Gait analysis after total knee arthroplasty assisted by three-dimensional printing navigation template_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Maolin ,  YANG Liu , HE Rui , CHEN Guangxing , GUO Lin , DUAN Xiaojun , ZHANG Ying , SUN Jiawei , FAN Huaquan

Center for Joint Surgery, the First Affiliated Hospital, Army Medical University, Chongqing, 400038, P.R.China;

Corresponding author：

YANG Liu, Email: jointsurgery@163.com

Keywords：

Three-dimensional printing technology; navigation template; total knee athroplasty; gait analysis; kinematics

DOI：

10.7507/1002-1892.201902068

Video：

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Objective To explore the gait trajectory characteristics of patients after total knee arthroplasty (TKA) assisted by three-dimensional (3D) printing navigation template.Methods Twenty female patients (20 knees) with knee osteoarthritis who were treated with TKA assisted by 3D printing navigation template between February 2017 and February 2018 were selected as the 3D printing group. The patients were 50-69 years old, with an average age of 57.2 years. The disease duration was 4-7 years, with an average of 5.6 years. The osteoarthritis was classified as Kellgren-Lawrence Ⅲ level in 5 cases and Ⅳ level in 15 cases. The preoperative hip-knee-ankle angle (HKA) was (170.8±5.6)°. All patients were varus deformity. According to age and affected side, 20 healthy female volunteers were selected as the control group. The volunteers were 51-70 years old, with an average age of 56.7 years. Preoperative HKA was (178.8±0.6)°. There was significant difference in HKA between the two groups (P>0.05). The HKA, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and visual analogue scale (VAS) scores of the 3D printing group before and after operation were compared. At 6 months after operation, the gait trajectory characteristics of 3D printing group and control group were analyzed by Vicon gait capture system. The kinematics parameters included velocity, cadence, stride length, maximum knee flexion angle (stance), minimum knee flexion angle (stance), maximum knee flexion angle (swing), mean hip rotation angle (stance), mean ankle rotation angle (stance).Results The incisions of 3D printing group healed by first intention, with no complications. All patients were followed up 7-12 months (mean, 9.0 months). The WOMAC and VAS scores at 6 months after operation were significant lower than those before operation (P<0.05). The HKA was (178.8±0.8)° at 4 weeks after operation and the difference was significant when compared with that before operation (t=39.203, P=0.000). The position of the prosthesis was good. The femoral posterior condyle osteotomy line, surgical transepicondylar axis, and patella transverse line were parallel, varus deformity was corrected, and lower limb alignment was restored to neutral position. Gait analysis at 6 months after operation showed that the differences in all kinematics parameters between the two groups were significant (P<0.05).Conclusion Assisted by 3D printing navigation template, TKA can alleviate pain symptoms and correct deformity, with satisfactory early effectiveness. Compared with healthy people, the early postoperative gait of the patients were characterized by decreasing velocity, cadence, stride length, knee flexion range, and increasing compensatory hip and ankle rotation range.

Citation： SUN Maolin, YANG Liu, HE Rui, CHEN Guangxing, GUO Lin, DUAN Xiaojun, ZHANG Ying, SUN Jiawei, FAN Huaquan. Gait analysis after total knee arthroplasty assisted by three-dimensional printing navigation template. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(8): 953-959. doi: 10.7507/1002-1892.201902068 Copy

1.	Hoorntje A, Witjes S, Koenraadt K, et al. More severe preoperative Kellgren-Lawrence grades of knee osteoarthritis were partially associated with better postoperative patient-reported outcomes in TKA patients. J Knee Surg, 2019, 32(3): 211-217.
2.	Onuora S. Arthroscopy does not delay TKA for knee OA. Nat Rev Rheumatol, 2018, 14(2): 62.
3.	Dexel J, Beyer F, Lützner C, et al. TKA for posttraumatic osteoarthritis is more complex and needs more surgical resources. Orthopedics, 2016, 39(3 Suppl): S36-S40.
4.	杜明昌, 柳椰, 翟良全, 等. 定制 3D 打印截骨导板辅助双膝关节同期置换的临床疗效观察. 中华关节外科杂志(电子版), 2018, 12(1): 18-23.
5.	刘峰, 张勇, 朱庭标, 等. 3D 打印截骨导板辅助 TKA 治疗膝外翻畸形. 中国骨与关节损伤杂志, 2017, 32(3): 329-331.
6.	刘奕宁, 刘利春, 李晓彬, 等. 3D 打印截骨导板在 TKA 术中的应用效果分析. 中国骨与关节损伤杂志, 2019, 34(2): 142-145.
7.	Yeo JH, Seon JK, Lee DH, et al. No difference in outcomes and gait analysis between mechanical and kinematic knee alignment methods using robotic total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1142-1147.
8.	Castelli CC, Falvo DA, Iapicca ML, et al. Rotational alignment of the femoral component in total knee arthroplasty. Ann Transl Med, 2016, 4(1): 4.
9.	刘德健, 李彦林, 蔡国锋, 等. 3D 打印截骨导板辅助人工全膝关节置换术早期疗效分析. 中国修复重建外科杂志, 2018, 32(7): 899-905.
10.	王平, 赵志江, 付卫杰, 等. 人工全膝关节置换术中股骨假体旋转的研究进展. 中国修复重建外科杂志, 2011, 25(9): 1140-1144.
11.	Amaranath JE, Moopanar TR, Sorial RM. Defining distal femoral anatomy for rotational alignment in total knee arthroplasty: a magnetic resonance imaging-based study. ANZ J Surg, 2014, 84(11): 852-855.
12.	Jabalameli M, Moradi A, Bagherifard A, et al. Evaluation of distal femoral rotational alignment with spiral CT scan before total knee arthroplasty (A Study in Iranian population). Arch Bone Jt Surg, 2016, 4(2): 122-127.
13.	Lee JK, Lee S, Chun SH, et al. Rotational alignment of femoral component with different methods in total knee arthroplasty: a randomized, controlled trial. BMC Musculoskelet Disord, 2017, 18(1): 217.
14.	Aihara AY, Cardoso FN, Debiex P, et al. Femoral component axial rotation in the gap-balancing approach to total knee arthroplasty: measurement by computed tomography. J Arthroplasty, 2018, 33(4): 1222-1230.e2.
15.	Hsu WH, Himeno S, Coventry MB, et al. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res, 1990, (255): 215-227.
16.	Baczkowicz D, Skiba G, Czerner M, et al. Gait and functional status analysis before and after total knee arthroplasty. Knee, 2018, 25(5): 888-896.
17.	Astephen Wilson JL, Dunbar MJ, Hubley-Kozey CL. Knee joint biomechanics and neuromuscular control during gait before and after total knee arthroplasty are sex-specific. J Arthroplasty, 2015, 30(1): 118-125.
18.	McClelland JA, Feller JA, Webster KE. Sex differences in gait after total knee arthroplasty. J Arthroplasty, 2018, 33(3): 897-902.
19.	Bonnefoy-Mazure A, Martz P, Armand S, et al. Influence of body mass index on sagittal knee range of motion and gait speed recovery 1-year after total knee arthroplasty. J Arthroplasty, 2017, 32(8): 2404-2410.

