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Ohmi T, Katagiri H, Amemiya M, Ikematsu K, Miyazaki M, Koga H, Yagishita K. Gait analysis of patients with knee osteoarthiritis who can run versus cannot run. Gait Posture 2024; 112:67-72. [PMID: 38744023 DOI: 10.1016/j.gaitpost.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Many middle-aged and older adults participate in running to maintain their health and fitness; however, some have to stop running due to osteoarthritis-attributed knee pain. It was unclear whether gait biomechanics and knee physical findings differ between those who can and cannot run. RESEARCH QUESTION What are the gait and knee physical findings of patients with knee osteoarthritis who remain capable of running in comparison to those who are not capable of running? METHODS This was a cross-sectional study, which recruited 23 patients over the age of 40 who had been diagnosed with knee osteoarthritis. Their knee joint ranges of motion and muscle strength, knee pain, and the maximum gait speed (walk as fast as possible) were measured. Knee alignment was calculated from X-ray images, and the knee joint extension angle and adduction moment during a self-selected gait speed were determined using motion analysis. Participants were divided into two groups-those able to run (n=11) and those unable to run (n=12). The measured and calculated outcomes were compared between groups, and logistic regression analyses of significantly different outcomes were performed. RESULTS There were significant group differences in the maximum knee extension angle during stance phase (p = 0.027), maximum gait speed during the 10-m walk test (p = 0.014), knee pain during gait (p = 0.039) and medial proximal tibial angle by X-ray (p = 0.035). Logistic regression analyses revealed that the maximum knee extension angle during stance phase (OR: 1.44, 95%CI: 1.06¬1.94, p = 0.02) was a significant factor. SIGNIFICANCE The ability to extend the knee during gait is an important contributing factor in whether participants with knee osteoarthritis are capable of running.
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Affiliation(s)
- Takehiro Ohmi
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Masaki Amemiya
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koji Ikematsu
- Department of Rehabilitation, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Midori Miyazaki
- Department of Rehabilitation, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Knee Joint Biomechanical Gait Data Classification for Knee Pathology Assessment: A Literature Review. Appl Bionics Biomech 2019; 2019:7472039. [PMID: 31217817 PMCID: PMC6536985 DOI: 10.1155/2019/7472039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 04/04/2019] [Accepted: 04/30/2019] [Indexed: 12/05/2022] Open
Abstract
Background The purpose of this study is to review the current literature on knee joint biomechanical gait data analysis for knee pathology classification. The review is prefaced by a presentation of the prerequisite knee joint biomechanics background and a description of biomechanical gait pattern recognition as a diagnostic tool. It is postfaced by discussions that highlight the current research findings and future directions. Methods The review is based on a literature search in PubMed, IEEE Xplore, Science Direct, and Google Scholar on April 2019. Inclusion criteria admitted articles, written in either English or French, on knee joint biomechanical gait data classification in general. We recorded the relevant information pertaining to the investigated knee joint pathologies, the participants' attributes, data acquisition, feature extraction, and selection used to represent the data, as well as the classification algorithms and validation of the results. Results Thirty-one studies met the inclusion criteria for review. Conclusions The review reveals that the importance of medical applications of knee joint biomechanical gait data classification and recent progress in data acquisition technology are fostering intense interest in the subject and giving a strong impetus to research. The review also reveals that biomechanical data during locomotion carry essential information on knee joint conditions to infer an early diagnosis. This survey paper can serve as a useful informative reference for research on the subject.
