Abstract：
BACKGROUND: Gait abnormalities have been described in patients after total knee arthroplasty (TKA), leading to the development of inter-joint coordination abnormalities and increased risk of falling. Such impairments have been reported to persist in the long-term, although the majority of studies assessed gait pattern especially in the first months after TKA.
OBJECTIVE: What are the long-term gait impairments in patients after TKA compared to healthy age-matched subjects?
METHODS: A systematic search was conducted on MEDLINE/PubMed, EMBASE, CENTRAL and Scopus databases. Observational studies or randomized controlled trials investigating gait spatial-temporal, kinematic and kinetics parameters in a time-window longer than 6 months in patients with TKA compared to healthy age-matched subjects were included. Methodological quality was assessed using the modified Downs and Black (D&B) checklist and participants\' characteristics, surgical procedures details and outcome measures were extracted. Pooled or un-pooled findings were categorized into \"6 months - 1 year\" and \"more than 1 year\" timepoint categories.
RESULTS: Twenty-eight studies (976 patients) were included. Overall quality was fair with a mean modified D&B score of 63.5 %. Reduced speed, stride length, cadence and longer stance phase were found in patients when compared to healthy individuals at \"6 months - 1 year\" follow-up. Spatial-temporal parameters deficits were also found at more than 1 year after TKA, where lower single-limb support and longer double-limb support durations were detected. These impairments occurred in concomitance with decreased knee range of motion along the sagittal and frontal planes and altered kinetic parameters. Hip kinematic and kinetic long-term impairments were also detected after TKA.
CONCLUSIONS: These findings highlighted long-term gait pattern alterations in patients with TKA compared to age-matched healthy subjects. Future studies should identify interventions able to reduce long-term gait pattern alterations and improve function in patients after TKA.
OBJECTIVE: What are the long-term gait impairments in patients after TKA compared to healthy age-matched subjects?
METHODS: A systematic search was conducted on MEDLINE/PubMed, EMBASE, CENTRAL and Scopus databases. Observational studies or randomized controlled trials investigating gait spatial-temporal, kinematic and kinetics parameters in a time-window longer than 6 months in patients with TKA compared to healthy age-matched subjects were included. Methodological quality was assessed using the modified Downs and Black (D&B) checklist and participants\' characteristics, surgical procedures details and outcome measures were extracted. Pooled or un-pooled findings were categorized into \"6 months - 1 year\" and \"more than 1 year\" timepoint categories.
RESULTS: Twenty-eight studies (976 patients) were included. Overall quality was fair with a mean modified D&B score of 63.5 %. Reduced speed, stride length, cadence and longer stance phase were found in patients when compared to healthy individuals at \"6 months - 1 year\" follow-up. Spatial-temporal parameters deficits were also found at more than 1 year after TKA, where lower single-limb support and longer double-limb support durations were detected. These impairments occurred in concomitance with decreased knee range of motion along the sagittal and frontal planes and altered kinetic parameters. Hip kinematic and kinetic long-term impairments were also detected after TKA.
CONCLUSIONS: These findings highlighted long-term gait pattern alterations in patients with TKA compared to age-matched healthy subjects. Future studies should identify interventions able to reduce long-term gait pattern alterations and improve function in patients after TKA.
摘要：
背景：已经在全膝关节置换术（TKA）后的患者中描述了步态异常，导致关节间协调异常的发展和跌倒的风险增加。据报道，这种损害长期持续存在，尽管大多数研究评估了步态模式，尤其是在TKA后的头几个月。
目的：与年龄匹配的健康受试者相比，TKA后患者的长期步态障碍是什么？
方法：对MEDLINE/PubMed进行了系统搜索，EMBASE,CENTRAL和Scopus数据库。观察性研究或随机对照试验调查步态的时空，与年龄匹配的健康受试者相比,TKA患者在超过6个月的时间窗内的运动学和动力学参数被纳入.使用修改后的DownsandBlack(D&B)检查表和参与者特征评估方法质量，提取了外科手术细节和结果指标.汇总或未汇总的结果分为“6个月-1年”和“超过1年”时间点类别。
结果：共纳入28项研究（976例患者）。总体质量一般，平均改良D&B得分为63.5%。降低的速度，步幅长度,在“6个月-1年”随访时，与健康个体相比，患者发现了节奏和更长的姿势阶段。在TKA后1年以上也发现了时空参数缺陷，检测到较低的单肢支撑和较长的双肢支撑持续时间。这些损伤伴随着沿着矢状和额面的膝盖运动范围的减小以及动力学参数的改变而发生。TKA后还检测到髋关节运动学和动力学长期损伤。
结论：这些发现强调了TKA患者与年龄匹配的健康受试者相比的长期步态模式改变。未来的研究应该确定能够减少TKA后患者长期步态模式改变并改善功能的干预措施。
目的：与年龄匹配的健康受试者相比，TKA后患者的长期步态障碍是什么？
方法：对MEDLINE/PubMed进行了系统搜索，EMBASE,CENTRAL和Scopus数据库。观察性研究或随机对照试验调查步态的时空，与年龄匹配的健康受试者相比,TKA患者在超过6个月的时间窗内的运动学和动力学参数被纳入.使用修改后的DownsandBlack(D&B)检查表和参与者特征评估方法质量，提取了外科手术细节和结果指标.汇总或未汇总的结果分为“6个月-1年”和“超过1年”时间点类别。
结果：共纳入28项研究（976例患者）。总体质量一般，平均改良D&B得分为63.5%。降低的速度，步幅长度,在“6个月-1年”随访时，与健康个体相比，患者发现了节奏和更长的姿势阶段。在TKA后1年以上也发现了时空参数缺陷，检测到较低的单肢支撑和较长的双肢支撑持续时间。这些损伤伴随着沿着矢状和额面的膝盖运动范围的减小以及动力学参数的改变而发生。TKA后还检测到髋关节运动学和动力学长期损伤。
结论：这些发现强调了TKA患者与年龄匹配的健康受试者相比的长期步态模式改变。未来的研究应该确定能够减少TKA后患者长期步态模式改变并改善功能的干预措施。
