The Temporal–Spatial Parameters of Gait After Total Knee Arthroplasty

Abstract

Background/Objectives: Gait abnormalities in advanced knee osteoarthritis (KOA) are characterized by decreased stride length, walking speed, and cadence. Total knee arthroplasty (TKA) is intended to improve temporal–spatial gait parameters; however, the extent and timing of functional recovery remain under investigation. To assess changes in stride length, walking speed, and cadence following TKA in short- and long-term perspectives, and to compare outcomes with a non-operated KOA cohort. Methods: A prospective observational study was conducted involving 46 patients with unilateral KOA (grades III–IV, Kellgren–Lawrence scale) who underwent cemented TKA via a medial parapatellar approach. Group I (n = 34) was assessed one day prior to surgery and six weeks postoperatively. Group II (n = 12), a follow-up subset, was reassessed 1.5 years postoperatively. Group III (n = 34) served as a non-operated control group, assessed only preoperatively. Temporal–spatial gait parameters were evaluated under standardized conditions using a two-dimensional video analysis (Kinovea® software version 0.8.27). Stride length (m) and walking speed (m/s) were assessed during continuous walking along a 15 m corridor, with at least three valid gait cycles averaged per trial. Cadence (steps/min) was determined during a one-minute walk and verified frame-by-frame. No structured outpatient physiotherapy was provided; all patients followed a standardized in-hospital rehabilitation protocol. Results: In Group I, the mean stride length increased from 0.40 ± 0.10 m to 0.42 ± 0.10 m (p = 0.247), walking speed improved from 0.41 ± 0.027 m/s to 0.47 ± 0.022 m/s (p = 0.063), and cadence increased significantly from 72.9 ± 7.8 to 77.1 ± 8.6 steps/min (p = 0.044). In Group II, the mean stride length rose from 0.39 ± 0.10 m to 0.52 ± 0.09 m (p < 0.001), walking speed improved from 0.44 ± 0.02 m/s to 0.69 ± 0.01 m/s (p < 0.001), and cadence increased from 73.7 ± 8.8 to 103.6 ± 7.4 steps/min (p < 0.001). Compared to the control group (Group III: stride length 0.42 ± 0.09 m; walking speed 0.41 ± 0.02 m/s; cadence 73.9 ± 7.9 steps/min), Group II demonstrated superior values across all parameters (p < 0.001 for each comparison). No significant correlations were observed between BMI and gait outcomes. Conclusions: Total knee arthroplasty resulted in progressive improvement in temporal–spatial gait parameters. While early postoperative gains were limited, substantial functional restoration was observed at long-term follow-up, emphasizing the importance of extended recovery monitoring in post-TKA evaluation.