The effect of digitally intelligent anti-gravity treadmill training on plantar pressure for patients after total knee arthroplasty

ZHANG Zi-heng; WANG Yu-tong; WANG Yi-fan; QI Yan-song; MA Bing-xian; WANG Yong-xiang; WEI Bao-gang; WEI Xing-hua; NIU Xiao-bo; BAO Hu-ri-cha; XU Yong-sheng

doi:10.3969/j.issn.2095-252X.2024.11.002

Abstract：Objective To analyze the effect of anti-gravity treadmill walking training on plantar pressure in the early postoperative period after total knee arthroplasty(TKA)for patients with knee osteoarthritis(KOA).Methods 42 patients were recruited after TKA and randomly divided into conventional rehabilitation group(n=21)and combined rehabilitation group(n=21).Standard TKA rehabilitation protocol was implemented in the conventional rehabilitation group,while anti-gravity treadmill walking training along with the standard protocol was incorporated in the combined rehabilitation group.Six weeks later,the changes in KSS scores were evaluated in both groups.Plantar pressure analysis equipment was utilized to gather plantar pressure-related metrics(contact area,maximum stress,and peak pressure)from the study participants in each group for a comparative analysis.Results The KSS scores of both groups were improved after rehabilitation,and the clinical(90.22±10.29)and functional(77.21±11.64)scores of the combined rehabilitation group were higher than those of the conventional rehabilitation group(80.43±9.70;65.09±6.59),and the differences were statistically significant(P＜0.05).Plantar contact areas of the affected side at MH1(7.27±1.92),MH2(8.02±1.44),and HM(7.09±1.45)in the conventional rehabilitation group were less than that in the combined rehabilitation group(8.54±1.69,8.97±1.52,8.11±1.67).The contact areas of the affected side at MH5(5.59±1.76)and MF(7.89±1.87)were larger than that of the combined rehabilitation group(4.18±1.82,6.71±1.41);within-group comparisons showed that the MH2(8.97±1.52)and HM(8.11±1.67)sites were larger than those of the healthy side in the combined rehabilitation group(6.06±2.11,5.19±1.88).The contact areas at MH5(5.59±1.76,4.18±1.52)and HC(7.06±1.62,6.98±1.12)on the affected side were smaller than those on the healthy side in the conventional(7.12±1.16,6.68±1.33)and combined rehabilitation group(10.12±2.12,10.03±2.15),and the differences were statistically significant(P＜0.05).Comparison of maximum stress showed that contact pressures at the T(75.69±40.15),MH1(138.50±51.64),MH2(135.88±52.3),and HM(229.48±51.45)sites of the conventional rehabilitation group on the affected side were less than those of the combined rehabilitation group(105.85±48.79,179.39±71.71,172.49±50.32,263.53±53.87).MH5(53.39±47.21)and HL(169.34±41.01)site contact pressure was greater than the combined rehabilitation group(30.79±14.31,142.15±37.64);the MH5(53.39±47.21)site was greater than that of the healthy side in the conventional group(39.37±19.1).T-region pressure of the affected side in both groups was smaller(75.69±40.15,105.85±48.79)than on the healthy side(129.51±48.91,127.95±47.18),and the differences were statistically significant(P＜0.05).Comparison of peak pressure showed that the site of MH1(982.00±268.56)in the conventional rehabilitation group on the affected side was smaller than that in the combined rehabilitation group(1155.96±223.36),and the sites of MH5(1169.65±286.11)and HL(1114.38±320.54)were larger than those in the combined rehabilitation group(948.62±263.55,928.54±267.74);the site of MH1(982.00±268.56)on the affected side was smaller than that on the healthy side(1068.98±245.96)in the conventional rehabilitation group,and the sites of MH5(948.62±263.55)and HL(928.54±267.74)on the affected side in the combined rehabilitation group were smaller than those on the healthy side(1114.39±269.19,1067.92±280.94),and the differences were statistically significant(P＜0.05).Conclusions For post-TKA patients,early anti-gravity treadmill walking rehabilitation achieves better clinical outcomes and plantar biomechanical improvement than conventional rehabilitation alone,providing a new strategy for the application of digital biomechanical testing systems combined with intelligent rehabilitation devices in enhanced recovery after knee arthroplasty.