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Chen G, Yu D, Wang Y, Ma Z, Bi M, Lu L, Zhang S, Liu J, Chen H, Shen H, Zhang H, Luo X, Si Y, Zhang P. A Prospective Randomized Controlled Trial Assessing the Impact of Preoperative Combined with Postoperative Progressive Resistance Training on Muscle Strength, Gait, Balance and Function in Patients Undergoing Total Hip Arthroplasty. Clin Interv Aging 2024; 19:745-760. [PMID: 38736563 PMCID: PMC11088839 DOI: 10.2147/cia.s453117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose The aim of this study is to investigate the effects of a preoperative combined with postoperative moderate-intensity progressive resistance training (PRT) of the operative side in patients with hip osteoarthritis (HOA) who are undergoing total hip arthroplasty (THA). The study seeks to evaluate the impact of this combined intervention on muscle strength, gait, balance, and hip joint function in a controlled, measurable, and objective manner. Additionally, the study aims to compare the outcomes of this combined intervention with those of preoperative or postoperative muscle strength training conducted in isolation. Methods A total of 90 patients with HOA scheduled for unilateral primary THA were randomly assigned to three groups: Pre group (preoperative PRT), Post group (postoperative PRT), and Pre& Post group (preoperative combined with postoperative PRT) focusing on hip flexion, extension, adduction, and abduction of operated side. Muscle strength, gait parameters, balance, and hip function were assessed at specific time points during a 12-month follow-up period. Results All three groups showed significant improvements in muscle strength, with the Pre& Post group demonstrating the most pronounced and sustained gains. Gait velocity and cadence were significantly improved in the Pre& Post group at 1-month and 3-month postoperative follow-ups compared to the other groups. Similarly, the Pre& Post group exhibited superior balance performance at 3-month and 12-month postoperative follow-ups. The Harris Hip Score also showed better outcomes in the Pre& Post group at all follow-up intervals. Conclusion Preoperative combined with postoperative moderate-intensity PRT in HOA patients undergoing THA led to superior improvements in muscle strength, gait, balance, and hip joint function compared to preoperative or postoperative PRT alone. This intervention shows significant promise in optimizing postoperative rehabilitation and enhancing patient outcomes following THA.
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Affiliation(s)
- Guo Chen
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Duoduo Yu
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Yichen Wang
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Zou Ma
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Mengna Bi
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Lisha Lu
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Shangshang Zhang
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Jiaxin Liu
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Hu Chen
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Hai Shen
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Huiwu Zhang
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Xiaobing Luo
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Yan Si
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Peng Zhang
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
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Çakmak MF, Bayram S, Birişik F, Ayik Ö, Şahinkaya T, Ergin ÖN, Öztürk İ. The effects of modified hardinge approach on hip muscle strength in patients with primary hip arthroplasty: a patient evaluation with isokinetic strength test and gait analyses. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1209-1218. [PMID: 38010444 DOI: 10.1007/s00590-023-03778-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Numerous factors affect abductor strength after Total hip arthroplasty (THA), including surgical technique, prosthesis type, postoperative rehabilitation program, and preoperative patient condition. We prospectively investigated the effects of the modified Hardinge approach on hip muscle strength, which was evaluated using the isokinetic test, functional results, and gait function of patients who underwent primary THA. METHODS The hip muscles strength were measured using an isokinetic dynamometer. The primary outcomes of the present study were measurement of isokinetic strength of hip abductor muscle strengths using an isokinetic evaluator and gait analyses preoperatively and at 6 months postoperatively in 27 patients. RESULTS Isokinetic muscle strength test, abductor and other hip circumference groups achieved the preoperative muscle strength at 3 months postoperatively, and the postoperative sixth month values showed a statistically significant improvement compared with the preoperative and third month values. In gait analyze, our temporospatial data showed a slight regression at postoperative 3 months but reached the same values at 6 months postoperatively. Kinematic data showed a significant regression, but the data were not compared with those in the preoperative period. CONCLUSIONS Adequate muscle strength and physiological gait pattern, similar to the preoperative status, can be achieved at 6 months postoperatively. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Mehmet Fevzi Çakmak
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey.
| | - Fevzi Birişik
- Department of Orthopaedics and Traumatology, Istanbul Research and Training Hospital University of Health Sciences, Istanbul, Turkey
| | - Ömer Ayik
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey
| | - Türker Şahinkaya
- Department of Sports Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ömer Naci Ergin
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey
| | - İrfan Öztürk
- Department of Orthopedics and Traumatology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Jöllenbeck T, Pietschmann J, Gerdesmeyer R, Hunfeld A. [Effects of joint replacement on spinal movement]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04405-2. [PMID: 37490137 DOI: 10.1007/s00132-023-04405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/26/2023]
Abstract
Although studies after joint replacement show significant improvements in important gait parameters during rehabilitation, the gait pattern at the end of rehabilitation is still clearly deficient. Patients show compensation strategies that also suggest changes in spinal movement. The aim of the present study was to analyse the spinal movement in dynamics in patients after total hip and knee replacement and to identify abnormalities in comparison to a reference group. 3D gait analyses and 4D spinal analyses were performed with the subjects at the beginning and at the end of rehabilitation. The analysis of the movement patterns showed abnormalities in all three movement dimensions, which manifested themselves in increased trunk forward tilt and lordosis, lateral tilt on the operative side and altered pelvic rotation. In consequence therapeutic measures after total hip and knee replacement should, therefore, include neighbouring joints such as the spine in order to avoid consequential complications.
