The importance to including objective functional outcomes in the clinical follow up of total knee arthroplasty patients

In clinical practice, it is increasingly important to assess patients' daily functionality routinely and objectively. Acceleration-based gait analysis (AGA) has shown to be reliable and technically suitable for routine clinical use outside the laboratory. This study investigated the suitability of AGA for measuring function in orthopaedic patients with symptomatic gonarthrosis listed for total knee arthroplasty (TKA) by investigating (a) the ability of AGA to distinguish patients from healthy subjects, (b) the sensitivity to gait changes of AGA in assessing recovery following total knee arthroplasty in a subpopulation, and (c) correlations between AGA parameters and clinical scales. Gait was assessed using AGA in 24 patients with symptomatic gonarthrosis listed for TKA, and in 24 healthy subjects. AGA parameters (e.g. speed, asymmetry) and clinical scales (e.g. KSS) were used to monitor progress in 12 patients 3 months after TKA. The Mann–Whitney-U test, Receiver Operating Characteristic (ROC) curves, repeated measurement ANOVA and Pearson correlations were performed. AGA differentiated pathological from healthy gait. The area under the ROC curve, sensitivity and specificity values were high for speed, step frequency and step length. Different recovery profiles were found, with clinical scales showing faster recovery rates. None or only weak correlations were found between AGA and clinical scores. AGA was found to be of clinical relevance in identifying and monitoring patients with symptomatic gonarthrosis in orthopaedic practice, providing objective and additional information about function beyond clinical scales. This, together with the fact that AGA can be applied routinely, suggests the suitability of AGA for use in rehabilitation programs.