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Rehabilitation Practice and Science

Translated Title

退化性膝關節炎早期之步態變化

Abstract

We design a case control study to evaluate the gait deviations of patients with early osteoarthritis(OA) of the knee, which are subtle and difficult to observe clinically. Twenty-six patients with symptomatic OA were recruited from the outpatient department. The control group consisted of 20 normal subjects who were matched for age, body weight, and body height. Both the patient and control groups were subjected to a similar protocol of gait analysis with comfortable speed. The peak value of angular displacement of pelvic tilt up, pelvic tilt down, knee valgus, ankle dorsifexion, and ankle rotation were significantly lower (p＜0.05) in the OA group. The peak angular displacement of knee varus of the OA group was significantly higher. The OA group also had significant higher peak moment in hip flexion, hip abduction, knee extension, knee valgus and plantarfiexion. However, the peak moment of knee flexion and varus were significantly lower than the control group. Patients tend to restrict the motion of ankle dorsiflexion, ankle rotation, and knee valgus to diminish pain. The decreased pelvic tilt up and down may also be due to the restricted motion of lower leg. The increased varus angular displacement is the result of varus deformity and ligamentous laxity, as a result of the long standing varus deformity of knee joint which transforms the mechanical axis of lower extremity and produces excess loading over the medial compartment. As the varus deformity increases, the valgus moment inevitably increases in order to achieve stability of knee joint during ambulation. The limited range of motion (ROM) at the end stage of knee extension may contribute to the increased extension moment of knee at stance phase to avoid buckling. This limitation of ROM also influences the ankle and hip joints, increasing the joint moment of plantarflexion, hip flexion and hip abduction. The OA group produces negative knee joint power and generate lower ankle joint power than the control group at pre-swing phase. Therefore, we can infer that the OA group can not generate power at pre-swing phase is due to poor propulsive force at pre-swing phase. In conclusion, patients with early osteoarthritis of knee joint have certain gait features during ambulation. The characteristic poor propulsion at pre-swing phase of knee and ankle joints could be an early sign of OA that may was used as a reference of clinical assessment.

Language

English

First Page

123

Last Page

130

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