Biomechanics of Gait Pattern Adaptation in Patients After Total Knee Arthroplasty
Condition: Knee Arthroplasty; Knee Arthritis Osteoarthritis; Osteoarthritis; Osteoarthritis, Knee; Musculoskeletal Diseases
MeSH terms: Osteoarthritis; Osteoarthritis, Knee; Musculoskeletal Diseases
Study type: Interventional

Summary: 
      This study aimed to discover the biomechanics of gait pattern adaptation in patients after a
      total knee replacement.

      The first hypothesis of the project was that center-of-pressure manipulation at the foot
      during dynamic loading is capable of changing the forces, torques and muscle activation
      patterns of the lower limb.

      The second hypothesis of the project was that patient-specific center-of-pressure
      manipulation at the foot combined with repetitive perturbation training over time will
      improve neuromuscular function, barefoot gait patterns, muscle activation patterns, pain,
      quality of life and energy consumption in patients after a total knee replacement.
    

Detailed description: 
      This study is a randomized prospective controlled study of patients after total knee
      arthroplasty. Patients will be recruited to the study and divided randomly into an
      experimental and control group. Both groups will match in terms of gender, age, pathology and
      clinical assessment. In addition to the intervention of the present study, all patients,
      whether in the experimental or control group, will carry out the usual physical therapy
      exercises for total knee arthroplasty as directed by their physician. The patients will be
      recruited and evaluated prior to surgery and for a follow-up period after surgery.

      After surgery, patients in the experimental group will be fitted with a customized
      biomechanical device worn on the feet (Apos System, Apos - Sports and Medical Technologies
      Ltd. Hertzlia, Israel). The device is calibrated personally to each patient. By calibrating
      the device, the center-of-pressure of the foot can be manipulated during all phases of the
      gait cycle. The device is capable of inducing controlled perturbation during gait. The
      immediate effects of the device will be evaluated using center-of-pressure measurements,
      three-dimensional gait analyses and surface electromyography. The patients are instructed to
      walk with the device according to a therapy protocol (AposTherapy). Patients will be
      evaluated for changes in gait via three-dimensional gait analyses, muscle activation pattern
      changes via surface electromyography, pain, quality of life and energy consumption.

      The patients in the control group will carry out the same walking exercises as the
      experimental group, but without the biomechanical intervention device (placebo walking shoe).
      The patients will be evaluated with the same tools over time as with the experimental group.
    

Intervention name(s): AposTherapy Biomechanical System; Physical Therapy Program
Intervention type(s): Device; Other
Intervention description(s): The device is comprised of four adjustable modular elements attached to foot-worn platforms that are capable of manipulating the foot's center-of-pressure and applying perturbation training throughout the gait cycle. The device allows for neuromuscular training during dynamic loading.; Their therapy program will be similar to the experimental group, but without the treatment device (placebo walking shoe).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Total knee arthroplasty; Total knee replacement; End-stage knee osteoarthritis; Gait patterns; Neuromuscular education