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Knee Problems

Currently, patients with osteoarthritis

of the knee are assessed on the basis

of history and examination, X-rays and

possibly MRI scans. In most cases, any

assessment of dynamic knee function

is by simple observation of the patient

walking into the consulting room, or

at most walking down the corridor. It

would be quite unusual, if not unheard

of in current orthopaedic practice, for

a gait analysis to be obtained.

This situation is accepted as the norm

both within the NHS and private

practice. However, with the advent of

digital gait analysis systems, there is a

case for change. Low cost routine gait

analysis can now be undertaken as

part of routine clinical examinations.

How can this help?

Firstly, the dynamic or functional

assessment provided by gait analysis

gives a very valuable insight into the

severity of the condition. A full range

of movement when examined on

the couch can be deceiving.The range

of knee movement during normal

walking is far more informative, as

I will demonstrate in the case report


Secondly, digital gait analysis provides

an objective and permanent record,

enabling careful comparisons to be

made before and after interventions.

The accuracy of measurement is far

superior to the human eye, the results

are readily understandable and this can

form a useful basis for discussion with

the patient.



In the diagnosis of early

osteoarthritis of the knee

Mr Glyn Evans is a Knee Surgeon

based in Central London who

treats young adults with sports-

related knee injuries and older

patients with early wear and

tear, or established arthritis of

the knee. He qualified in Cardiff

in 1975 and then trained in

Liverpool and Edinburgh. He

was appointed to the Academic

Orthopaedic Unit, Southampton,

as a lecturer in 1984 with a major

interest in external fixation of

tibial fractures. He became an

NHS Consultant in 1990 and

worked at St Mary’s Hospital, Isle

ofWight,Treloar Hospital,Alton

and, more recently, Royal Hospital

Haslar, Gosport.

Mr Evans has been performing

knee arthroscopies and knee

replacements since 1985. During

his first decade as a Consultant,

he did several thousand joint

replacements, including hips

and knees and developed an

early interest in partial knee

replacements using the ‘Oxford

Knee’. In 2004, he decided

to concentrate solely on the

investigation and treatment of

knee disorders and was appointed

to the London Knee Clinic at

London Bridge Hospital. Since

then, he has performed between

250 and 300 knee operations per

year including Anterior Cruciate

Ligament (ACL) reconstructions,

partial/total knee replacements

and correction of bone

deformities (osteotomies).

Mr Glyn Evans

Consultant Orthopaedic

& Knee Surgeon

MB BCh FRCS (Edin)

Private only

Secretary: Carole Segger

T: 020 7407 3069

F: 020 7407 3138

[email protected]



An elderly man had previously had

a total right knee replacement,

and was beginning to have pain

and functional impairment in his

previously normal left knee. X-rays

of the left knee demonstrated

early medial compartment


Clinical examination revealed a

mild limp and a minor reduction

in passive knee flexion to135

degrees; about the same as the

right knee that had previously

undergone knee replacement.

Gait analysis was carried out, and

the figures opposite show the

movements of the left knee in

blue and the right knee in green.

The motion of both knees

has been superimposed for

comparison.The first gait analysis

(Figure 1) revealed quite a

reasonable gait pattern in the

right knee that had previously

been replaced, but a significant

deficit in the left knee.You can

see that peak left knee flexion

in the swing phase is only 48°

compared with 54° in the right

knee.There is also early heel

strike on the left side, and peak

knee flexion of the left knee

in the stance phase is only 12°;

no more than in the right side

that has undergone a total knee

replacement. Normally you

would expect around 20°.

Knee Problems