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Paquette MR, Zhang S, Milner CE, Fairbrother JT, Reinbolt JA. Effects of increased step width on frontal plane knee biomechanics in healthy older adults during stair descent. Knee 2014; 21:821-6. [PMID: 24767736 DOI: 10.1016/j.knee.2014.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 02/15/2014] [Accepted: 03/24/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Peak internal knee abduction moment is a common surrogate variable associated with medial compartment knee loading. Stair descent has been shown to yield a greater peak knee abduction moment compared to level-walking. Changes in step width (SW) may lead to changes in frontal plane lower extremity limb alignment in the frontal plane and alter peak knee abduction moment. The purpose of this study was to investigate the effects of increased SW on frontal plane knee biomechanics during stair descent in healthy older adults. METHODS Twenty healthy adults were recruited for the study. A motion analysis system was used to obtain three-dimensional lower limb kinematics during testing. An instrumented 3-step staircase with two additional customized wooden steps was used to collect ground reaction forces (GRF) data during stair descent trials. Participants performed five stair descent trials at their self-selected speed using preferred, wide (26% leg length), and wider (39% leg length) SW. RESULTS The preferred normalized SW in older adults during stair descent was 20% of leg length. Wide and wider SW during stair descent reduced both first and second peak knee adduction angles and abduction moments compared to preferred SW in healthy adults. CONCLUSIONS Increased SW reduced peak knee adduction angles and abduction moments. The reductions in knee abduction moments may have implications in reducing medial compartment knee loads during stair descent.
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Affiliation(s)
- Max R Paquette
- Department of Health & Sport Science, The University of Memphis, Memphis, TN, USA.
| | - Songning Zhang
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Clare E Milner
- Department of Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA, USA
| | - Jeffrey T Fairbrother
- Department of Kinesiology, Recreation and Sport Studies, The University of Tennessee, Knoxville, TN, USA
| | - Jeffrey A Reinbolt
- Department of Mechanical, Aerospace and Biomedical Engineering, The University of Tennessee, Knoxville, TN, USA
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Abstract
Successful total knee arthroplasty (TKA) has often been based on the restoration of the knee to neutral alignment postoperatively. Numerous reports have linked malaligned TKA components to increased wear, poor functional outcomes, and failure. There have been many different alignment philosophies and surgical techniques that have been established to attain the goal of proper alignment, which includes such techniques as computerized navigation, and custom cutting guides. In addition, these methods could potentially have the added benefit of leading to improved functional outcomes following total knee arthroplasty. In this report, we have reviewed and analyzed recent reports concerning mechanical, anatomic, and kinematic axis/alignment schemes used in total knee arthroplasty.
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Kim W, Veloso AP, Vleck VE, Andrade C, Kohles SS. The stationary configuration of the knee. J Am Podiatr Med Assoc 2014; 103:126-35. [PMID: 23536503 DOI: 10.7547/1030126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ligaments and cartilage contact contribute to the mechanical constraints in the knee joints. However, the precise influence of these structural components on joint movement, especially when the joint constraints are computed using inverse dynamics solutions, is not clear. METHODS We present a mechanical characterization of the connections between the infinitesimal twist of the tibia and the femur due to restraining forces in the specific tissue components that are engaged and responsible for such motion. These components include the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments and cartilage contact surfaces in the medial and lateral compartments. Their influence on the bony rotation about the instantaneous screw axis is governed by restraining forces along the constraints explored using the principle of reciprocity. RESULTS Published kinetic and kinematic joint data (American Society of Mechanical Engineers Grand Challenge Competition to Predict In Vivo Knee Loads) are applied to define knee joint function for verification using an available instrumented knee data set. We found that the line of the ground reaction force (GRF) vector is very close to the axis of the knee joint. It aligns the knee joint with the GRF such that the reaction torques are eliminated. The reaction to the GRF will then be carried by the structural components of the knee instead. CONCLUSIONS The use of this reciprocal system introduces a new dimension of foot loading to the knee axis alignment. This insight shows that locating knee functional axes is equivalent to the static alignment measurement. This method can be used for the optimal design of braces and orthoses for conservative treatment of knee osteoarthritis.
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Affiliation(s)
- Wangdo Kim
- Univ Tecn Lisboa, Fac Motricidade Humana, CIPER, LBMF, P-1499-002 Lisbon, Portugal.
