Principal Component Analysis of Knee Joint Differences Between Bilateral and Unilateral Total Knee Replacement Patients During Level Walking

Many unilateral total knee replacement (TKR) patients will need a contralateral TKR. Differences in knee joint biomechanics between bilateral patients and unilateral patients are not well established. The purpose of this study was to examine knee joint differences in level walking between bilateral and unilateral patients, and asymptomatic controls, using principal component analysis. Knee joints of 1st replaced limbs of 15 bilateral patients (69.40 ± 5.04 years), 15 replaced limbs of unilateral patients (66.47 ± 6.15 years), and 15 asymptomatic controls (63.53 ± 9.50 years) were analyzed during level walking. Principal component analysis examined knee joint sagittal- and frontal-plane kinematics and moments, and vertical ground reaction force (GRF). A one-way analysis of variance analyzed differences between principal component scores of each group. TKR patients exhibited more flexed and abducted knees throughout stance, decreased sagittal knee range of motion (ROM), increased early-stance adduction ROM, decreased loading-response knee extension and push-off knee flexion moments, decreased loading-response and push-off peak knee abduction moment (KAbM), increased KAbM at midstance, increased midstance vertical GRF, and decreased loading-response and push-off vertical GRF. Additionally, bilateral patients exhibited reduced sagittal knee ROM, increased adduction ROM, decreased sagittal knee moments throughout stance, decreased KAbM throughout stance, an earlier loading-response peak vertical GRF, and a decreased push-off vertical GRF, compared to unilateral patients. TKR patients, especially bilateral patients had stiff knee motion in the sagittal-plane, increased frontal-plane joint laxity, and a quadriceps avoidance gait.