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Affiliation(s)
- Thomas Jöllenbeck
- Institut für Biomechanik, Klinik Lindenplatz, Weslarner Str. 29, 59505, Bad Sassendorf, Deutschland.
- Arbeitsbereich Psychologie und Bewegung, Universität Paderborn, Department Sport & Gesundheit, Paderborn, Deutschland.
| | - Juliane Pietschmann
- Institut für Biomechanik, Klinik Lindenplatz, Weslarner Str. 29, 59505, Bad Sassendorf, Deutschland
| | - Rica Gerdesmeyer
- Institut für Biomechanik, Klinik Lindenplatz, Weslarner Str. 29, 59505, Bad Sassendorf, Deutschland
| | - Annika Hunfeld
- Zentrum für Trainingstherapie und Leistungsphysiologie, Nordic Science GmbH, Hannover, Deutschland
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Ghislieri M, Lanotte M, Knaflitz M, Rizzi L, Agostini V. Muscle synergies in Parkinson's disease before and after the deep brain stimulation of the bilateral subthalamic nucleus. Sci Rep 2023; 13:6997. [PMID: 37117317 PMCID: PMC10147693 DOI: 10.1038/s41598-023-34151-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/25/2023] [Indexed: 04/30/2023] Open
Abstract
The aim of this study is to quantitatively assess motor control changes in Parkinson's disease (PD) patients after bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS), based on a novel muscle synergy evaluation approach. A group of 20 PD patients evaluated at baseline (before surgery, T0), at 3 months (T1), and at 12 months (T2) after STN-DBS surgery, as well as a group of 20 age-matched healthy control subjects, underwent an instrumented gait analysis, including surface electromyography recordings from 12 muscles. A smaller number of muscle synergies was found in PD patients (4 muscle synergies, at each time point) compared to control subjects (5 muscle synergies). The neuromuscular robustness of PD patients-that at T0 was smaller with respect to controls (PD T0: 69.3 ± 2.2% vs. Controls: 77.6 ± 1.8%, p = 0.004)-increased at T1 (75.8 ± 1.8%), becoming not different from that of controls at T2 (77.5 ± 1.9%). The muscle synergies analysis may offer clinicians new knowledge on the neuromuscular structure underlying PD motor types of behavior and how they can improve after electroceutical STN-DBS therapy.
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Affiliation(s)
- Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129, Turin, Italy.
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy.
| | - Michele Lanotte
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126, Turin, Italy
- AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
| | - Marco Knaflitz
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129, Turin, Italy
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
| | - Laura Rizzi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, 10126, Turin, Italy
- AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129, Turin, Italy
- PolitoBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
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Houben M, van Hoeve S, Leenstra BS, Willems P, Meijer K, Poeze M. Gait analysis and clinical outcome in patients after pilon fracture surgery. Foot Ankle Surg 2022; 28:1229-1234. [PMID: 35562225 DOI: 10.1016/j.fas.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/24/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND In this study kinematic parameters, radiographic findings and PROM in pilon fractures after operative treatment were compared with healthy subjects. METHODS 16 patients treated with osteosynthesis after pilon fracture underwent kinematic analysis with the OFM. Fractures were evaluated for post-operative step-off and gap on CT-scans and PROM were collected. Results were compared to 10 healthy persons. RESULTS Range of motion (ROM) crural was lower in the flexion/extension for pilon fractures (10.03 vs. 13.15, p = 0.017). The ROM in the inversion/eversion was low, but ROM in the abduction/adduction was higher. Correlations were found between flexion/extension and AO-classification (r = -0.357 p < 0.05), PROM score of the AOFAS (r = 0.445 p < 0.01), post-operative gap and step-off in the tibia plafond. CONCLUSION Pilon fractures showed decreased ROM between the hindfoot and tibia in the sagittal and transverse plane, but increased ROM in the frontal plane during push-off phase as compensatory kinetics. ROM showed significant correlations with PROM and intra-articular step-off and gap in the tibia plafond.