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Gaudreault N, Hagemeister N, Poitras S, de Guise JA. Comparison of knee gait kinematics of workers exposed to knee straining posture to those of non-knee straining workers. Gait Posture 2013. [PMID: 23206900 DOI: 10.1016/j.gaitpost.2012.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Workers exposed to knee straining postures, such as kneeling and squatting, may present modifications in knee gait kinematics that can make them vulnerable to osteoarthritis. In this study, knee kinematics of workers exposed to occupational knee straining postures (KS workers) were compared to those of non-knee straining (non-KS) workers. Eighteen KS workers and 20 non-KS workers participated in the study. Three-dimensional gait kinematic data were recorded at the knee using an electromagnetic motion tracking system. The following parameters were extracted from flexion/extension, adduction/abduction and internal/external rotation angle data and used for group comparisons: knee angle at initial foot contact, peak angles, minimal angles and angle range during the entire gait cycle. Group comparisons were performed with Student t-tests. In the sagittal plane, KS workers had a greater knee flexion angle at initial foot contact, a lower peak knee flexion angle during the swing phase and a lower angle range than non-KS workers (p<0.05). In the frontal plane, all parameters indicated that KS workers had their knees more adducted than non-KS workers. External/internal rotation range was greater for KS workers. This study provides new knowledge on work related to KS postures and knee kinematics. The results support the concept that KS workers might exhibit knee kinematics that are different from those of non-KS workers.
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Purser JL, Golightly YM, Feng Q, Helmick CG, Renner JB, Jordan JM. Association of slower walking speed with incident knee osteoarthritis-related outcomes. Arthritis Care Res (Hoboken) 2012; 64:1028-35. [PMID: 22392700 PMCID: PMC3384768 DOI: 10.1002/acr.21655] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether slower walking speed was associated with an increased risk of incident hip and knee osteoarthritis (OA)-related outcomes. METHODS After providing informed consent, community-dwelling participants in the Johnston County Osteoarthritis Project completed 2 home-based interviews and an additional clinic visit for radiographic and physical evaluation. One thousand eight hundred fifty-eight noninstitutionalized residents ages ≥ 45 years living for at least 1 year in 1 of 6 townships in Johnston County, North Carolina, completed the study's questionnaires and clinical examinations at baseline and at followup testing. Walking time was assessed using a manual stopwatch in 2 trials over an 8-foot distance, and walking speed was calculated as the average of both trials. For the hip and knee, we examined 3 outcomes per joint site: radiographic OA (weight-bearing anteroposterior knee radiographs, supine anteroposterior pelvic radiographs of the hip), chronic joint symptoms, and symptomatic OA. Covariates included age, sex, race, education, marital status, body mass index, number of self-reported chronic conditions diagnosed by a health care provider, number of prescriptions, depressive symptoms, self-rated health, number of lower body functional limitations, smoking, and physical activity. RESULTS Faster walking speed was consistently associated with a lower incidence of radiographic (adjusted odds ratio [OR] 0.88, 95% confidence interval [95% CI] 0.79-0.97) and symptomatic knee OA (adjusted OR 0.84, 95% CI 0.75-0.95); slower walking speed was associated with a greater incidence of these outcomes across a broad range of different clinical and radiographic OA outcomes. CONCLUSION Slower walking speed may be a marker for incident knee OA, but other studies must confirm this finding.
