Preoperative and Post-Rehabilitation Predictors of Gait Biomechanics Six Months After Total Knee Arthroplasty

Document Type

Article

Publication Date

11-2025

Publisher

Wiley

Source Publication

Journal of Orthopaedic Research

Source ISSN

0736-0266

Original Item ID

DOI: 10.1002/jor.70052

Abstract

The primary purpose of this study was to determine the preoperative predictors of gait biomechanics 6 months after unilateral total knee arthroplasty (TKA). There were 126 participants (age 64.4 ± 7.1 years, 75 females) who underwent instrumented biomechanical assessments while walking at a self-selected pace preoperatively, 10 weeks after (post-rehabilitation), and 6 months after unilateral TKA. Outcomes were peak knee extension moment (pKEM), knee angle excursion, and vertical ground reaction force (vGRF) ratio (surgical/contralateral). Potential clinical, demographic, and biomechanical predictors were tested univariately and considered a candidate for the final model if p <  0.15. Each multivariate model initially contained all candidates, and backward selection was used to determine the final model. Greater 6-month surgical limb pKEM was predicted (r2 = 0.31) by greater preoperative pKEM (β = 0.44, p <  0.0001), better quadriceps activation (β = 0.23, p = 0.004), and male sex (β = −0.21, p = 0.009). Greater 6-month surgical knee excursion was predicted (r2 = 0.34) by greater preoperative excursion (β = 0.39, p <  0.0001), male sex (β = −0.28, p = 0.0007), and preoperative quadriceps strength (β = 0.16, p = 0.047). Six-month vGRF ratio was predicted (r2 = 0.16) by preoperative vGRF ratio (β = 0.37, p <  0.0001) and study treatment group (β = 0.18, p = 0.03). Preoperative biomechanical variables at post-rehabilitation were also the strongest predictors of 6-month biomechanics.

Statement of Clinical Significance: The strongest and most consistent predictor of gait biomechanics 6 months after TKA was the respective preoperative gait biomechanics variable, which may have important clinical implications for surgical decision making and prehabilitation/rehabilitation strategies. Biofeedback targeting vGRF predicted vGRF symmetry, but no other gait parameters, suggesting targeted interventions are needed. Improving quadriceps strength and activation may also facilitate knee biomechanics.

Comments

Journal of Orthopaedic Research, Vol. 43, No. 11 (November 2025): 1964-1972. DOI.

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