Conference Coverage

Slower Pre-op Gait Predicts Better PROM Thresholds After TKA

Edited by:
Brian McCurdy

Key Highlights

  • Slower preoperative gait speed was independently associated with achieving an acceptable postoperative symptom state on the KOOS JR.
  • Slower walking speed also predicted clinically important improvement in Knee Society pain with climbing stairs scores.
  • Predictive discrimination for these outcomes yielded areas under the curve of 0.763–0.772.

Slower preoperative walking speed was associated with a greater likelihood of achieving clinically relevant patient-reported outcome thresholds after total knee arthroplasty (TKA), according to a prospective study of 40 patients presented at the American Association of Hip and Knee Surgeons Annual Meeting 2026 in Dallas. The findings linked an objective measure of preoperative function to postoperative symptom acceptability and improved stair-related pain.

Investigators evaluated whether clinical characteristics and gait parameters could predict meaningful outcomes after primary TKA. They reasoned that patients with worse preoperative status may show greater improvement in patient-reported outcome measures (PROMs), while associations between objective gait measurements and postoperative PROMs remain incompletely established.

We conducted preoperative and postoperative three-dimensional, level-ground walking analyses using infrared motion capture. Researchers evaluated 15 demographic variables, comorbidities, and potential covariates, along with 16 gait parameters, including walking speed. Multivariable logistic regression identified predictors of clinically relevant thresholds in validated PROMs, using a significance level of 0.05. Mean PROM follow-up was 26 months.

Study Findings

The cohort was 65% women, with a mean age of 69 years and mean body mass index of 31 kg/m2. Most patients, 69%, had preoperative varus tibiofemoral alignment. In adjusted analyses, slower preoperative gait speed was independently associated with higher odds of reaching the patient-acceptable symptom-state threshold on the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR). The reported odds ratio for gait speed was 0.14 (95% CI, 0.02–0.93; P = .041).

Slower preoperative gait speed was also independently associated with achieving the minimal clinically important difference for the Knee Society pain with climbing stairs score (OR, 0.15; 95% CI, 0.03–0.87; P = .035). Receiver operating characteristic analyses yielded areas under the curve of 0.763–0.772 for these outcomes, which the investigators characterized as good predictive ability.

Clinical Implications

According to the authors, slower preoperative gait speed may serve as a surrogate for osteoarthritis severity. They suggested that gait speed could offer a simple, objective marker for preoperative counseling and identification of patients more likely to achieve meaningful improvement after TKA.

Expert Commentary

“Preoperative gait speed may serve as a simple, objective marker for preoperative counseling and identification of patients more likely to achieve meaningful improvement,” the researchers concluded.

Reference

Deckard ER, Meding JB, Meneghini RM. Slower preoperative gait speed predicts achievement of clinically relevant PROM thresholds after TKA. Paper #7. Abstract presented at the American Association of Hip and Knee Surgeons Annual Meeting, November 5–8, 2026, Dallas, TX.