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Affiliation(s)
- Jama L. Purser
- Division of Geriatrics, Department of Medicine, Duke University Medical Center (DUMC), Durham, NC, USA
- Doctor of Physical Therapy Division, Department of Community and Family Medicine, DUMC, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University Medical Center, DUMC, Durham, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Qiushi Feng
- Department of Sociology, National University of Singapore
| | - Charles G. Helmick
- Department of Sociology, National University of Singapore
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
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Farrokhi S, Tashman S, Gil AB, Klatt BA, Fitzgerald GK. Are the kinematics of the knee joint altered during the loading response phase of gait in individuals with concurrent knee osteoarthritis and complaints of joint instability? A dynamic stereo X-ray study. Clin Biomech (Bristol, Avon) 2012; 27:384-9. [PMID: 22071429 PMCID: PMC3289733 DOI: 10.1016/j.clinbiomech.2011.10.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 07/05/2011] [Accepted: 10/12/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Joint instability has been suggested as a risk factor for knee osteoarthritis and a cause of significant functional decline in those with symptomatic disease. However, the relationship between altered knee joint mechanics and self-reports of instability in individuals with knee osteoarthritis remains unclear. METHODS Fourteen subjects with knee osteoarthritis and complaints of joint instability and 12 control volunteers with no history of knee disease were recruited for this study. Dynamic stereo X-ray technology was used to assess the three-dimensional kinematics of the knee joint during the loading response phase of gait. FINDINGS Individuals with concurrent knee osteoarthritis and joint instability demonstrated significantly reduced flexion and internal/external rotation knee motion excursions during the loading response phase of gait (P<0.01), while the total abduction/adduction range of motion was increased (P<0.05). In addition, the coronal and transverse plane alignment of the knee joint at initial contact was significantly different (P<0.05) for individuals with concurrent knee osteoarthritis and joint instability. However, the anteroposterior and mediolateral tibiofemoral joint positions at initial contact and the corresponding total joint translations were similar between groups during the loading phase of gait. INTERPRETATIONS The rotational patterns of tibiofemoral joint motion and joint alignments reported for individuals with concurrent knee osteoarthritis and joint instability are consistent with those previously established for individuals with knee osteoarthritis. Furthermore, the findings of similar translatory tibiofemoral motion between groups suggest that self-reports of episodic joint instability in individuals with knee osteoarthritis may not necessarily be associated with adaptive alterations in joint arthrokinematics.
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Affiliation(s)
- Shawn Farrokhi
- Assistant Professor, Department of Physical Therapy, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Associate Professor & Director of Biodynamics Laboratory, Departments of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, PA, USA
| | - Alexandra B. Gil
- Research Associate, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian A. Klatt
- Assistant Professor of Orthopaedic Surgery, Departments of Orthopaedic Surgery, University of Pittsburgh, PA, USA
| | - G. Kelley Fitzgerald
- Associate Professor, Department of Physical Therapy, Director, Physical Therapy Clinical and Translational Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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Barrios JA, Higginson JS, Royer TD, Davis IS. Static and dynamic correlates of the knee adduction moment in healthy knees ranging from normal to varus-aligned. Clin Biomech (Bristol, Avon) 2009; 24:850-4. [PMID: 19703728 PMCID: PMC2763946 DOI: 10.1016/j.clinbiomech.2009.07.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 07/23/2009] [Accepted: 07/27/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with medial knee osteoarthritis often present with varus knee alignment and ambulate with increased knee adduction moments. Understanding the factors that relate to the knee adduction moment in healthy individuals may provide insight into the development of this disease. Thus, this study aimed to examine the relationships of both static and dynamic lower extremity measures with the knee adduction moment. We hypothesized that the dynamic measures would be more closely related to this moment. METHODS Arch height index, hip abduction strength and two static measures of knee alignment were recorded for 37 young asymptomatic knees that varied from normal to varus-aligned. Overground gait analyses were also performed. Correlation coefficients were used to assess the relationships between the static and dynamic variables to the knee adduction moment. Hierarchical regression analyses were then conducted using the static measures, the dynamic measures, and the static and dynamic measures together. RESULTS Among the static measures, the tibial mechanical axis and the distance between the medial knee joint lines were correlated with the knee adduction moment. The best predictive static model (R(2)=0.53) included only the tibial mechanical axis. Among the dynamic variables, knee adduction and rearfoot eversion angles were correlated with the knee adduction moment. Knee adduction and rearfoot eversion, together, were the best dynamic model (R(2)=0.53). The static and dynamic measures together created the strongest of the three models (R(2)=0.59). CONCLUSIONS These results suggest that dynamic measures slightly enhance the predictive strength of static measures when explaining variation in the knee adduction moment.