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Affiliation(s)
- Michaël Houben
- Department of Surgery, division of Trauma surgery, Maastricht University Medical Center. P. Debyelaan 251. PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Sander van Hoeve
- Department of Surgery, division of Trauma surgery, Maastricht University Medical Center. P. Debyelaan 251. PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Bernard S Leenstra
- Department of Surgery, division of Trauma surgery, Maastricht University Medical Center. P. Debyelaan 251. PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Paul Willems
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25. PO Box 616, 6200 MD Maastricht, The Netherlands; NUTRIM, School for Nutrition and Translational Research in Metabolism, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - Kenneth Meijer
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25. PO Box 616, 6200 MD Maastricht, The Netherlands; NUTRIM, School for Nutrition and Translational Research in Metabolism, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - Martijn Poeze
- Department of Surgery, division of Trauma surgery, Maastricht University Medical Center. P. Debyelaan 251. PO Box 5800, 6202 AZ Maastricht, The Netherlands; NUTRIM, School for Nutrition and Translational Research in Metabolism, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Bahadori S, Middleton RG, Wainwright TW. Using Gait Analysis to Evaluate Hip Replacement Outcomes—Its Current Use, and Proposed Future Importance: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10102018. [PMID: 36292465 PMCID: PMC9601798 DOI: 10.3390/healthcare10102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Total hip replacement (THR) is one of the most common elective orthopaedic operations. However, evidence suggests that despite postoperative pain improvements, aspects of longer-term physical performance, such as walking ability, do not reach the levels expected when compared to the general population. Walking is best assessed by using gait analysis. This review aims to explain the concept of gait analysis, its use to evaluate THR outcomes, and its proposed future importance when evaluating new technologies proposed to improve functional recovery in individuals undergoing THR surgery. Furthermore, this review discusses the advantages and challenges of gait analysis in THR patients and provides recommendations for future work.
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Affiliation(s)
- Shayan Bahadori
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset BH8 8EB, UK
| | - Robert G. Middleton
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset BH8 8EB, UK
- Orthopaedic Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth, Dorset BH7 7DW, UK
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset BH8 8EB, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth, Dorset BH7 7DW, UK
- Correspondence:
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Martinez L, Noé N, Beldame J, Matsoukis J, Poirier T, Brunel H, Van Driessche S, Lalevée M, Billuart F. Quantitative gait analysis after total hip arthroplasty through a minimally invasive direct anterior approach: A case control study. Orthop Traumatol Surg Res 2022; 108:103214. [PMID: 35092851 DOI: 10.1016/j.otsr.2022.103214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/20/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Total Hip Arthroplasty (THA) leads to excellent clinical and functional results. The Minimally Invasive Anterior Approach (MIAA) theoretically allows rapid recovery and a reduction in the need for rehabilitation, but alterations in muscle and static balance have previously been demonstrated. Kinetic, kinematic and muscular alterations have been shown to persist up to 1year postoperatively but data beyond 1year postoperatively is lacking. Thus, the objective of this study was to compare the data from Quantitative Gait Analysis (QGA) coupled with electromyography (EMG), of patients one year postoperatively with THA through MIAA, compared to an asymptomatic control group. HYPOTHESIS We hypothesized that QGA and EMG parameters would not normalize beyond one year postoperatively. PATIENTS AND METHODS Twenty-seven patients were recruited, including 15 subjects (64.6±6.6years) operated on by MIAA, who at 15.9±3.1months postoperatively, along with 12 asymptomatic control subjects (68.9±9.7years), who underwent QGA and maximal isometric muscle strength tests, coupled with EMG on the gluteus medius and maximus, Tensor Fascia Lata (TFL) and Sartorius muscles. The spatiotemporal parameters of walking (step length, walking speed, cadence, single leg support time), kinetics (vertical ground reaction forces, hip moments in the 3 planes) and kinematics (coxofemoral and pelvic amplitudes) were analyzed. RESULTS The walking speed was lower on the non-operated side of the experimental subjects (0.96ms-1 compared to 1.13ms-1 for asymptomatic [p=0.018]), as was the step length on the operated side (0.53m compared to 0.60m for asymptomatic [p=0.042]). Maximal isometric muscle strength was lower in subjects operated on for the gluteus maximus and medius (p=0.004), compared to asymptomatic subjects. Moments were lower in the subjects operated on in extension (0.72Nm on the operated side, 0.75Nm on the non-operated side compared to 1.06Nm for asymptomatic [p=0.007 and p=0.024]) and lateral rotation (0.09Nm on the operated side, 0.05Nm on the non-operated side compared to 0.16Nm for asymptomatic subjects [p=0.009 and p=0.0005]). Hip adduction amplitudes were lower on the operated side compared to asymptomatic subjects (3.93° versus 9.14° for asymptomatic [p=0.005]). Pelvic amplitudes in the frontal plane were lower amongst operated subjects (0.44° against 1.97° for asymptomatic [p=0.041]). Pelvic amplitudes in the sagittal plane were higher in the operated subjects (15.74° on the operated side, 15.43° on the non-operated side compared to 9.65° for asymptomatic [p=0.041 and p=0.032]). DISCUSSION Our initial hypothesis was validated, since walking deficits persisted beyond one year postoperatively after THA through MIAA. A decrease in maximal isometric muscle strength of the gluteus medius and gluteus maximus was observed, as well as an alteration of kinetic and kinematic parameters in the sagittal and frontal planes. The results were in agreement with the literature and reflected the establishment of compensatory mechanisms to overcome alterations in joint strength and range more than one year postoperatively. These results would allow rehabilitation programs to be more specific and would justify a study on the other approaches for THA. LEVEL OF EVIDENCE III; non-randomized control trial.
