Gait analysis in patients after total knee arthroplasty using a threedimensional system OptiTrack

Sažetak: Ugradnja totalne endoproteze kolena predstavlja jednu od najčešćih elektivnih operacija u ortopedskoj hirurgiji. Bez obzira na to, i dalje su aktuelne nesuglasice u smislu ograničenosti restitucije obima pokreta nakon artroplastike kolena kao i procenta nezadovoljstva pacijenata. Cilj: Cilj disertacije predstavlja definisanje uspešnosti hirurške operacije kroz analizu hoda operisanih bolesnika u smislu vraćanja obima pokreta zgloba kolena i normalizacije hoda, kao i da na osnovu analize hoda nakon bilateralne artroplastike hoda ukaže da li postoji razlika u obrascu hoda u zavisnosti od dizajna ugrađene endoproteze. Materijal i metodi: U ispitivanju je učestvovalo 78 pacijenta koji su imali osteoartozu jednog kolena, koje je bilo operisano (artroplastika kolena) a drugo koleno je bilo zdravo i 35 pacijenata kod kojih je urađena bilateralna artroplastika kolena različitih dizajna endoproteze. Podaci su zabeleženi korišćenjem komercijalnog OptiTrack sistema za snimanje kretanja sa šest infracrvenih kamera. Markeri su postavljani na donje ekstremitete pacijenata, i to u tačno određenim anatomskim regionima. Nakon izvršenog snimanja, podataci su obrađeni korišćenjem programskog okruženja MATLAB. Rezultati: Merenjem smo dobili veoma izraženu redukciju u pokretima kod obolelih kolena u odnosu na zdrava. Nakon ugradnje proteze kolena, obim pokreta se povećava i vrednosti se približavaju vrednostima koje su izmerena na zdravom kolenu. Rezultatima je pokazan veći stepen fleksije kod PS u odnosu na CR proteze. Takođe, rezultati pokazuju zanemarljive vrednosti ML translacije, lateralnog međuprostora i medijalnog međuprostora kod oba tipa proteza. Zaključak: U rezultatima smo pokazali da postoji jasna razlika u obrascu kretanja kod pacijenata sa gonartrozom pre i posle ugradnje endoproteze i da se ta razlika uspešno i brzo može utvrditi uz pomoć OptiTrack sistema. Pored toga dokazano je da artroplastika kolena dovodi do normalizacije hoda, ali bez statistički značajne razlike u obimu pokreta nakon ugradnje PS i CR endoproteze kolena.Abstract: Introduction: Implantation of a total knee endoprosthesis represents one of the most common elective procedures in orthopedic surgery. Nevertheless, debate exists regarding the limitations in restoring the motion range after knee arthroplasty and the levels of patiets dissatisfaction. Aim: The aim of this dissertation is to define success of surgery using gait analysis of patients regarding the restoration of the motion range of the knee joint and of normal walking. It also aims to point to the presence of the difference in the gait patterns depending on the design of the implanted endoprothesis and based on the gait analysis after the implantation of bilateral arthroplasty. Materials and Methods: 78 patients with knee osteoarthrosis were examined; total knee arthroplasty was implanted in the patients’ affected knee whereas the other knee was in a healthy state. Bilateral knee arthroplasty was implanted in 35 patients including various endoprosthesis designs. The data was collected with the commercial OptiTrack system for motion detection using six infrared cameras. The markers were placed on the exact anatomical positions of the lower extremities. After recording, the data was processed using the MATLAB program. Results: The measurements show a significant reduction in the motion of affected knees compared to the natural knees in their healthy state. After the implantation of the knee prosthesis, the motion range is increased and the values approximate those of the natural knees in their healthy state. The results show an increased degree of flexion in the PS prostheses compared to the CR ones. Moreover, the results show insignificant values of ML translation, lateral gap, and medial gap in both types of prostheses. Conclusion: The results show that there is a clear difference in gait pattern in patients with gonarthrosis, before and after the implantation of endoprosthesis. This difference can be successfully determined with OptiTrack system. Moreover, it proves that the total knee arthroplasty leads to the restored gait, however without a statistically significant difference in the range of motion after the implantation of the PS and CR knee endoprostheses