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Affiliation(s)
- Joaquin A. Barrios
- 326 McKinly Lab, University of Delaware, Newark, DE 19716, USA, 302-831-4646, 301-831-4234 (fax),
| | - Jill S. Higginson
- 201A Spencer Lab, University of Delaware, Newark, DE 19716, USA, 302-831-6622,
| | - Todd D. Royer
- 144 Rust Ice Arena, 541 South College Avenue, University of Delaware, Newark, DE 19716, USA, 302-831-4351,
| | - Irene S. Davis
- 305 McKinly Lab, University of Delaware, Newark, DE 19716, USA, 302-831-4263,
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de Groot IB, Bussmann JB, Stam HJ, Verhaar JAN. Actual everyday physical activity in patients with end-stage hip or knee osteoarthritis compared with healthy controls. Osteoarthritis Cartilage 2008; 16:436-42. [PMID: 17900934 DOI: 10.1016/j.joca.2007.08.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 08/13/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Few data are available on the level of actual physical activity in patients with osteoarthritis (OA) of the hip and knee. The aim of this study was to measure the level of actual physical activity of patients with end-stage OA of the hip and the knee, to compare this with that of matched healthy controls, and to analyze the data in order to ascertain the factors of influence. METHOD The actual physical activity was measured with an activity monitor (AM) in 40 hip and 44 knee OA patients, and compared with measurements obtained from healthy controls. Data were also collected on pain and psychological aspects as anxiety, depression and mental functioning. The primary outcome parameter of the actual physical activity was the percentage of movement-related activity. RESULTS The percentage of movement-related activity did not differ between the two OA groups. It was 8.8 (4.2)% for the hip and 8.1 (3.8)% for the knee OA patients. The matched controls were significantly higher movement-related active than OA patients (about 11.0 (2.9)%). Increasing age and body mass index were negatively associated with the percentage of movement-related activity (beta=-0.29 and beta=-0.25, respectively), whereas mental functioning was positively related (beta=0.30). CONCLUSION The impact of end-stage OA on the level of actual physical activity is equal for hip and knee OA patients. The actual physical activity for both of the OA groups was significantly and clinically relevantly lower compared to controls. However, this difference was smaller than expected and less dominant than patients' perception of limitations in daily life. Clinicians must be aware that the patients' perception of physical functioning in daily life does not always correspond to the actual physical activity.
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Affiliation(s)
- I B de Groot
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Deluzio KJ, Astephen JL. Biomechanical features of gait waveform data associated with knee osteoarthritis: an application of principal component analysis. Gait Posture 2007; 25:86-93. [PMID: 16567093 DOI: 10.1016/j.gaitpost.2006.01.007] [Citation(s) in RCA: 270] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Revised: 10/12/2005] [Accepted: 01/21/2006] [Indexed: 02/02/2023]
Abstract
This study compared the gait of 50 patients with end-stage knee osteoarthritis to a group of 63 age-matched asymptomatic control subjects. The analysis focused on three gait waveform measures that were selected based on previous literature demonstrating their relevance to knee osteoarthritis (OA): the knee flexion angle, flexion moment, and adduction moment. The objective was to determine the biomechanical features of these gait measures related to knee osteoarthritis. Principal component analysis was used as a data reduction tool, as well as a preliminary step for further analysis to determine gait pattern differences between the OA and the control groups. These further analyses included statistical hypothesis testing to detect group differences, and discriminant analysis to quantify overall group separation and to establish a hierarchy of discriminatory ability among the gait waveform features. The two groups were separated with a misclassification rate (estimated by cross-validation) of 8%. The discriminatory features of the gait waveforms were, in order of their discriminatory ability: the amplitude of the flexion moment, the range of motion of the flexion angle, the magnitude of the flexion moment during early stance, and the magnitude of the adduction moment during stance.
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Affiliation(s)
- K J Deluzio
- School of Biomedical Engineering, Dalhousie University, 5981 University Avenue, Halfiax, NS, Canada B3H 3J5.
