orthop Relat Res. 1976. 120:83–85.

14. Kaufman KR, Hughes C, Morrey BF, Morrey M, An KN. Gait characteristics of patients with knee osteoarthritis. J Biomech. 2001. 34:907–915.

15. Kettelkamp DB, Nasca R. Biomechanics and knee replacement arthroplasty. Clin Orthop Relat Res. 1973. 94:8–14.

16. Kim HY. Gait Analysis of the Patients with Degenerative Arthritis in the Bilateral Knee Joints. 2006. Graduate School of Medicine, WonKwang University;Dissertation of Doctor's degree.

17. Laskin RS. Unicompartmental tibiofemoral resurfacing arthroplasty. J Bone Joint Surg Am. 1978. 60:182–185.

18. Laurencin CT, Zelicof SB, Scott RD, Ewald FC. Unicompartmental versus total knee arthroplasty in the same patient. A comparative study. Clin Orthop Relat Res. 1991. 273:151–156.

19. Marmor L. Unicompartmental arthroplasty of the knee with a minimum ten-year follow-up period. Clin Orthop Relat Res. 1988. 228:171–177.

20. Mattsson E, Olsson E, Brostrom LA. Assessment of walking before and after unicompartmental knee arthroplasty. A comparison of different methods. Scand J Rehabil Med. 1990. 22:45–50.

21. Murray MP, Gore DR, Laney WH, Gardner GM, Mollinger LA. Kinesiologic measurements of functional performance before and after double compartment Marmor knee arthroplasty. Clin Orthop Relat Res. 1983. 173:191–199.

22. Olsson E, Barck A. Correlation between clinical examination and quantitative gait analysis in patients operated upon with the Gunston-Hult knee prosthesis. Scand J Rehabil Med. 1986. 18:101–106.

23. Otsuki T, Nawata K, Okuno M. Quantitative evaluation of gait pattern in patients with osteoarthrosis of the knee before and after total knee arthroplasty. Gait analysis using a pressure measuring system. J Orthop Sci. 1999. 4:99–105.

24. Padgett DE, Stern SH, Insall JN. Revision total knee arthroplasty for failed unicompartmental replacement. J Bone Joint Surg Am. 1991. 73:186–190.

25. Patil S, Colwell CW, Ezzet KA, D'Lima DD. Can normal knee kinematics be restored with unicompartmental knee replacement? J Bone Joint Surg Am. 2005. 87:332–338.

26. Scott RD, Cobb AG, McQueary FG, Thornhill TS. Unicompartmental knee arthroplasty. Eight- to 12-year follow-up evaluation with survivorship analysis. Clin Orthop Relat Res. 1991. 271:96–100.

27. Skinner HB, Barrack RL, Cook SD, Haddad RJ Jr. Ambulatory function in total knee arthroplasty. South Med J. 1983. 76:1237–1240.

28. Webster KE, Wittwer JE, Feller JA. Quantitative gait analysis after medial unicompartmental knee arthroplasty for osteoarthritis. J Arthroplasty. 2003. 18:751–759.

29. Weidenhielm L, Olsson E, Broström LA, Börjesson-Hederström M, Mattsson E. Improvement in gait one year after surgery for knee osteoarthrosis: a comparison between high tibial osteotomy and prosthetic replacement in a prospective randomized study. Scand J Rehabil Med. 1993. 25:25–31.