Total Diz Artroplastisi Sonrası Erken Dönemde Plantar Basınç Dağılımı Nasıl Değişir? Pilot Çalışma

Year 2019, Volume: 41 Issue: 4, 388 - 398, 01.10.2019

Meltem Isıntaş Arık , Özgen Aras , Hakan Akkan , Nilay Yürekdeler Şahin Vedat Kurt Cihan Caner Aksoy Alaaddin Oktar Üzümcügil

https://doi.org/10.20515/otd.441904

Abstract

Total diz artroplasti (TDA) cerrahisi sonrasında ayak tabanındaki statik ve dinamik yüklenme paternlerinin nasıl
değiştiğini basınç platformu ile değerlendirmektir. Çalışmaya dahil olma
kriterlerini karşılayan 10 hasta (yaş ortalaması 68.5±7.9) alındı. Değerlendirmeler cerrahi öncesinde ve cerrahi
sonrası 15. günde yapıldı. Statik denge parametreleri (ayak ön-arka ve total
yük dağılımları, sağ-sol ayaklardaki ağrılık taşıma oranı, basınç merkezi elips
alanı ve salınım hızı) Zebris™ FDM-2
(zebris® Medical
GmbH, Germany)  cihazı ile
ölçülerek kaydedildi. Olguların
yürüme sırasında hasta tarafta arka ayakta oluşan maksimum kuvveti, bu kuvvetin
oluştuğu yürüme siklusundaki zaman yüzdesi ile orta ayak maksimum basınç
değerleri anlamlı olarak azaldığı bulundu (p<0,05). Olguların ayak rotasyon
dereceleri cerrahi sonrası azaldığı fakat bu azalmanın istatistiksel olarak
anlamlı olmadığı görüldü. Olguların, ayakta statik duruşta, ayağa binen toplam
yük, elips alanı, basınç merkezi (center of pressure (COP)) çizgi uzunluğu ve
COP ortalama hızı cerrahi öncesi ve sonrası ölçüm değerleri arasında anlamlı
bir fark bulunmadı (p>0,05). Hasta tarafta ayakta duruşta ön ayağa binen yük
ölçüm değerleri cerrahi sonrası anlamlı olarak artarken, arka ayağa binen yük
ölçüm değerleri anlamlı derecede azaldığı görüldü (p<0,05). TDA cerrahisi geçiren diz
osteoartritli hastalarda cerrahi sonrası 15. günde statik duruş sırasında arka
ayağa binen yük azalmış, ön ayağa binen yük artmıştır. Cerrahi öncesi ve sonrası kuvvet platformu
kullanılarak yapılan değerlendirmeler, ortopedik cerrahlar için yararlı
olabilir çünkü diz uyumunu düzeltmek için kullanılan TDA cerrahisi, erken
dönemde yükleme parametrelerini de etkilemektedir.

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Keywords

ayak; diz osteoartriti; pedobarografi; total diz artroplastisi; yürüme analizi.

How does Plantar Pressure Distribution Change Early after Total Knee Arthroplasty? A Pilot Study

Abstract

To evaluate how the static and dynamic plantar
overload distribution patterns change following total knee arthroplasty (TKA)
surgery using a pressure platform. Ten patients who met the inclusion criteria
were included (mean age 68.5±7.9 years). Evaluations were performed prior to
the surgery and on the 15th day after the surgery. Static balance parameters
(anterior-posterior and total load distribution of the foot, ratio of weight
bearing of the right and left foot, elliptic area of the pressure center and
oscillation speed) were measured and recorded by  Zebris™ FDM-2 (Zebris® Medical GmbH, Germany)
device. Maximum strength produced in the posterior foot during walking, time
percent of the walking cycle produced by this strength and middle foot maximum
pressure values were found to be significantly decreased (p<0,05). Rotation
degrees of the foot were found to be decreased in the patients, though not
statistically significant. No significant differences were found in the total
weight load on the foot, elliptic area, center of pressure (COP), line length
and mean COP rate during static standing between the pre-surgical and
post-surgical measurement results (p>0,05). Weight load measurement values
on the forefoot of the opere side during standing were found to be
significantly increased following surgery, while the weight load on the rear
foot was found to be significantly decreased (p<0,05).  The
weight load on the rear foot and forefoot upon static stance was decreased and
increased, respectively 15 days after the surgery in patients who underwent TKA
surgery. The
evaluations using force platform before and after surgery may be useful for
orthopedic surgeons because TKA surgery used to correct knee alignment also
affect loading parameters in early period.

