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DOI: 10.1055/a-2294-6873
Geschlechtsspezifische Unterschiede von Motorik und Balance bei Gonarthrosepatienten
Gender different motor function and balance at patients with gonarthritis
Zusammenfassung
Hintergrund Trotz vielfältiger perioperativer Verbesserungen sind bis heute noch 10 bis 20 Prozent der Patienten nach Knietotalendoprothesen Operationen unzufrieden. Individuelle und insbesondere auch geschlechtsspezifische Defizite motorischer und propriozeptive Fähigkeiten könnten dabei eine wichtige Rolle spielen. Bisher wird dieser Tatsache wenig Aufmerksamkeit gewidmet und vor Endoprothesen Operationen routinemäßig keine Messungen durchgeführt.
Methoden Bei jeweils 30 weiblichen und männlichen Patienten erfolgte einen Tag vor Implantation einer bikondylären Knietotalendoprothese mittels mobiler Kraftmessplatte KMP die Messung von Kraft/Leistung und Balance. Die Kraft der Beinmuskulatur konnte durch modifiziertes Kreuzheben bestimmt und die Leistung mit 5 schnellen Kniebeugen gemessen werden. Die Balance umfasste die Parameter Schwankungsweg (in mm) und Schwankungsfläche (in mm²). Freies Stehen im Einbeinstand bzw. mit Hilfestellung wurden durch kurzes Antippender Finger an seitlich angebrachten Stützen bzw. permanentes Festhalten zusätzlich als Balanceunterstützung erfasst.
Ergebnisse Die Mittelwerte der Gesamtperformance Kraft/Leistung waren bei Männer mit 0.44 (SD 0.96, Min –1.15, Max 2.43) statistisch gesichert (p<0.0001) höher als bei Frauen –0.41 (SD 0.61, Min –1,34, Max 1,32). In der Gesamtperformance Balance aus Schwankungsweg und -fläche zeigten sich statistisch signifikant bessere Ergebnissen bei Frauen (p = 0.013). Der Mittelwert betrug für Frauen –0.24 (SD 0.72, Min –1,72, Max 1,22) und bei Männer 0.27 (SD 0.89, Min –1.56, Max 3,21).
Schlussfolgerung Bei weiblichen und männlichen Gonarthrosepatienten waren präoperativ mit alltagstauglichem Aufwand motorische/propriozeptive Eigenschaften messbar. Es konnte gezeigt werden, dass statistisch gesicherte Leistungsunterschiede zwischen Frauen und Männern mit Gonarthrose Gard 4 vorhanden sind. Diese Defizite können zukünftig sowohl prä- als auch postoperativgezielter bestimmt werden. Inwieweit sich die Fähigkeiten mit individualisierten Rehabilitationsmaßnahmen verbessern lassen, muss in Folgestudien untersucht werden.
Abstract
Background Despite numerous perioperative improvements, 10 to 20 percent of patients are still dissatisfied after total knee arthroplasty surgery. Individual and gender-specific deficits in motor and proprioceptive skills could play an important role in this. So far, little attention has been paid to this fact and no measurements are routinely taken before endoprosthesis operations.
Methods In 30 female and 30 male patients, strength/performance and balance were measured one day before implantation of a total bicondylar knee endoprosthesis using a mobile force plate KMP. The strength of the leg muscles could be determined by modified deadlifts and the performance could be measured with 5 fast squats. The balance included the parameters fluctuation path (in mm) and fluctuation area (inmm²). Free standing in a one-legged stance or with assistance were additionally recorded as balance support by briefly tapping the fingers on side-mounted supports or permanent holding.
Results The mean values of the overall performance strength/power were statistically confirmed (p<0.0001) higher for men than for women (SD 0.61, min –1.34, max 1.34, max 1.32) at 0.44 (SD 0.96, min –1.15, max 2.43). The overall performance balance of fluctuation path and area showed statistically significantly better results for women (p = 0.013). The mean value was –0.24 for women (SD 0.72, min –1.72, max 1.22) and for men 0.27 (SD 0.89, min –1.56, max 3.21).
Inference In female and male Gonarthrosis patients, motor/proprioceptive properties were measurable preoperatively with effort suitable for everyday use. It could be shown that there are statistically proven differences in performance between women and men with Gonarthrosis Gard 4. In the future, these deficits can bedetermined in a more targeted manner both pre- and postoperatively. The extent to which skills can be improved with individualized rehabilitation measures must be investigated in follow-up studies.
Publication History
Received: 04 September 2023
Accepted after revision: 25 March 2024
Article published online:
17 April 2024
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