1. Hoorntje A, Witjes S, Koenraadt K, et al. More severe preoperative Kellgren-Lawrence grades of knee osteoarthritis were partially associated with better postoperative patient-reported outcomes in TKA patients. J Knee Surg, 2019, 32(3): 211-217.
2. Onuora S. Arthroscopy does not delay TKA for knee OA. Nat Rev Rheumatol, 2018, 14(2): 62.
3. Dexel J, Beyer F, Lützner C, et al. TKA for posttraumatic osteoarthritis is more complex and needs more surgical resources. Orthopedics, 2016, 39(3 Suppl): S36-S40.
4. 杜明昌, 柳椰, 翟良全, 等. 定制 3D 打印截骨导板辅助双膝关节同期置换的临床疗效观察. 中华关节外科杂志(电子版), 2018, 12(1): 18-23.
5. 刘峰, 张勇, 朱庭标, 等. 3D 打印截骨导板辅助 TKA 治疗膝外翻畸形. 中国骨与关节损伤杂志, 2017, 32(3): 329-331.
6. 刘奕宁, 刘利春, 李晓彬, 等. 3D 打印截骨导板在 TKA 术中的应用效果分析. 中国骨与关节损伤杂志, 2019, 34(2): 142-145.
7. Yeo JH, Seon JK, Lee DH, et al. No difference in outcomes and gait analysis between mechanical and kinematic knee alignment methods using robotic total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2019, 27(4): 1142-1147.
8. Castelli CC, Falvo DA, Iapicca ML, et al. Rotational alignment of the femoral component in total knee arthroplasty. Ann Transl Med, 2016, 4(1): 4.
9. 刘德健, 李彦林, 蔡国锋, 等. 3D 打印截骨导板辅助人工全膝关节置换术早期疗效分析. 中国修复重建外科杂志, 2018, 32(7): 899-905.
10. 王平, 赵志江, 付卫杰, 等. 人工全膝关节置换术中股骨假体旋转的研究进展. 中国修复重建外科杂志, 2011, 25(9): 1140-1144.
11. Amaranath JE, Moopanar TR, Sorial RM. Defining distal femoral anatomy for rotational alignment in total knee arthroplasty: a magnetic resonance imaging-based study. ANZ J Surg, 2014, 84(11): 852-855.
12. Jabalameli M, Moradi A, Bagherifard A, et al. Evaluation of distal femoral rotational alignment with spiral CT scan before total knee arthroplasty (A Study in Iranian population). Arch Bone Jt Surg, 2016, 4(2): 122-127.
13. Lee JK, Lee S, Chun SH, et al. Rotational alignment of femoral component with different methods in total knee arthroplasty: a randomized, controlled trial. BMC Musculoskelet Disord, 2017, 18(1): 217.
14. Aihara AY, Cardoso FN, Debiex P, et al. Femoral component axial rotation in the gap-balancing approach to total knee arthroplasty: measurement by computed tomography. J Arthroplasty, 2018, 33(4): 1222-1230.e2.
15. Hsu WH, Himeno S, Coventry MB, et al. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res, 1990, (255): 215-227.
16. Baczkowicz D, Skiba G, Czerner M, et al. Gait and functional status analysis before and after total knee arthroplasty. Knee, 2018, 25(5): 888-896.
17. Astephen Wilson JL, Dunbar MJ, Hubley-Kozey CL. Knee joint biomechanics and neuromuscular control during gait before and after total knee arthroplasty are sex-specific. J Arthroplasty, 2015, 30(1): 118-125.
18. McClelland JA, Feller JA, Webster KE. Sex differences in gait after total knee arthroplasty. J Arthroplasty, 2018, 33(3): 897-902.
19. Bonnefoy-Mazure A, Martz P, Armand S, et al. Influence of body mass index on sagittal knee range of motion and gait speed recovery 1-year after total knee arthroplasty. J Arthroplasty, 2017, 32(8): 2404-2410.

Chinese Journal of Reparative and Reconstructive Surgery

Gait analysis after total knee arthroplasty assisted by three-dimensional printing navigation template

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