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Affiliation(s)
- Lucas Martinez
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de recherche ERPHAN, UR 20201, UVSQ, Versailles, France
| | - Nathalie Noé
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, Groupe hospitalier du Havre, BP24, 76083, Le Havre cedex, France
| | - Thomas Poirier
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | | | - Matthieu Lalevée
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Service de chirurgie orthopédique et traumatologique, Centre hospitalier universitaire de Rouen, 76000 Rouen, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de recherche ERPHAN, UR 20201, UVSQ, Versailles, France.
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Cabañes-Martínez L, Villadóniga M, Millán AS, Del Álamo M, Regidor I. Effects of deep brain stimulation on the kinematics of gait and balance in patients with idiopathic Parkinson's disease. Clin Biomech (Bristol, Avon) 2022; 98:105737. [PMID: 35998434 DOI: 10.1016/j.clinbiomech.2022.105737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/13/2022] [Accepted: 08/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Advanced stages of idiopathic Parkinson's disease are often characterised by gait alterations and postural instability. Despite improvements in patients' motor symptoms after deep brain stimulation of the subthalamic nucleus, its effects on gait and balance remain a matter of debate. This study investigated the effects of deep brain stimulation on balance and kinematic parameters of gait. METHODS The gait of 26 patients with advanced idiopathic Parkinson's disease was analysed before and after (between 3 and 6 months) after bilateral deep brain stimulation of the subthalamic nucleus. Computerised analysis was used to study cadence, number of cycles with the correct support sequence, number of cycles, duration of the cycle stages, and knee and ankle goniometry. Balance, postural instability, and mobility were assessed using the Tinetti and Timed Up and Go test. FINDINGS After stimulation, the following changes were significant (p < 0.01): number of cycles with the correct support sequence, number of total cycles, and foot contact. Patients improved significantly (p < 0.01) in the Tinetti and Timed Up and Go tests, the risk factors for falls changed from high (median 17) to low (median 25), and they improved from minor dependence (statistical median 14) to normality (statistical median 8.70). INTERPRETATION Deep brain stimulation to inhibit hyperactivity of the subthalamic nucleus was associated with an improvement in the space-time variables of gait and balance in patients with Parkinson's disease for up to 3-6 months. These results highlight the major role of the subthalamic nucleus in motor control mechanisms during locomotion and balance.
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Affiliation(s)
- Lidia Cabañes-Martínez
- Clinical Neurophysiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - Marta Villadóniga
- Clinical Neurophysiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Marta Del Álamo
- Neurosurgery Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ignacio Regidor
- Clinical Neurophysiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Schoenmakers S, Houben M, van Hoeve S, Willems P, Meijer K, Poeze M. The influence of size and comminution of the posterior malleolus fragment on gait in trimalleolar ankle fractures. Clin Biomech (Bristol, Avon) 2022; 91:105550. [PMID: 34922095 DOI: 10.1016/j.clinbiomech.2021.105550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 11/22/2021] [Accepted: 12/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle fractures involving the posterior malleolus generally lead to worse outcome. However, no studies on gait in trimalleolar ankle fractures have evaluated the influence of size and comminution of the posterior malleolar fragment. METHODS We expected patients with more severely comminuted posterior malleolus, more severe fracture type and larger posterior fragment to have reduced gait kinematics and poorer patient-reported outcomes. 26 trimalleolar ankle fracture patients were compared with 14 healthy controls and kinematically analyzed using the Oxford Foot Model. Functional outcome was based on 4 patient reported outcome questionnaires. Effects of posterior fragment size, comminution and Haraguchi fracture classification were determined on conventional and 3D CT-scans. FINDINGS Trimalleolar patients had lower walking speed and reduced range of motion between the hindfoot and tibia in both loading and push-off phases in the sagittal and transverse planes. The range between the hindfoot and tibia in the sagittal plane in the push-off phase correlated significantly with patient reported outcomes. The absolute and relative surface area of the posterior fragment on conventional CT-scans and 3D CT-scans, correlated significantly with range of motion. Patients with a posterior malleolus size >10% of the posterior malleolus had lower flexion-extension between forefoot and hindfoot during loading phase than patients with a size ≤10%. INTERPRETATION Trimalleolar fractures reduce walking speed and range of motion in the talocrural joint. Reduced range in the talocrural joint is associated with poorer outcomes. Posterior fragment size correlated significantly with range of motion in talocrural and midfoot joints and with patient reported outcomes. LEVEL OF EVIDENCE Level 3, retrospective study.