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Lynn SK, Reid SM, Costigan PA. The influence of gait pattern on signs of knee osteoarthritis in older adults over a 5-11 year follow-up period: a case study analysis. Knee 2007; 14:22-8. [PMID: 17092727 DOI: 10.1016/j.knee.2006.09.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 09/05/2006] [Accepted: 09/11/2006] [Indexed: 02/02/2023]
Abstract
There is evidence that joint load is a factor in the development of osteoarthritis (OA) and, while altered gait profiles have been linked with OA, it is unknown if abnormal gait is a cause or effect of the disease. While the knee's adduction moment has been implicated in the development and progression of knee OA, it is also known that shearing forces are detrimental to the health of cartilage. The purpose of this pilot study was to examine the adduction moment and gait shear forces to determine if they may lead to signs of knee OA in older adults as they age. Knee gait kinetics, standardized radiographs and a questionnaire were collected on 28 older adults (M:13) during an initial visit, and 5 to 11 years later. Radiographic score increased (knees became more osteoarthritic in 15 of 28 subjects) over time. However, gait time-distance measures remained constant in disease free participants. Two returning participants developed symptoms and radiographic evidence of knee OA. The subject with the largest adduction moment developed signs of medial OA while the subject with the smallest adduction moment developed signs of lateral OA. In addition, there was a strong correlation between the magnitudes of the adduction moment and lateral-medial shear force that needs to be investigated further. Results suggest that gait can remain stable over time in older adults. Also, the medial and lateral OA case study findings suggest that the extreme gait profiles seen in these two participants may be important in explaining cartilage breakdown and the development of OA. This longitudinal study would suggest that perhaps it is the abnormal gait pattern that leads to the development of OA, although a much larger study would be needed to confirm this finding.
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Affiliation(s)
- Scott K Lynn
- Queen's University, School of Kinesiology and Health Studies, Physical Education Centre, Kingston, Ontario, Canada K7L 3N6
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Landry SC, McKean KA, Hubley-Kozey CL, Stanish WD, Deluzio KJ. Knee biomechanics of moderate OA patients measured during gait at a self-selected and fast walking speed. J Biomech 2006; 40:1754-61. [PMID: 17084845 DOI: 10.1016/j.jbiomech.2006.08.010] [Citation(s) in RCA: 170] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Accepted: 08/02/2006] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is a chronic disorder resulting in degenerative changes to the knee joint. Three-dimensional gait analysis provides a unique method of measuring knee dynamics during activities of daily living such as walking. The purpose of this study was to identify biomechanical features characterizing the gait of patients with mild-to-moderate knee OA and to determine if the biomechanical differences become more pronounced as the locomotor system is stressed by walking faster. Principal component analysis was used to compare the gait patterns of a moderate knee OA group (n=41) and a control group (n=43). The subjects walked at their self-selected speed as well as at 150% of that speed. The two subject groups did not differ in knee joint angles, stride length, and stride time or walking speed. Differences in the magnitude and shape of the knee joint moment waveforms were found between the two groups. The OA group had larger adduction moment magnitudes during stance and this higher magnitude was sustained for a longer portion of the gait cycle. The OA group also had a reduced flexion moment and a reduced external rotation moment during early stance. Increasing speed was associated with an increase in the magnitude of all joint moments. The fast walks did not, however, increase or bring out any biomechanical differences between the OA and control groups that did not exist at the self-selected walks.
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Affiliation(s)
- Scott C Landry
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada
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Kawakami H, Sugano N, Yonenobu K, Yoshikawa H, Ochi T, Nakata K, Toritsuka Y, Hattori A, Suzuki N. Change in the locus of dynamic loading axis on the knee joint after high tibial osteotomy. Gait Posture 2005; 21:271-8. [PMID: 15760742 DOI: 10.1016/j.gaitpost.2004.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2003] [Accepted: 02/18/2004] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to visualise the locus of the dynamic loading axis on the knee joint, and to evaluate changes in this locus during gait after high tibial osteotomy (HTO) in three patients who underwent HTO for medial compartment osteoarthritis (OA) of a varus knee. The bone structure of the lower limb and the relative position of skin markers were acquired from CT images. Motion capture data was acquired using spherical skin markers. Skeletal model movement during gait was calculated based on the movement of the markers. The locus of the dynamic loading axis on the knee joint was defined as the point on the proximal tibia joint surface that intersected with the loading axis of the lower limb, which passed through the centre of the femoral head and the centroid of multiple points surrounded by the distal tibia joint surface contour. This system was able to visualise the locus of the dynamic loading axis on the knee joint and not only lateral but also anterior-posterior direction movement. After HTO, the locus shifted from a medial and posterior area of the medial joint edge of the knee to a central area of the knee joint surface. This indicates that HTO shifted the dynamic loading axis. Lateral movement of the dynamic loading axis in the early stance phase of gait was reduced within a year after HTO.
