Compensation by nonoperated joints in the lower limbs during walking after endoprosthetic knee replacement following bone tumor resection.

Abstract

Endoprosthetic knee replacement is often used to preserve joint function in patients with bone tumors of the distal femur or proximal tibia. Recently, because of improved oncologic outcome, surgeons are focusing more on the functional outcome of patients with musculoskeletal tumors. We hypothesized that patients who have undergone endoprosthetic knee replacement are forced to compensate for deficiency in their operated joint during walking. In this study, we investigated differences in gait kinematics, kinetics, and energetics between patients with endoprosthetic knee replacement and healthy subjects. We performed gait analysis for 8 patients who underwent endoprosthetic knee replacement after bone tumor resection and 8 matched healthy subjects. Gait kinematics, kinetics, and energetics of patients' ipsilateral and contralateral limbs were compared with those of healthy subjects by using Dunnett's test. Compared with healthy subjects, patients showed increased negative joint power around the ipsilateral ankle, greater second peak in the contralateral vertical ground reaction forces, and abnormal hip movement on both sides after initial contact. Patients tended to compensate for dysfunction of the reconstructed knee by muscles around the ipsilateral ankle and contralateral hip, with increased load on the contralateral limb during walking. These differences could lead to secondary impairments. Further analysis, including musculoskeletal simulation and assessment of long-term functional outcome with regard to secondary musculoskeletal impairment, is needed to verify the significance of the change in gait and to determine the need for special care for secondary musculoskeletal dysfunction in these patients.