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Affiliation(s)
- S Schoenmakers
- Department of Surgery, Division of Trauma surgery, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - M Houben
- Department of Surgery, Division of Trauma surgery, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - S van Hoeve
- Department of Surgery, Division of Trauma surgery, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands
| | - P Willems
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25, PO Box 616, 6200 MD Maastricht, the Netherlands; NUTRIM, School for Nutrition and Translational Research in Metabolism, PO Box 616, 6200 MD Maastricht, the Netherlands.
| | - K Meijer
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25, PO Box 616, 6200 MD Maastricht, the Netherlands; NUTRIM, School for Nutrition and Translational Research in Metabolism, PO Box 616, 6200 MD Maastricht, the Netherlands.
| | - M Poeze
- Department of Surgery, Division of Trauma surgery, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, the Netherlands; NUTRIM, School for Nutrition and Translational Research in Metabolism, PO Box 616, 6200 MD Maastricht, the Netherlands.
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Kaynak G, Karaismailoglu B, Ozsahin MK, Gorgun B, Inan M, Erdogan F. High hip center arthroplasty in the treatment of severe hip dysplasia: Are knee and ankle compromised? Clin Biomech (Bristol, Avon) 2022; 91:105542. [PMID: 34861496 DOI: 10.1016/j.clinbiomech.2021.105542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited information about the effect of hip center location on gait parameters of knee and ankle. This study aimed to compare anatomical vs. high hip center arthroplasty according to gait parameters of knee and ankle and investigate whether the high hip center has any adverse effect on these joints or not. METHODS 20 patients who underwent unilateral total hip arthroplasty (Group 1; 10 patients with anatomical reconstruction, Group 2; 10 patients with high hip center) due to Crowe type III-IV developmental dysplasia of the hip and completed 2 years of follow-up were included. The patients were examined by 3-D gait analysis. FINDINGS The maximum extension of the knee on the operated side was lower in Group 2 (p = 0.044). Longitudinal knee joint force was higher in Group 2 on both operated (p = 0.041) and non-operated sides (p = 0.031). Lateral knee joint force was also higher in Group 2 (p = 0.023). No significant difference was detected in ankle parameters. INTERPRETATION Unilateral high hip center has been shown to restrict the dynamic knee range of motion on the operated side and increase the knee load on both sides, thus putting the knees at risk for osteoarthritis. LEVEL OF EVIDENCE Level III, Retrospective comparative study.
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Affiliation(s)
- Gokhan Kaynak
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Bedri Karaismailoglu
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Mahmut Kursat Ozsahin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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11
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Evaluation of Muscle Function by Means of a Muscle-Specific and a Global Index. SENSORS 2021; 21:s21217186. [PMID: 34770493 PMCID: PMC8587884 DOI: 10.3390/s21217186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/19/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
Gait analysis applications in clinics are still uncommon, for three main reasons: (1) the considerable time needed to prepare the subject for the examination; (2) the lack of user-independent tools; (3) the large variability of muscle activation patterns observed in healthy and pathological subjects. Numerical indices quantifying the muscle coordination of a subject could enable clinicians to identify patterns that deviate from those of a reference population and to follow the progress of the subject after surgery or completing a rehabilitation program. In this work, we present two user-independent indices. First, a muscle-specific index (MFI) that quantifies the similarity of the activation pattern of a muscle of a specific subject with that of a reference population. Second, a global index (GFI) that provides a score of the overall activation of a muscle set. These two indices were tested on two groups of healthy and pathological children with encouraging results. Hence, the two indices will allow clinicians to assess the muscle activation, identifying muscles showing an abnormal activation pattern, and associate a functional score to every single muscle as well as to the entire muscle set. These opportunities could contribute to facilitating the diffusion of surface EMG analysis in clinics.
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12
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Ghislieri M, Cerone GL, Knaflitz M, Agostini V. Long short-term memory (LSTM) recurrent neural network for muscle activity detection. J Neuroeng Rehabil 2021; 18:153. [PMID: 34674720 PMCID: PMC8532313 DOI: 10.1186/s12984-021-00945-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The accurate temporal analysis of muscle activation is of great interest in many research areas, spanning from neurorobotic systems to the assessment of altered locomotion patterns in orthopedic and neurological patients and the monitoring of their motor rehabilitation. The performance of the existing muscle activity detectors is strongly affected by both the SNR of the surface electromyography (sEMG) signals and the set of features used to detect the activation intervals. This work aims at introducing and validating a powerful approach to detect muscle activation intervals from sEMG signals, based on long short-term memory (LSTM) recurrent neural networks. METHODS First, the applicability of the proposed LSTM-based muscle activity detector (LSTM-MAD) is studied through simulated sEMG signals, comparing the LSTM-MAD performance against other two widely used approaches, i.e., the standard approach based on Teager-Kaiser Energy Operator (TKEO) and the traditional approach, used in clinical gait analysis, based on a double-threshold statistical detector (Stat). Second, the effect of the Signal-to-Noise Ratio (SNR) on the performance of the LSTM-MAD is assessed considering simulated signals with nine different SNR values. Finally, the newly introduced approach is validated on real sEMG signals, acquired during both physiological and pathological gait. Electromyography recordings from a total of 20 subjects (8 healthy individuals, 6 orthopedic patients, and 6 neurological patients) were included in the analysis. RESULTS The proposed algorithm overcomes the main limitations of the other tested approaches and it works directly on sEMG signals, without the need for background-noise and SNR estimation (as in Stat). Results demonstrate that LSTM-MAD outperforms the other approaches, revealing higher values of F1-score (F1-score > 0.91) and Jaccard similarity index (Jaccard > 0.85), and lower values of onset/offset bias (average absolute bias < 6 ms), both on simulated and real sEMG signals. Moreover, the advantages of using the LSTM-MAD algorithm are particularly evident for signals featuring a low to medium SNR. CONCLUSIONS The presented approach LSTM-MAD revealed excellent performances against TKEO and Stat. The validation carried out both on simulated and real signals, considering normal as well as pathological motor function during locomotion, demonstrated that it can be considered a powerful tool in the accurate and effective recognition/distinction of muscle activity from background noise in sEMG signals.
