Frontal plane biomechanics of the operated and non-operated knees before and after unilateral total knee arthroplasty

• The change in knee biomechanics after total knee arthroplasty is unclear.
• This study measures the changes in knee biomechanics after surgery.
• Surgery reduces frontal loading patterns in the operated knee.
• Surgery does not change the frontal loading in the non-operated knee.

BackgroundAfter unilateral total knee arthroplasty, frontal plane loading patterns on the operated knee remain pathological in the long term, but it is unclear how they change in the early postoperative period. Additionally, researchers have suggested that the non-operated knee bears greater frontal plane loads postoperatively, but this effect is unclear. The objective of the present study was to compare the preoperative and early postoperative frontal plane loading patterns of both knees after unilateral total knee arthroplasty.MethodsFifty patients with end-stage knee osteoarthritis were examined prior to and six weeks after surgery. Patients underwent a three-dimensional gait analysis that determined the frontal plane loading patterns of knee varus angle and knee adduction moment during gait, and completed self-evaluative questionnaires and functional tests.FindingsThere were no significant loading differences between limbs preoperatively. The operated knee showed large reductions in varus angle and adduction moment after surgery (all p < 0.001). The non-operated knee showed no increases in varus angle or adduction moment, but did show a small reduction in the adduction moment (p < 0.001). Both knees showed reduction in pain after surgery (p < 0.001) and the operated Knee Society Score improved after surgery (p = 0.01).InterpretationTotal knee arthroplasty reduces frontal plane loading in the operated knee and does not worsen frontal plane loading in the non-operated knee. Therapy after surgery should focus on retaining the reduction in knee adduction moment in the operated knee and preventing further worsening loading patterns in the non-operated knee.