Biomechanics of Lower Limbs during Walking among Candidates for Total Knee Arthroplasty with and without Low Back Pain

Abstract

The effect of joint pathologies, such as unilateral knee osteoarthritis (UKOA) or low back pain (LBP), on bilateral gait symmetry has gained increased attention during the past decade. This study is the first to compare gait patterns between patients with UKOA and LBP in combination and with UKOA only. Temporal, kinematic, and kinetic variables were measured bilaterally during gait stance phase in 31 subjects with UKOA and LBP (Group I) and 11 subjects with only UKOA (Group II). Group I patients exhibited less hip rotation in the affected limb (A) than in the nonaffected (NA) limb during walking in contrast to Group II patients. Group I patients had minimal bilateral differences in hip abduction and flexion, but Group II patients displayed significantly larger values in the NA limb compared to the A limb for both parameters. Hip flexion patterns were significantly different between Groups I and II. Subjects in both groups adapted gait patterns that minimized vertical ground reaction force, knee flexion motion, and stance time on the UKOA affected limb. The distinct kinematic gait patterns that were revealed in this study may provide clinical value for assessment of patients with UKOA in conjunction with LBP.

Figure 1

Modified Helen Hayes marker arrangement utilized for 3D motion analysis.

Figure 2

Comparison of vertical ground reaction force (VGRF), hip range of motion (ROM), knee ROM, and stance time symmetry between limbs and groups during gait stance phase. Significant differences (p < 0.05) in the biomechanical parameter measured in the surgically affected (a) limb compared to the nonsurgically affected (NA) limb indicated by an (⋆) displayed above the bar for that variable and that group. The significant differences between groups as determined by post hoc analyses are indicated by an arrow (↔).