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Affiliation(s)
- Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico Di Torino, 10129, Turin, Italy.
- PoliToBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy.
| | - Giacinto Luigi Cerone
- PoliToBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
- Laboratory for Engineering of the Neuromuscular System (LISiN), Departement of Electronics and Telecommunications, Politecnico di Torino, 10129, Turin, Italy
| | - Marco Knaflitz
- Department of Electronics and Telecommunications, Politecnico Di Torino, 10129, Turin, Italy
- PoliToBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico Di Torino, 10129, Turin, Italy
- PoliToBIOMed Lab, Politecnico di Torino, 10129, Turin, Italy
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13
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Ippolito G, Serrao M, Conte C, Castiglia SF, Rucco F, Bonacci E, Miscusi M, Pierelli F, Bini F, Marinozzi F, Zitiello M, Ragona C, De Marinis G. Direct anterior approach for total hip arthroplasty: Hip biomechanics and muscle activation during three walking tasks. Clin Biomech (Bristol, Avon) 2021; 89:105454. [PMID: 34482068 DOI: 10.1016/j.clinbiomech.2021.105454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/20/2021] [Accepted: 08/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total hip replacement with minimally invasive direct anterior approach using the "Smith Petersen" interval is an alternative technique to conventional surgery aimed at preserving the integrity of the muscles around the hip joint. This study aimed to observe hip biomechanics, gait variables, hip muscle activation and locomotor performance during three locomotor tasks (forward, lateral, and backward walking), in subjects who undergo total hip arthroplasty with direct anterior approach. METHODS Fourteen patients with primary osteoarthritis who underwent direct anterior approach were included in the study. The optoelectronic 3-D motion analysis system integrated with an electromyography surface device was used to acquire the biomechanics of patients before surgery and at 3 and 6 months post-surgery. Spatio-temporal, dynamic, and hip muscle electromyographic parameters were analyzed and compared whit those of healthy controls. FINDINGS Almost all gait parameters improved after surgery. The majority of gait variables neared to the control group at 6 months, while the hip joint range of motion did not. The abnormally increased activation of the muscles around the hip joint was reduced at 6 months post-surgery during all three locomotor tasks. Conversely, the altered gait phase-related electromyographic pattern did not change after the surgery. INTERPRETATION Our results indicate that hip and gait function during several locomotor tasks improved after surgery, while simultaneously either preserve or restore the muscle activation around the hip joint. A full biomechanical evaluation of the hip function during locomotion may aid physicians and surgeons in optimizing the management of patients before and after hip replacement surgery.
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Affiliation(s)
- Giorgio Ippolito
- Istituto Chirurgico Ortopedico Traumatologico, Via Franco Faggiana, 1668 Latina, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina, Italy; Movement Analysis LAB, Policlinico Italia, Piazza del Campidano 6, Rome, Italy
| | - Carmela Conte
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina, Italy
| | - Ferdinando Rucco
- Istituto Chirurgico Ortopedico Traumatologico, Via Franco Faggiana, 1668 Latina, Italy
| | - Enrico Bonacci
- Istituto Chirurgico Ortopedico Traumatologico, Via Franco Faggiana, 1668 Latina, Italy
| | - Massimo Miscusi
- Department of Neuroscience, Mental Health, and Sense Organs, Faculty of Medicine and Psychology, Sapienza University of Rome, via di Grottarossa 1035-1039, Rome, Italy
| | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina, Italy; IRCCS Neuromed, Via Atinense 18, Pozzili, Isernia, Italy
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, Mechanical & Thermal Measurement Lab, Sapienza University of Rome, Via Eudossiana 18, Rome, Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, Mechanical & Thermal Measurement Lab, Sapienza University of Rome, Via Eudossiana 18, Rome, Italy
| | - Michele Zitiello
- Istituto Chirurgico Ortopedico Traumatologico, Via Franco Faggiana, 1668 Latina, Italy
| | - Chiara Ragona
- Movement Analysis LAB, Policlinico Italia, Piazza del Campidano 6, Rome, Italy; Department of Mechanical and Aerospace Engineering, Mechanical & Thermal Measurement Lab, Sapienza University of Rome, Via Eudossiana 18, Rome, Italy
| | - Giancarlo De Marinis
- Istituto Chirurgico Ortopedico Traumatologico, Via Franco Faggiana, 1668 Latina, Italy
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14
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Ghislieri M, Agostini V, Rizzi L, Knaflitz M, Lanotte M. Atypical Gait Cycles in Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2021; 21:5079. [PMID: 34372315 PMCID: PMC8347347 DOI: 10.3390/s21155079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022]
Abstract
