Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Effect of an Exercise Program in Gait Asymmetry in Patients after Total Knee Arthroplasty.

Neto3,  Francisco J. Maia, Almeida2,  Gustavo J. M., Fitzgerald1,  G. Kelley, Piva3,  Sara R.

Univ of Pittsburgh, Pittsburgh, PA
University of Pittsburgh
University of Pittsburgh, Pittsburgh, PA

Purpose:

Total knee arthroplasty (TKA) relieves pain and improves quality of life in end-stage knee osteoarthritis (OA). Unfortunately, significant functional deficits, such as gait asymmetry, often persist for years after TKA. Gait asymmetry may expose subjects to greater risk of developing OA in other weight-bearing joints. To prevent possible consequences of gait asymmetry, exercise interventions should target such impairment. We have developed and implemented an intense exercise program after TKA. The program includes balance exercises and movement control activities. The aim of this study was to determine if an intense exercise program that included balance and movement control activities decreases gait asymmetry in subjects after TKA.

Methods:

Pre-test/post-test design. Subjects underwent unilateral TKA 2–6 months prior to the study. Patients completed 12 sessions of supervised exercise over 6 weeks, followed by 4 months of home exercise program (2x/week). Data were collected prior to intervention (pre) and at the end of the home exercise program (6 mo). Gait parameters were measured using the GAITRite walkway (CIR Systems Inc). Patients walked at a self-selected pace over the GAITRite. Step length was the spatial gait parameter; while the temporal parameters were loading, single support, and unloading times of the stance phase. To account for the effect of gait speed, the temporal parameters were analyzed as a percentage of the gait cycle. Spatial and temporal gait parameters between the surgical and non-surgical legs (at pre and 6mo) were analyzed using paired t-test.

Results:

Twenty-five subjects participated. Mean age and BMI were 68.8±7.7 years and 29.9±4.5 respectively. Nineteen patients were females (76%), and 13 patients (52%) had surgery on the right side. At baseline, loading time was significantly longer in the surgical than the non-surgical side (15.3 ± 1.6 vs 14.7 ± 1.6 % of gait cycle, p=.02). Single support time was shorter in the surgical (34.8 ± 1.6 vs 35.4 ± 1.6 % of gait cycle, p=.02). Differences were not statistically significant for unloading time and step length. At 6 months, there were no significant differences between surgical and non-surgical sides. The Figure demonstrates that, at 6 months, the subjects decreased the time spent during loading, and increased the time spent during single support in the surgical side. Although not significant, step length became slightly larger in the surgery side compared to the non-surgical.

Figure. Loading (A), single support (B), and unloading (C) phases of gait from pre-intervention to the 6 months follow-up. Dashed lines represent the surgical lower extremity, whereas the solid lines represent the non-surgical side.

Conclusion:

Spatial and temporal gait asymmetries after TKA were mainly during the loading and single support phases of stance. The exercise program seemed beneficial to decrease temporal gait asymmetries. If our results are confirmed in larger studies, intense exercises programs that include balance and movement control activities should be considered for subjects after TKA with asymmetrical gait.

To cite this abstract, please use the following information:
Neto, Francisco J. Maia, Almeida, Gustavo J. M., Fitzgerald, G. Kelley, Piva, Sara R.; The Effect of an Exercise Program in Gait Asymmetry in Patients after Total Knee Arthroplasty. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2059
DOI: 10.1002/art.29824

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