References

• 1. Butler RJ, Barrios JA, Royer T, Davis IS. Frontal-plane gait mechanics in people with medial knee osteoarthritis are different from those in people with lateral knee osteoarthritis. Physical therapy. 2011;91(8):1235-43.
• 2. Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. The Journal of rheumatology. 2006;33(11):2271-9.
• 3. Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. The Journal of rheumatology. 2007;34(1):172-80.
• 4. Tanaka S, Kubota K, Yoshimura O, Kobayashi R, Minematsu A, Hosoda M, et al. Gait Analysis after Total Knee Arthroplasty - Comparison of Cemented Type and Cementless Type. Journal of Physical Therapy Science. 2000;12(2):101-5.
• 5. Yoshida Y, Joseph Zeni J, Snyder-Mackler L. Do Patients Achieve Normal Gait Patterns 3 Years After Total Knee Arthroplasty? Journal of Orthopaedic & Sports Physical Therapy. 2012;42(12):1039-49.
• 6. Piva SR, Gil AB, Almeida GJM, DiGioia IIIAM, Levison TJ, Fitzgerald GK. A Balance Exercise Program Appears to Improve Function for Patients With Total Knee Arthroplasty: A Randomized Clinical Trial. Physical therapy. 2010;90(6):880-94.
• 7. Turcot K, Armand S, Lübbeke A, Fritschy D, Hoffmeyer P, Suvà D. Does knee alignment influence gait in patients with severe knee osteoarthritis? Clinical Biomechanics. 2013;28(1):34-9.
• 8. Saito I, Okada K, Nishi T, Wakasa M, Saito A, Sugawara K, et al. Foot Pressure Pattern and its Correlation With Knee Range of Motion Limitations for Individuals With Medial Knee Osteoarthritis. Archives of physical medicine and rehabilitation.94(12):2502-8.
• 9. Chandler JT, Moskal JT. Evaluation of knee and hindfoot alignment before and after total knee arthroplasty. The Journal of Arthroplasty.19(2):211-6.
• 10. Cho W-S, Cho H-S, Byun S-E. Changes in hindfoot alignment after total knee arthroplasty in knee osteoarthritic patients with varus deformity. Knee Surgery, Sports Traumatology, Arthroscopy. 2017;25(11):3596-604.
• 11. Bankes MJK, Back DL, Cannon SR, Briggs TWR. The effect of component malalignment on the clinical and radiological outcome of the Kinemax total knee replacement. The Knee.10(1):55-60.
• 12. Matsuda S, Miura H, Nagamine R, Urabe K, Harimaya K, Matsunobu T, et al. Changes in knee alignment after total knee arthroplasty. The Journal of Arthroplasty. 1999;14(5):566-70.
• 13. Altman R. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Arthritis Rheumatology. 1986;29:1039-49.
• 14. Mandeville D, Osternig LR, Chou L-S. The effect of total knee replacement surgery on gait stability. Gait & Posture.27(1):103-9.
• 15. Freitas SMSF, Wieczorek SA, Marchetti PH, Duarte M. Age-related changes in human postural control of prolonged standing. Gait & Posture.22(4):322-30.
• 16. Mullaji A, Shetty GM. Persistent Hindfoot Valgus Causes Lateral Deviation of Weightbearing Axis after Total Knee Arthroplasty. Clinical Orthopaedics and Related Research®. 2011;469(4):1154-60.
• 17. Norton AA, Callaghan JJ, Amendola A, Phisitkul P, Wongsak S, Liu SS, et al. Correlation of Knee and Hindfoot Deformities in Advanced Knee OA: Compensatory Hindfoot Alignment and Where It Occurs. Clinical Orthopaedics and Related Research®. 2015;473(1):166-74.
• 18. Hara Y, Ikoma K, Arai Y, Ohashi S, Maki M, Kubo T. Alteration of Hindfoot Alignment After Total Knee Arthroplasty Using a Novel Hindfoot Alignment View. The Journal of Arthroplasty.30(1):126-9.
• 19. Güven M, Kocadal O, Akman B, Şayli U, Altıntaş F. Pedobarographic Analysis in Total Knee Arthroplasty. J Knee Surg. 2017;30(09):951-9.20. Voronov ML, Pinzur MS, Havey RM, Carandang G, Gil JA, Hopkinson WJ. The Relationship Between Knee Arthroplasty and Foot Loading. Foot & Ankle Specialist. 2012;5(1):17-22.
• 21. Shull PB, Shultz R, Silder A, Dragoo JL, Besier TF, Cutkosky MR, et al. Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis. Journal of Biomechanics.46(1):122-8.
• 22. Guo M, Axe MJ, Manal K. The influence of foot progression angle on the knee adduction moment during walking and stair climbing in pain free individuals with knee osteoarthritis. Gait & Posture.26(3):436-41.