It is important to find objective biomarkers for evaluating gait in Parkinson's Disease (PD), especially related to the foot and lower leg segments. Foot-switch signals, analyzed through Statistical Gait Analysis (SGA), allow the foot-floor contact sequence to be characterized during a walking session lasting five-minutes, which includes turnings. Gait parameters were compared between 20 PD patients and 20 age-matched controls. PDs showed similar straight-line speed, cadence, and double-support compared to controls, as well as typical gait-phase durations, except for a small decrease in the flat-foot contact duration (-4% of the gait cycle, p = 0.04). However, they showed a significant increase in atypical gait cycles (+42%, p = 0.006), during both walking straight and turning. A forefoot strike, instead of a "normal" heel strike, characterized the large majority of PD's atypical cycles, whose total percentage was 25.4% on the most-affected and 15.5% on the least-affected side. Moreover, we found a strong correlation between the atypical cycles and the motor clinical score UPDRS-III (r = 0.91, p = 0.002), in the subset of PD patients showing an abnormal number of atypical cycles, while we found a moderate correlation (r = 0.60, p = 0.005), considering the whole PD population. Atypical cycles have proved to be a valid biomarker to quantify subtle gait dysfunctions in PD patients.
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Affiliation(s)
- Marco Ghislieri
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (V.A.); (M.K.)
- PoliToBIOMed Lab, Politecnico di Torino, 10129 Turin, Italy
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (V.A.); (M.K.)
- PoliToBIOMed Lab, Politecnico di Torino, 10129 Turin, Italy
| | - Laura Rizzi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (L.R.); (M.L.)
- AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Knaflitz
- Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Turin, Italy; (V.A.); (M.K.)
- PoliToBIOMed Lab, Politecnico di Torino, 10129 Turin, Italy
| | - Michele Lanotte
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy; (L.R.); (M.L.)
- AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
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15
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Zhang X, Butts WJ, You T. Exercise interventions, physical function, and mobility after hip fracture: a systematic review and meta-analysis. Disabil Rehabil 2021; 44:4986-4996. [PMID: 34101525 DOI: 10.1080/09638288.2021.1924299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the effects of different exercise components on physical function and mobility in adults after hip fracture. METHODS Pubmed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO were searched up to March 2021. Randomized controlled trials investigating the effects of exercise interventions on physical function and mobility in adults after hip fracture were included. RESULTS Fifteen studies (12 trials) were included (n = 1198, age = 80 ± 8 years). Exercise interventions had a moderate effect on overall physical function after hip fracture compared to non-exercise (SMD = 0.46, 95% CI = 0.27-0.65). Among different exercise components, progressive resistance exercise showed the largest effect (SMD = 0.48, 95% CI = 0.27-0.69), while aerobic exercise alone had no effect (SMD 0.41, 95% -0.44 to1.26) on physical function. Exercise had a small effect on mobility (SMD = 0.28, 95% CI = 0.12-0.43). Specifically, functional exercise showed a moderate effect (SMD = 0.41, 95% CI = 0.16-0.65) on mobility. CONCLUSIONS Available evidence supports that exercise interventions improve physical function and mobility in older adults after hip fracture; specifically, resistance exercise with progressive load of 60-80% 1RM, and functional exercise may be critical intervention components respectively. Future high-quality research is needed to establish best practices.IMPLICATIONS FOR REHABILITATIONProgressive resistance exercise with 60-80% 1RM resulted in the largest improvement in physical function after hip fracture.Functional exercise appears to be a critical component for improving mobility after hip fracture. Functional exercise plus resistance and balance exercises was the most effective intervention for enhancing mobility.Exercise should be supervised by a trainer or a physiotherapist, and self-reported exercise may not result in the same benefits.
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Affiliation(s)
- Xiaorui Zhang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - William J Butts
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Tongjian You
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
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16
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Marin L, Vandoni M, Zaza G, Febbi M, Pedrotti L, Chiodaroli M, Lovecchio N, Manzoni F. The Effects of Insole-Based Visual Feedback on Weight-Bearing in Patients Undergoing Total Hip Replacement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3346. [PMID: 33804915 PMCID: PMC8037670 DOI: 10.3390/ijerph18073346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/10/2021] [Accepted: 03/20/2021] [Indexed: 01/10/2023]
Abstract
This study aimed to investigate the visual biofeedback effect of a sensorized system for plantar pressure dynamic evaluation of in patients with a total hip replacement. Experimental group followed the rehabilitation training wearing sensorized insoles that provided images on three monitors. The control group followed the verbal instructions of physiotherapists during training. Weight bearing percentage healthy limb (WBPH), weight bearing percentage surgical limb (WBPS), swing healthy limb (SWH) and swing surgical limb (SWS) improved significantly more in the experimental group. The results underline the effectiveness of visual biofeedback based on sensorized system with dynamic evaluation of the plantar pressure.
