Unveiling distinct kinematic profiles among total knee arthroplasty candidates through clustering technique

Background: Characterizing the condition of patients suffering from knee osteoarthritis is complex due to multiple associations between clinical, functional, and structural parameters. While significant variability exists within this population, especially in candidates for total knee arthroplasty, there is increasing interest in knee kinematics among orthopedic surgeons aiming for more personalized approaches to achieve better outcomes and satisfaction. The primary objective of this study was to identify distinct kinematic phenotypes in total knee arthroplasty candidates and to compare different methods for the identification of these phenotypes.

Methods: Three-dimensional kinematic data obtained from a Knee Kinesiography exam during treadmill walking in the clinic were used. Various aspects of the clustering process were evaluated and compared to achieve optimal clustering, including data preparation, transformation, and representation methods.

Results: A K-Means clustering algorithm, performed using Euclidean distance, combined with principal component analysis applied on data transformed by standardization, was the optimal approach. Two unique kinematic phenotypes were identified among 80 total knee arthroplasty candidates. The two distinct phenotypes divided patients who significantly differed both in terms of knee kinematic representation and clinical outcomes, including a notable variation in 63.3% of frontal plane features and 81.8% of transverse plane features across 77.33% of the gait cycle, as well as differences in the Pain Catastrophizing Scale, highlighting the impact of these kinematic variations on patient pain and function.

Conclusion: Results from this study provide valuable insights for clinicians to develop personalized treatment approaches based on patients' phenotype affiliation, ultimately helping to improve total knee arthroplasty outcomes.