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Affiliation(s)
- Hideo Kawakami
- Department of Medical Robotics and Image Sciences, Division of Robotic Therapy, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
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15
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Astephen JL, Deluzio KJ. Changes in frontal plane dynamics and the loading response phase of the gait cycle are characteristic of severe knee osteoarthritis application of a multidimensional analysis technique. Clin Biomech (Bristol, Avon) 2005; 20:209-17. [PMID: 15621327 DOI: 10.1016/j.clinbiomech.2004.09.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2002] [Accepted: 09/20/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteoarthritis of the knee is related to many correlated mechanical factors that can be measured with gait analysis. Gait analysis results in large data sets. The analysis of these data is difficult due to the correlated, multidimensional nature of the measures. METHODS A multidimensional model that uses two multivariate statistical techniques, principal component analysis and discriminant analysis, was used to discriminate between the gait patterns of the normal subject group and the osteoarthritis subject group. Nine time varying gait measures and eight discrete measures were included in the analysis. All interrelationships between and within the measures were retained in the analysis. FINDINGS The multidimensional analysis technique successfully separated the gait patterns of normal and knee osteoarthritis subjects with a misclassification error rate of <6%. The most discriminatory feature described a static and dynamic alignment factor. The second most discriminatory feature described a gait pattern change during the loading response phase of the gait cycle. INTERPRETATION The interrelationships between gait measures and between the time instants of the gait cycle can provide insight into the mechanical mechanisms of pathologies such as knee osteoarthritis. These results suggest that changes in frontal plane loading and alignment and the loading response phase of the gait cycle are characteristic of severe knee osteoarthritis gait patterns. Subsequent investigations earlier in the disease process may suggest the importance of these factors to the progression of knee osteoarthritis.
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Affiliation(s)
- J L Astephen
- School of Biomedical Engineering, Dalhousie University, 5981 University Avenue, Halifax, NS, Canada B3H 3J5
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16
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Fantozzi S, Benedetti MG, Leardini A, Banks SA, Cappello A, Assirelli D, Catani F. Fluoroscopic and gait analysis of the functional performance in stair ascent of two total knee replacement designs. Gait Posture 2003; 17:225-34. [PMID: 12770636 DOI: 10.1016/s0966-6362(02)00096-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Understanding total knee replacement mechanics and their influence on patient mobility requires accurate analysis of knee joint kinematics and traditional full body kinematics and kinetics. Three-dimensional fluoroscopic and gait analysis techniques were carried out on patients with either mobile bearing or posterior stabilized knee prostheses during stair ascent. Statistically significant correlation was found between knee flexion at foot strike and the position of the mid-condylar contact points, and between maximum knee adduction moment and corresponding lateral trunk tilt. A more complete and powerful assessment of the functional performances of different TKR designs can be performed in-vivo by combining gait and fluoroscopic analyses.
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Affiliation(s)
- Silvia Fantozzi
- Dipartimento di Elettronica Informatica e Sistemistica, Università di Bologna, Bologna, Italy.
