Clinical and biomechanical outcome in patients undergoing knee arthroplasty
Knee arthroplasty is still the treatment of choice for end-stage knee osteoarthritis. The Belgian national register for arthroplasty reports that over 20.000 knee replacement procedures are performed each year. Mostly total knee arthroplasty (TKA) is performed. This type of arthroplasty replaces the entire articular surfaces (tibial and femoral) of the knee, including both cruciate ligaments. In contrast, unicondylar knee arthroplasty (UKA) replaces solely the compartment (medial or lateral) that is the most worn out. Furthermore, UKA preserves the integrity of the cruciate ligaments, which are considered to have a crucial role in joint proprioception and stability .
Despite the high prevalence of knee replacement procedures, up to 30% of patients experience difficulties when returning to recreational and work related activities, leaving them dissatisfied with the results of the surgery . Regrettably, the underlying cause for this high dissatisfaction rate is still unclear. Furthermore, there are little to no studies comparing the differences in clinical (muscle strength, mobility, pain and function) and biomechanical (kinematics and kinetics of gait and functional movements) outcome after UKA and TKA. Moreover, Komnik et al. stated in a recent systematic review an urgent need for studies comparing UKA and TKA patients during more demanding tasks of daily living . Therefore, it is of the utmost importance that good quality movement research is conducted to address these shortcomings.
This doctoral project will primarily focus on the longitudinal evaluation of clinical and biomechanical parameters of patients with UKA and TKA. In this longitudinal study, patients will be assessed five times (3 days, 6 weeks, 6 months, 1 year and 2 years postoperatively) during a 2 year follow-up. The clinical outcome measurements will be evaluated by means of standardized questionnaires (functionality), hand held dynamometry (muscle strength) and goniometry (range of motion). The biomechanical variables will be evaluated using inertial measurement units (IMUs). These sensors are lightweight boxes that comprise an accelerometer, gyroscope and a magnetometer. Furthermore, these devices are wireless and battery powered and can therefore be implemented in settings where the use of a standard gait analysis system may be not possible . These features will allow the biomechanical evaluation of patients with UKA and TKA in more realistic, daily situations and in the hospital.
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2. Fridén T, Roberts D, Ageberg E, Waldén M, Zätterström R Review of knee proprioception and the relation to extremity function after an anterior cruciate ligament rupture. The Journal of orthopaedic and sports physical therapy 31:567
3. Komnik I, Weiss S, Fantini Pagani CH, Potthast W (2015) Motion analysis of patients after knee arthroplasty during activities of daily living – A systematic review. Gait & Posture 41:370-377
4. Shull PB, Jirattigalachote W, Hunt MA, Cutkosky MR, Delp SL Quantified self and human movement: A review on the clinical impact of wearable sensing and feedback for gait analysis and intervention. Gait & Posture 40:11-19