PATIENT-SPECIFIC PATTERNS OF PASSIVE AND DYNAMIC KNEE JOINT MECHANICS BEFORE AND AFTER TOTAL KNEE ARTHROPLASTY
Young, Kathryn Louise
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Disregard for patient-specific joint-level variability may be related to decreased functional ability, poor implant longevity and dissatisfaction post-TKA. The purpose of this study was to, 1) compare pre and post-implant intraoperative passive knee adduction angle kinematic patterns and characterize the effect of surgical intervention on each pattern, 2) examine the association between passive pre and post-implant knee kinematics measured intraoperatively and dynamic knee kinematics and kinetics pre and post-TKA measured during gait, and 3) compare dynamic post-TKA kinematic and kinetic patterns between patient-specific knee recipients and traditional TKA recipient. Patients received a TKA using the Stryker Precision Knee navigation system capturing pre/post-implant kinematics through a passive range of flexion. One-week prior and 1-year post-TKA patients underwent three-dimensional gait analysis. Knee joint waveforms were calculated according to the joint coordinate system. Principal component analysis (PCA) was applied to frontal plane gait angles, moments and navigation angles. Paired two- tailed t-tests were used to compare principal component (PC) scores between pre and post-implant patterns, and a one-way ANOVA was used to test if post-implant patterns were significantly different from zero. Two-tailed Pearson correlation coefficients tested for associations between navigation and gait PCscores, and an un-paired two-tailed t-test was used to compare PCscores between patient-specific and traditional TKA groups. Six different passive kinematic phenotypes were captured pre-implant. Although some waveform patterns persisted at small magnitudes post-implant (PC1 and PC3: p<0.001), curves remained within the clinically acceptable alignment range through passive motion. A positive correlation was found between navigation adduction angle PC1 and gait adduction moment PC1 pre and post-TKA (p<0.001, r=0.79; p<0.01 r=0.67), and a negative correlation between navigation adduction angle PC1 and gait adduction angle PC1 post-TKA (p=0.03, r=-0.53). The patient-specific group showed significantly lower PC2 scores than the traditional TKA group (p=0.03), describing a lower flexion moment magnitude during early stance phase, possibly representing a functional limitation or non- confidence during gait. These results were an important first step to assess patient- specific approaches to TKA, suggesting possible applications for patient-specific intraoperative kinematics to aid in surgical decision-making and influence functional outcomes.