Effect of alignment strategy on lower limb kinematics during stair descent after robot-assisted total knee arthroplasty

IF 5 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2026-03-31 Epub Date: 2025-09-22 DOI:10.1002/ksa.70070

Zhijun Li, Philip Winnock de Grave, Tamaya Van Criekinge, Thomas Luyckx, Kurt Claeys

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引用次数: 0

Abstract

Purpose

Total knee arthroplasty (TKA) effectively treats end-stage osteoarthritis; however, many patients still struggle with gait and functional movements such as stair descent. This study investigates how two surgical alignment techniques, inverse kinematic alignment (iKA) and adjusted mechanical alignment (aMA), affect lower limb kinematics during stair descent compared to healthy controls.

Methods

Forty-five participants (15 per group: iKA, aMA, controls) performed low (165 mm) and high (280 mm) stair descent tasks. Sagittal hip, knee, and ankle movements were recorded with 3D motion capture and analysed using Statistical Parametric Mapping (SPM).

Results

The aMA group exhibited significantly longer descent times for both low (p = 0.038) and high stairs (p = 0.003). Additionally, the aMA group demonstrated a reduction in trailing knee range of motion (ROM) during low stair descent (80.65°) compared to the control group (92.87°, p = 0.023). The mean joint angle of the trailing hip during low stair descent also differed significantly between the aMA group and healthy controls. Although no significant differences were observed in the trailing hip joint angle during low stair descent between the iKA and healthy control groups, substantial deviations were noted during high stair descent (p = 0.011). Furthermore, the ROM of the leading knee in the iKA group differed significantly from that of the healthy control group during both low and high stair descents.

Conclusions

The iKA group exhibited movement patterns that were slightly more similar to those of healthy controls during low stair descent but showed deviations during the more demanding high stair descent. These findings underscore the need for further research into the mechanisms underlying these adaptations to optimise rehabilitation and surgical strategies aimed at restoring more natural movement patterns in TKA patients.

Level of Evidence

Level III.

查看原文本刊更多论文

机器人辅助全膝关节置换术后下楼梯过程中下肢运动学的影响。

目的：全膝关节置换术（TKA）能有效治疗终末期骨关节炎；然而，许多患者仍然在步态和功能运动方面挣扎，如下楼梯。本研究调查了两种手术对齐技术，逆运动学对齐（iKA）和调整机械对齐（aMA），与健康对照组相比，如何影响楼梯下走时的下肢运动学。方法：45名参与者（每组15人：iKA， aMA，对照组）执行低（165毫米）和高（280毫米）楼梯下降任务。用三维运动捕捉记录髋、膝关节和踝关节矢状面运动，并使用统计参数映射（SPM）进行分析。结果：aMA组在低楼梯（p = 0.038）和高楼梯（p = 0.003）上均表现出较长的下降时间。此外，与对照组（92.87°，p = 0.023）相比，aMA组在低楼梯下行时后膝关节活动范围（ROM）减少（80.65°）。aMA组和健康对照组在低楼梯下降过程中，后髋关节的平均关节角也有显著差异。尽管iKA组与健康对照组在低阶楼梯下走时髋关节角度没有显著差异，但在高阶楼梯下走时存在显著差异（p = 0.011）。此外，在低楼梯和高楼梯下走时，iKA组的前膝关节活动度与健康对照组有显著差异。结论：iKA组在低楼梯下走时表现出的运动模式与健康对照组稍微相似，但在高楼梯下走时表现出偏差。这些发现强调需要进一步研究这些适应的机制，以优化康复和手术策略，旨在恢复TKA患者更自然的运动模式。证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).