Ground Reaction Force Patterns in Total vs Uni Knee Replacement
Research type
Research Study
Full title
Characteristics of ground reaction force patterns during treadmill walking at different speeds and inclinations, uphill and downhill in patients with postoperative knee arthoplasty- A comparisson between Total and Unicompartmental implants
IRAS ID
147176
Contact name
Jose D J Salazar-Torres
Contact email
Sponsor organisation
Belfast HSC Trust
Duration of Study in the UK
1 years, 6 months, 0 days
Research summary
Research Summary
Knee osteoarthritis affects people’s quality of life in different degrees, with varying forms of treatment. In principle, these aim to relieve pain and discomfort, to reduce stiffness and to minimise further damage to the joint. Such approaches include physiotherapy, medicines and surgery to replace the diseased joint. Amongst the surgical options, some surgeons feel that it is always best to replace both the knee compartments with a Total Knee Replacement (TKR) and others feel it is best to replace just the damaged component of the knee with a Unicompartmental Knee Replacement (UKR). Unfortunately, existing clinical outcome measures may not be sensitive and/or specific enough to identify subtle but important factors affecting daily activities.
Recent studies suggests that patients with UKR have near normal gait at higher speeds (Wiik et al., 2013)and walk downhill faster (Wiik et al., 2015) when compared with patients with TKR. The limitations of this study are the lack of randomisation, small number of subjects and outcome measurements limited to the vertical ground reaction force. In this project we propose the use of an AMTI instrumented treadmill, capable of measuring vertical, horizontal and transverse ground reaction forces and moments during walking providing information regarding walking ability at different speeds and inclinations up and downhill.
Patients will only need to attend once to walk on the instrumented treadmill located in the physiotherapy gym in Musgrave Park Hospital.
An ongoing UK multicentre prospective superiority randomised controlled trial, TOPKAT is assessing the clinical and cost effectiveness of TKR vs UKR using an appropriate patient base and long term assessments. This study will look at this group of patients, who have already been randomised to a particular type of implant and assess the ground reaction force patterns during treadmill walking.A. V. Wiik, V. Manning, R.K. Strachan, A.A. Amis, J.P. Cobb, Unicompartmental knee arthroplasty enables near normal gait at higher speeds, unlike total knee arthroplasty, J. Arthroplasty. 28 (2013) 176–178. doi:10.1016/j.arth.2013.07.036.
A. V. Wiik, A. Aqil, S. Tankard, A.A. Amis, J.P. Cobb, Downhill walking gait pattern discriminates between types of knee arthroplasty: improved physiological knee functionality in UKA versus TKA, Knee Surgery, Sport. Traumatol. Arthrosc. 23 (2015) 1748–1755. doi:10.1007/s00167-014-3240-x.Summary of Results
Ground reaction forces (GRF) occurring during walking are a result of the ability of the lower limb joints to accelerate and decelerate the displacement of an individual's body weight up and down, front and back, and side to side.
People with osteoarthritis (OA), tend to walk with altered joint patterns due to pain and/or stiffness. Joint replacements aim to restore function by restoring or improving joint range of movement and reduce pain.
Thus, ground reaction forces in people who have had joint replacement are a quantitative measure potentially capable of measuring the effectiveness of the implant.
The aim of this study is to determine the differences between two different types of knee implants, namely Total Knee Replacement (TKR) and Unicompartmental Knee Replacement (UKR). as its name states TKR the overall joint is replaced whereas in UKR only the medial compartment, where OA usually starts is replaced In this study, an instrumented treadmill capable of measuring GRF was used in a subgroup of participants of an existing randomized control trial and age matched comparison group with no history of orthopaedic or neurological involvement while level, and downhill walking at different speeds and uphill walking at different inclines. Oxford knee scores were also recorded preoperatively, and 3 and 12 months postoperatively. Results Maximum walking speed was not significantly different between TKR (5.15 km/hr) and UKR (6.4 km/hr) but the TKR group walked significantly slower than the comparison group (6.86 km/hr, p<0.05)Level walking GRF measurements were compared at the maximum speed all individuals achieved (5km/hr). There were no significant differences in GRF measurements between any of the three groups.
During incline walking at 4km/hr and 10% grade, both, TKR and UKR had lower GRF values than the comparison group during early single support.
During decline walking, there were no significant differences between the three groups when walking at 4km/hr and 10% grade.
REC name
London - City & East Research Ethics Committee
REC reference
16/LO/1425
Date of REC Opinion
27 Jul 2016
REC opinion
Favourable Opinion