| Background:Knee osteoarthritis has become one of the common diseases in the elderly.In recent years,the proportion of the elderly population has increased,and a large number of knee arthritis patients have emerged.Knee osteoarthritis is mainly characterized by knee joint pain,deformity and dysfunction,and its high disability rate,high treatment costs and other characteristics bring serious negative effects on the life of the elderly population.The risk factors of knee osteoarthritis include age,sex,personal lifestyle and geographical location.Obesity,excessive activity,genetics,metabolism,congenital and acquired deformities greatly increase the prevalence rate of knee arthritis.Patients with knee osteoarthritis showed the characteristic gait of shortened stride length,reduced absolute support time of the affected side,and decreased stride stability.There were also specific changes in the occupation time of each phase during the support of the affected side.Due to the widespread compensation of the healthy side of unilateral knee osteoarthritis,if the abnormal gait is not corrected by timely treatment,it will often involve the other side of the knee and the entire spine,resulting in dysfunction of the relevant parts.Total knee arthroplasty is a common surgical treatment for end-stage knee osteoarthritis.It has become an important field of joint surgery by replacing damaged articular cartilage,meniscus and other structures with artificial joint prostheses to relieve pain,improve function and patients’ quality of life.In patients with knee osteoarthritis,arthroplasty operation can reshape lower limb alignment,restore normal walking ability,reduce the risk of falls and other disease complications.As a quantitative gait analysis method,plantar pressure test can effectively quantify the characteristics biomechanical of lower extremity load,and show high sensitivity in the risk prediction and efficacy evaluation of lower extremity diseases.The use of plantar pressure test finely divided plantar region and dynamic parameters to detect the abnormal performance in the gait period can help judge the changes in the condition of knee osteoarthritis patients pre-and postoperative,convenient for adjusting therapeutic plan and guiding the postoperative rehabilitation.Patients with unilateral knee osteoarthritis often show obvious difference in load and support time between the both lower limbs during walking,resulting in abnormal gait of asymmetric walking on both sides.Most current gait studies focus on the description of temporal and spatial parameters of lower limbs,relatively ignoring the systematic study of lower extremity load.It has great significance to analyze the variation rules of lower extremity load and influencing factors of total knee arthroplasty patients for the diagnosis of postoperative musculoskeletal dysfunction.Purpose:The plantar pressure data of patients with KOA and normal elderly people were collected by plantar pressure testing system to compare the difference of peak plantar pressure of bilateral lower extremities in patients with knee osteoarthritis between pre-and postoperative of TKA,and the difference between patients with knee osteoarthritis and normal population.The symmetry index(Symmetry Index,SI)was used to summarize the changes in the symmetry of bilateral plantar pressure and the proportion of KOA patients at each phase of the support period pre-and postoperative,and to analyze the factors for the changes in plantar pressure symmetry and the reasons for the changes in gait period adaptability.Methods:Ten normal elderly people were randomly selected as the control group,and another 10 patients with unilateral knee osteoarthritis who were treated in the First Department of Orthopaedics,people’s Hospital of Huangpi District,Wuhan from June to September 2022 were selected as the experimental group.The data of 16 areas of plantar pressure were collected by Med Track plantar pressure test system of Xinkang Biomedical Technology Company before and 4 weeks after total knee arthroplasty.The peak value of plantar pressure,the proportion of each phase in the support period and the symmetry index were selected as the main parameters for statistical analysis.Results:1.The peak value of plantar pressure in the pre-and postoperative of KOA patients and normal population(1)Before TKA surgery,the pressure of MA,M3 and HM in the healthy side of KOA patients were lower than that of the normal group,while the pressure of CL was higher than that of normal group,there are significant differences(P<0.05).The pressure of FA,MA,HA,M2,M3,HM and HL in the affected side were lower than that in the normal group,there are significant differences(P<0.05).(2)After TKA surgery,the pressure of MA,M2,M3 and HM in the healthy side were lower than that in the normal group,there are significant differences(P<0.05).The pressure of the MA,HA,M2,M3,M4,HM and HL in the affected side were lower than that in the normal group,there are significant differences(P<0.05).(3)The pressure of M1 in the healthy side of KOA patients preoperative was lower than that of postoperative,there are significant differences(P<0.05),while the pressure of TA,MA,HA,T1,M2,M3,CL and HL were higher than that of postoperative,there are significant differences(P<0.05).The pressure of FA,TA,MA,CA,M1,M2,M3,CL and HL in the affected side of KOA patients preoperative were lower than that of the postoperative,there are significant differences(P<0.05).2.The proportion at each phase of support in the pre-and postoperative of KOA patients and the normal population.(1)Before TKA surgery,the proportion of forefoot contact phase in the healthy side of KOA patients was higher than that of the normal group,there are significant differences(P < 0.05),and the proportion of the total foot support phase was lower than that of the normal group,there are significant differences(P<0.05).The proportion of the forefoot contact phase in the affected side was higher than that of the normal population,there are significant differences(P < 0.05),while the proportion of the total foot support phase and push off phase was significantly lower than that of the ipsilateral foot of the normal population,there are significant differences(P < 0.05).(2)After TKA surgery,there were no significant difference in each phase of foot support of both sides between KOA patients and normal population(P>0.05).(3)Before TKA surgery,the proportion of the forefoot contact stage of the healthy forefoot was lower than that of the affected side,and the proportion of the push off phase was higher than that of the affected side,there are significant differences(P<0.05).There were no significant difference between the both sides in each phase of foot support after TKA(P>0.05).3.Plantar pressure symmetry of both sidesThe plantar pressure symmetry index in the FA,MA,M1,M2,and HL of KOA patients higher than that of the normal population,there are significant differences(P<0.05),there was no significant difference of plantar pressure symmetry index between KOA patients and the normal population after TKA(P>0.05),the areas of FA,TA,MA,CA,HA,M1,M2,M3,CL,HM,and HL of preoperative were higher than those of postoperative,there are significant differences(P<0.05).Conclusion:1.The peak pressure in the metatarsal area and the lateral heel area of unilateral KOA patients was significantly lower than normal,and improved four weeks after TKA,but it was still slightly lower than normal;Compared with pre operatively,the increase of plantar pressure was concentrated in the middle foot and the lateral heel area of the affected foot.2.The symmetry of plantar pressure in the second metatarsal area and lateral heel area of KOA patients was significantly lower than normal.4 weeks after TKA,the symmetry in the medial metatarsal area,lateral arch area and heel area of both side was significantly improved. |
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