Gait analysis before and after corrective osteotomy in patients with knee osteoarthritis and a valgus deformity

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 25; no. 9; pp. 2904 - 2913
• Main Authors: van Egmond, N., Stolwijk, N., van Heerwaarden, R., van Kampen, A., Keijsers, N. L. W.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2017; Springer Nature B.V
• Subjects: Alignment; Ankle; Arthritis; Balance; Biocompatibility; Biomechanical Phenomena - physiology; Bone Malalignment - physiopathology; Bone Malalignment - surgery; Cartilage; Cartilage diseases; Case-Control Studies; Clinical outcomes; Deformation mechanisms; Female; Femur; Femur - physiopathology; Femur - surgery; Gait; Gait - physiology; Hip; Hip Joint - physiology; Humans; Kinematics; Kinetics; Knee; Leg; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteoarthritis; Osteoarthritis, Knee - physiopathology; Osteoarthritis, Knee - surgery; Osteotomy; Pain; Patients; Prospective Studies; Surgical implants; Tibia - physiopathology; Tibia - surgery; Valgus alignment; Closed wedge medial high tibial osteotomy; Supracondylar femoral osteotomy; Double osteotomy; Gait analysis
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-016-4045-x

Purpose In this prospective study, the changes in kinetics and kinematics of gait and clinical outcomes after a varus osteotomy (tibial, femoral or double osteotomy) in patients with osteoarthritis (OA) of the knee and a valgus leg alignment were analysed and compared to healthy subjects. Methods Twelve patients and ten healthy controls were included. Both kinetics and kinematics of gait and clinical and radiographic outcomes were evaluated. Results The knee adduction moment increased significantly postoperatively ( p  < 0.05) and almost similar to the control group. Patients showed less knee and hip flexion/extension motion and moment during gait pre- and postoperatively compared to the controls. A significant improvement was found in WOMAC [80.8 (SD 16.1), p  = 0.000], KOS [74.9 (SD 14.7), p  = 0.018], OKS [21.2 (SD 7.5), p  = 0.000] and VAS-pain [32.9 (SD 20.9), p  = 0.003] in all patients irrespective of the osteotomy technique used. The radiographic measurements showed a mean hip knee ankle (HKA) angle correction of 10.4° (95 % CI 6.4°–14.4°). Conclusion In patients with knee OA combined with a valgus leg alignment, the varus-producing osteotomy is a successful treatment. Postoperatively, the patients showed kinetics and kinematics of gait similar as that of a healthy control group. A significant increase in the knee adduction moment during stance phase was found, which was related to the degree of correction. The HKA angle towards zero degrees caused a medial shift in the dynamic knee loading. The medial shift will optimally restore cartilage loading forces and knee ligament balance and reduces progression of OA or the risk of OA. A significant improvement in all clinical outcomes was also found. Level of evidence III.