부산대학교 도서관

Background: Gait analysis is used to measure objectively the ability to walk before and after hip and knee joint replacement. Most gait literature to date has measured patients walking at slow speeds, which may have unintentionally characterized successful lower limb operations as the same regardless of its operation type. The aim of this thesis was to use an instrumented treadmill to (1) test the upper limits of gait performance of patients awaiting and after lower limb arthroplasty and (2) describe and compare different joint procedures to healthy controls. Method: Gait analysis was carried out using an instrumented treadmill. Study participants walked at their preferred walking and top walking speed on the treadmill. Their vertical ground reaction force and spatiotemporal data was captured for both limbs by tandem force plates beneath the treadmill's belt. Results: The results suggest that at preferred walking speed on the flat, all subjects' gait characteristics were similar irrespective of joint state. The differences between patient groups became more apparent at top walking speed. Weight acceptance, step length and stride length were the most useful variables assessing these differences. Unicompartmental knee replacement and hip resurfacing had closer to normal gait patterns when compared to total knee replacement and conventional total hip replacement respectively. Predictably patients with knee osteoarthritis had asymmetrical gait patterns, impulse was found to be the best variable distinguishing patients with knee osteoarthritis from healthy controls. The downhill walking assessment established that patients with unicompartmental knee replacements had a more normal gait pattern than total knee replacement patients. Conclusion: The gait results suggest that an instrumented treadmill is a useful metric to describe patient gait patterns. Testing performance at higher walking speeds allowed differences to be detected, which were undetectable at slower speeds. Anatomically conserving procedures such as unicompartmental knee replacement and hip resurfacing appear to have convincing functional advantages compared to less conserving joint replacement procedures.