The association of objective gait measures with patient-reported outcome measures and physical performance following total knee arthroplasty: A systematic review.

Abstract

Gait analysis, patient-reported outcomes (PROMs), and performance measures are used to assess outcomes following total knee arthroplasty (TKA). Comprehensive understanding of the relationship between gait measures from three-dimensional (3D) motion analysis and clinical outcomes, including falls, remains unclear. This review aims to explore the association of objective gait measures with PROMs and physical performance. Using standardized systematic review methodology, 4 databases were searched from inception to April 2025. Eligible studies reported gait measures alongside at least one clinical outcome, using a cross-sectional comparison with controls or a longitudinal comparison from pre-TKA to at least 6 months post-TKA. 12 articles (11 primary and 1 secondary study), totalling 372 unique participants, were included. Across 11 studies comparing 8 PROMs with multiple gait measures, gait typically improved as PROMs improved. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and gait measures were most commonly compared (n = 6), with correlations ranging from 0.003 with step length to 0.537 with anterior-posterior velocity of centre of mass. Correlations between other PROMs and gait measures ranged from 0.000 between knee adduction/abduction angle and 12-Item Short Form Survey (SF-12) to 0.810 between a multi-biomechanical measure and Oxford Knee Score (OKS). Physical performance measures also appeared to improve with improved gait. No study evaluated gait measures with falls. Improvements in PROMs and physical measures align with better gait, yet their moderate associations indicate PROMs reflect aspects of recovery but do not fully capture biomechanical complexity, suggesting the value of both outcomes in rehabilitation.