Analyse clinique et cinématique de la prothèse totale de genou douloureuse

Abstract

Objective: Up to 20% of TKA patients remain unsatisfied post-surgery and lots of them report anterior knee pain. The aim of this study is to compare knee 3D kinematics during gait of TKA patients with anterior knee pain to an asymptomatic TKA group and a healthy control group. TKA patients were recruited following a clinical protocol and control patients following a research protocol. Our hypothesis is that the painful TKA group would exhibit kinematic characteristics during gait that increase patellofemoral (PF) stresses compared to the other two groups. Methods:To add a control group, a preceding validation study was performed to confirm that the data from two different protocols (clinical and research) could be comparable. Finally, a control group of 17 healthy patients and 39 TKA patients were recruited 12 to 36 months post-surgery. 3D knee kinematics during treadmill walking was captured and computed using the KneeKGTM system. Results:. The validation study showed that healthy subjects’ data from a previous protocol could be used in this project to add a control group. Furthermore, painful TKA presented two of the known kinematic characteristics identified for patients suffering from PF syndrome. Indeed, a dynamic flexion contracture with a lower flexion during loading and stance and a loss of excursion in flexion during loading was observed. Also, painful TKA exhibited a valgus alignment during stance which increases the Q angle and lateralizes the patella. In comparison, the pain-free group remained at 4° varus (p<0.01). Conclusions: These results provide new insight on origin of symptoms. Conservative treatments for PF pain syndrome addressing the valgus misalignment have shown to improve symptoms in the past and could be a treatment avenue for painful TKA patients.

Date	2 May 2016
Original language	French
Awarding Institution	École de technologie supérieure
Supervisor	Nicola Hagemeister (Supervisor)