Effet de l’obésité sur la récupération fonctionnelle de la marche après prothèses totales de hanche et de genou : analyse biomécanique et clinique

Abstract : Introduction : Body Mass Index (BMI) impact on gait recovery after total hip and total knee arthroplasty (THA and TKA) remains misunderstood. Few studies have analyzed the influence of BMI on the recovery of hip and knee range of motion (ROM) during gait or walking speed after THA and TKA. Our objective was to assess this impact preoperatively and post-operatively using both 3D gait analysis and clinical assessment. Our hypothesis was that obesity (BMI> 30kg /m2) would be a negative factor in the recovery of gait parameters.Material and methods: After conducting a systematic review of the literature on functional recovery after total prostheses of the lower limb (THA and TKA) to ensure the originality of this work and its relevance we conducted 2 independent prospective studies: including 76 THA in hip osteoarthritis patients on the one hand and 79 TKA in knee osteoarthritis patients on the other hand. All patients had a quantified gait analysis of preoperatively and postoperatively (at 6 months for THA and 1 year for TKA). A control group of matched healthy people followed the same protocol. The gait speed, ROM hip and knee, as well as functional and quality of life scores were evaluated, for all parameters the gain was calculated. Patients were divided into 2 groups in each cohort: non-obese patients (G1): BMI <30kg/m2 and obese patients (G2): BMI≥30kg/m2. Paired t-tests were used to evaluate the pre- and post-operative differences between G1 and G2, then the differences in gain between G1 and G2. Finally, a uni- and multivariate linear regression sought associations between BMI, gait speed, and ROM.Results: In both cohorts: preoperatively, gait speed and ROM were significantly lower in obese patients. Postoperatively, walking speed and ROM were significantly lower for all patients undergoing TKA or THA compared with the control group. Preoperatively obese patients were more symptomatic. A significant difference was found between G1 and G2 regarding pain improvement in favor of the obese (on the gain of WOMAC pain for TKA and analogic pain scale for THA). For all other parameters the gains were not different between G1 and G2. Uni- and multivariate regression showed no significant relationship between gait speed, ROM and BMI.Conclusion: BMI has no direct negative effect on recovery of walking parameters after THA or TKA. Indeed despite a higher preoperative symptomatology obese patients show a comparable improvement in terms of gain to non-obese patients clinically and biomechanically. However, postoperative gait parameters after THA or TKA remain significantly lower than those of controls, regardless of the BMI of patients without full clinical or biomechanical recovery. Though, obesity appears to have a similar effect on the gait parameters recovery after THA or TKA.
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Pierre Martz. Effet de l’obésité sur la récupération fonctionnelle de la marche après prothèses totales de hanche et de genou : analyse biomécanique et clinique. Médecine humaine et pathologie. Université Bourgogne Franche-Comté, 2018. Français. ⟨NNT : 2018UBFCI009⟩. ⟨tel-02139446⟩

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