Relationship between gait parameter characteristics and joint function recovery after arthroscopic minimally invasive surgery in patients with knee osteoarthritis

Abstract

BACKGROUND: There are individual differences in the effectiveness of arthroscopic surgery in improving knee osteoarthritis, and subjective scoring scales may be biased in evaluating the clinical efficacy of arthroscopic treatment for knee osteoarthritis. OBJECTIVE: To explore the correlation between gait parameters and joint function recovery in patients with knee osteoarthritis after arthroscopic surgery. METHODS: A total of 98 patients with knee osteoarthritis admitted to Chongqing Armed Police Corps Hospital from October 2023 to October 2024 were selected as the research subjects. According to Lysholm knee function score after 6 months of follow-up, they were divided into the excellent group (n=63) and the fair group (n=35). Clinical data including gender, age, body mass index, disease duration, respiration, heart rate, Kellgren-Lawrence grade, smoking history, drinking history, hypertension history, location of onset, and postoperative complications were collected. The intraoperative and postoperative indicators, as well as the knee joint function scores and gait parameters at different times before and after surgery were compared between the two groups. Multivariate Logistic regression was used to analyze the independent influencing factors of knee joint function recovery. Stratified regression analysis was conducted to explore the impact of different clinical and pathological characteristics after treatment on gait parameters. Generalized estimating equations were used to analyze the differences in gait parameters among patients with different knee joint functions after treatment. Generalized additive models were used to analyze the impact of gait parameters on Lysholm score after treatment. Receiver operating characteristic curves were drawn to analyze the value of gait parameters in judging the recovery of knee joint function after treatment. RESULTS AND CONCLUSION: (1) There were significant differences in age, disease duration, Kellgren-Lawrence grade, and postoperative complications between the excellent and fair groups (P < 0.05). (2) The fair group had longer operation time, more intraoperative blood loss, longer postoperative swelling regression time, and longer rehabilitation time than the excellent group (P < 0.05). (3) After surgery, the fair group had higher Western Ontario and McMaster Universities Osteoarthritis Index and visual analog scale scores, and lower Lysholm score, step frequency, and step speed than the excellent group (P < 0.05). (4) Logistic regression analysis showed that age, Kellgren-Lawrence grade, postoperative complications, and postoperative swelling regression time were independent risk factors affecting knee joint function recovery (P < 0.05). (5) Stratified regression analysis showed that age, Kellgren-Lawrence grade, postoperative swelling regression time, and postoperative complications all had negative effects on step frequency and step speed (β < 0, P < 0.05). (6) Generalized estimating equation analysis showed that the degree of knee joint function recovery was associated with gait characteristics (β > 0, P < 0.05). (7) Generalized additive model analysis showed that the effects of step frequency and step speed on Lysholm score after treatment were linear. (8) Receiver operating characteristic curve analysis showed that the combined detection of step frequency and step speed had higher predictive efficacy (area under the curve > 0.85, P < 0.05). (9) These findings suggest that arthroscopic surgery can improve knee joint function in patients with knee osteoarthritis, and dynamic tracking of postoperative gait parameter changes combined with functional scoring scales reveals the association between step frequency, step speed, and knee joint function outcome, further clarifying its clinical predictive value and providing a new quantitative tool for clinical functional assessment to achieve more precise postoperative rehabilitation guidance.

1. Introduction

Knee osteoarthritis is a chronic degenerative disease characterized by articular cartilage degeneration, synovial inflammation, and osteophyte formation. It is a major cause of decreased quality of life and increased medical resource consumption in middle-aged and elderly populations. Patients often experience gait abnormalities due to pain, joint stiffness, and limited mobility, manifesting as shortened stride length and reduced walking speed, which further exacerbates cartilage wear and muscle compensation, creating a vicious cycle. Although total knee arthroplasty is the main treatment for advanced knee osteoarthritis and its efficacy has been clinically validated, it carries risks of major surgery and complications. Arthroscopic minimally invasive surgery, due to its minimal trauma and rapid recovery, is widely used for symptom relief and functional improvement in early and mid-stage patients. However, recent studies have questioned its efficacy, suggesting that arthroscopic surgery may damage intra-articular tissues and cause postoperative inflammatory reactions, affecting patient recovery. Therefore, objectively evaluating the effectiveness of arthroscopic minimally invasive surgery and predicting functional recovery has become a clinical challenge.

Currently, postoperative evaluation of knee osteoarthritis mainly relies on subjective scales such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm score, and imaging examinations, all of which have limitations. Subjective scores are susceptible to patients' psychological state and recall bias, and imaging findings of anatomical improvement often do not correlate with actual functional recovery. In recent years, gait analysis technology, which can non-invasively and quantitatively capture biomechanical features of movement, has gradually become a research hotspot for postoperative assessment. Studies have shown that dynamic changes in postoperative gait parameters may be closely related to pain relief, muscle strength recovery, and joint stability reconstruction.