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17
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Wada M, Imura S, Nagatani K, Baba H, Shimada S, Sasaki S. Relationship between gait and clinical results after high tibial osteotomy. Clin Orthop Relat Res 1998:180-8. [PMID: 9755778 DOI: 10.1097/00003086-199809000-00022] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Thirty-two patients with primary osteoarthritis of the medial compartment of the knee were studied prospectively to assess the relationship between clinical results, limb alignment, and adduction moment of the knee. Clinical and radiographic examination and gait analyses were performed preoperatively and repeated at 6 months and at 1, 3, and 6 years after high tibial osteotomy. The preoperative peak adduction moment was high in 25 patients and low in seven. In both groups, the adduction moment of the knee decreased at 6 months after surgery but increased after that period. Alignment of the affected knee in both groups remained valgus after surgery (average femorotibial angle, 167 degrees-169 degrees). Clinical outcome in both groups improved after surgery and remained unchanged after 1 year. The peak adduction moment of the knee for the whole group significantly correlated with alignment and foot angle before and 6 years after surgery but did not correlate with stride length and walking velocity. In addition, only alignment was associated significantly with clinical results at 6 years. These results suggest that the preoperative peak adduction moment of the knee does not correlate with clinical or radiographic outcomes of high tibial osteotomy, provided sufficient valgus alignment is achieved at surgery.
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Affiliation(s)
- M Wada
- Department of Orthopaedic Surgery, Fukui Medical University, Japan
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18
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Benedetti MG, Catani F, Leardini A, Pignotti E, Giannini S. Data management in gait analysis for clinical applications. Clin Biomech (Bristol, Avon) 1998; 13:204-215. [PMID: 11415789 DOI: 10.1016/s0268-0033(97)00041-7] [Citation(s) in RCA: 206] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/1995] [Accepted: 06/20/1997] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To study the reliability of gait analysis data obtained using the Calibrated Anatomical System Technique (CAST) protocol and to verify the suitability and repeatability of the extraction of a number of parameters from the waveforms obtained. DESIGN: The experimental protocol and the parametric analysis technique were applied on a population of able-bodied subjects. BACKGROUND: The clinical interpretation process of gait data still needs a more accurate analysis of the reliability and repeatability of the measurements and a suitable procedure for data reduction useful for data comparison. METHODS: Gait analysis was performed in 20 able-bodied subjects using a stereophotogrammetric system and a forceplate. 124 parameters relative to time-distance, kinematic and kinetic variables were calculated by means of an automatic procedure and statistically analysed. RESULTS: Most of the parameters were found to be normally distributed with relatively small range of variation. Few of them showed poor repeatability, mostly due to the experimental inaccuracies introduced. Correlation of several gait parameters with age, sex, and speed of progression was also identified.
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Affiliation(s)
- M G Benedetti
- Movement Analysis Laboratory, Istituti Ortopedici Rizzoli, Bologna, Italy
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19
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Yu B, Stuart MJ, Kienbacher T, Growney ES, An KN. Valgus-varus motion of the knee in normal level walking and stair climbing. Clin Biomech (Bristol, Avon) 1997; 12:286-293. [PMID: 11415736 DOI: 10.1016/s0268-0033(97)00005-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/1996] [Accepted: 12/27/1996] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: The knee valgus-varus moment and the knee angles were compared between normal level walking and stair climbing. DESIGN: Ten healthy subjects were tested for ascent, descent, and level walking. BACKGROUND: An understanding of the normal valgus-varus motion of the knee during stair climbing is needed to apply biomechanical analysis of stair climbing as a evaluation tool for knee osteoarthritis patients. METHODS: A motion analysis system, three force plates, and a flight of stairs were used to collect kinematic and kinetic data. The knee angles and moments were calculated from the collected kinematic and kinetic data. RESULTS: The knee varus angle for the maximum knee valgus moments in stair climbing was significantly greater than that in level walking. The knee valgus moment was significantly correlated to ground reaction forces and knee valgus-varus angle during stair climbing and level walking. CONCLUSIONS: There is a coupling between the knee valgus-varus motion and flexion-extension motion. Ground reaction forces are the major contributors to the within-subject variation in the knee valgus-varus moment during stair climbing and level walking. The knee valgus-varus angle is a major contributor to the between-subject variation in the knee valgus moment during stair climbing and level walking.
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Affiliation(s)
- B Yu
- Orthopedic Biomechanics Laboratory, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
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