Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients

After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.膝关节置换术（knee arthroplasty, KA）后，患者在多项日常活动中会出现异常的运动学与动力学表现。现有生物力学研究多聚焦于平地行走，而被证实可显著影响膝关节运动学与动力学的斜坡行走，迄今仍未得到充分关注。本研究旨在分析平地与斜坡地面行走场景，重点探究膝关节置换术患者的膝关节横断面与额状面运动学及动力学特征。研究于全膝关节置换术（total knee arthroplasty, TKA）与单髁膝关节置换术（unicompartmental arthroplasty, UKA）术后1.8±0.4年，采用光电立体摄影测量技术开展三维（3D）运动分析，并借助AnyBody™建模系统完成逆动力学计算。结果显示，相较于健康对照组（control group, CG），全膝关节置换术组在完成下坡行走任务时，膝关节内旋峰值角度显著降低；下坡行走过程中，全膝关节置换术组与单髁膝关节置换术组的膝关节内收力矩第一峰值分别较健康对照组降低27%与22%。无论行走任务类型如何，全膝关节置换术组与单髁膝关节置换术组间均未检测到显著差异。相较于平地行走，下坡行走可更显著地暴露膝关节置换术患者相较于健康对照组的膝关节额状面与横断面异常调节模式。因此，未来开展膝关节置换术患者的运动分析研究时，应纳入斜坡行走场景，以发掘平地行走中不易显现的潜在运动功能缺陷。