Ph.D Thesis

Ph.D StudentDebbi Eytan Magen
SubjectBiomechanics of Motor Re-education of Gait Patterns in
Patients after Total Knee Arthroplasty
DepartmentDepartment of Mechanical Engineering
Supervisor PROF. Alon Wolf


Background: Total knee arthroplasty (TKA) corrects the mechanical deformities of end-stage knee osteoarthritis (OA), but is unable to correct the chronic pathological neuromuscular walking patterns developed. The knee loading patterns remain abnormal, which results in prolonged postoperative recovery, as well as high rates of implant deterioration and surgical revision.

Methods: This was a randomized, controlled, double-blind trial involving 50 patients after unilateral TKA for end-stage knee OA. The active group underwent a biomechanical therapy program aimed at gait rehabilitation using a foot-worn device that modifies knee-loading patterns, while the control group received a sham walking sneaker. Patients were evaluated throughout the first postoperative year using self-evaluation scores, functional tests, clinical knee scores, and three-dimensional analysis biomechanical walking analysis in a gait lab measuring knee joint loading and electromyographic patterns.

Results: Better outcomes were seen in the active group compared to the control group in pain scores (88% vs 32%, p=0.011), function (86% vs 21%, p=0.001), knee scores (83% vs 38%, p=0.001) and walking distance (109% vs 47%, p=0.001). These outcomes correlated with significant improvements in knee joint loading patterns in multiple planes of motion and with electromyographic patterns in the active group compared to the control group. Linear regression models revealed faster improvements in the active group in all clinical, gait and knee loading parameters.

Conclusions: A gait rehabilitation program improves outcomes following TKA and should be used as an adjuvant therapy postoperatively to enhance the operative success and reduce long-term disabilities.