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Affiliation(s)
- Luca Marin
- Department of Rehabilitation, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic; (L.M.); (M.F.)
- Laboratory for Rehabilitation, Medicine and Sport (LARMS), 00100 Rome, Italy;
- Department of Rehabilitation, Città di Pavia Hospital, 27100 Pavia, Italy;
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Giancarlo Zaza
- Laboratory for Rehabilitation, Medicine and Sport (LARMS), 00100 Rome, Italy;
| | - Massimiliano Febbi
- Department of Rehabilitation, Faculty of Medicine, University of Ostrava, 70103 Ostrava, Czech Republic; (L.M.); (M.F.)
- Laboratory for Rehabilitation, Medicine and Sport (LARMS), 00100 Rome, Italy;
| | - Luisella Pedrotti
- Department of Pediatric Diagnostic Surgical Clinical Science, Section of Pathologies of the Musculoskeleta System, Orthopedics Unit, University of Pavia, 27100 Pavia, Italy;
| | - Matteo Chiodaroli
- Department of Rehabilitation, Città di Pavia Hospital, 27100 Pavia, Italy;
| | - Nicola Lovecchio
- Laboratory of Adapted Motor Activity (LAMA), Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Federica Manzoni
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Health Promotion—Environmental Epidemiology Unit, Hygiene and Health Prevention Department, Health Protection Agency, 27100 Pavia, Italy
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17
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Wang J, Siddicky SF, Dohm MP, Barnes CL, Mannen EM. Kinematic and Kinetic Changes after Total Hip Arthroplasty during Sit-To-Stand Transfers: Systematic Review. Arthroplast Today 2021; 7:148-156. [PMID: 33553542 PMCID: PMC7851329 DOI: 10.1016/j.artd.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/20/2020] [Indexed: 11/16/2022] Open
Abstract
Background Total hip arthroplasty (THA) is a common and effective surgical procedure that allows patients with hip osteoarthritis to restore functional ability and relieve pain. Sit-to-stand transfers are common demanding tasks during activities of daily living and are performed more than 50 times per day. The purpose of this systematic review is to obtain a comprehensive understanding of biomechanical changes during sit-to-stand transfers after THA. Methods Relevant articles were selected through MEDLINE, Scopus, Embase, and Web of Science. Articles were included if they met the following inclusion criteria: 1) participants underwent total hip arthroplasty without restriction on the arthroplasty design, 2) involved either kinematic or kinetic variables as the primary outcome measure, 3) evaluated sit-to-stand, and 4) were written in English. Results A total of 11 articles were included in the current systematic review. The THA group exhibited altered movement patterns as compared to healthy controls. Improvement in loading asymmetry was found up to 1 year after THA, but other kinetic changes indicate intensified contralateral limb loading. Limb differences were apparent, but whether these differences persist over 10 months after THA is still unknown. Conclusion Despite the inevitable changes in kinematics and kinetics in sit-to-stand transfers after THA, it appears to be important to resolve asymmetrical loading between the operative and nonoperative limbs to minimize risk for subsequent joint problems.
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Affiliation(s)
- Junsig Wang
- Department of Orthopaedic Surgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Safeer F Siddicky
- Department of Orthopaedic Surgery, University of Arkansas for Medical Science, Little Rock, AR, USA.,Mechanical and Biomedical Engineering Department, College of Engineering, Boise State University, Boise, ID, USA
| | - Michael P Dohm
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Erin M Mannen
- Department of Orthopaedic Surgery, University of Arkansas for Medical Science, Little Rock, AR, USA.,Mechanical and Biomedical Engineering Department, College of Engineering, Boise State University, Boise, ID, USA
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18
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Agostini V, Ghislieri M, Rosati S, Balestra G, Knaflitz M. Surface Electromyography Applied to Gait Analysis: How to Improve Its Impact in Clinics? Front Neurol 2020; 11:994. [PMID: 33013656 PMCID: PMC7502709 DOI: 10.3389/fneur.2020.00994] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/29/2020] [Indexed: 12/22/2022] Open
Abstract
Surface electromyography (sEMG) is the main non-invasive tool used to record the electrical activity of muscles during dynamic tasks. In clinical gait analysis, a number of techniques have been developed to obtain and interpret the muscle activation patterns of patients showing altered locomotion. However, the body of knowledge described in these studies is very seldom translated into routine clinical practice. The aim of this work is to analyze critically the key factors limiting the extensive use of these powerful techniques among clinicians. A thorough understanding of these limiting factors will provide an important opportunity to overcome limitations through specific actions, and advance toward an evidence-based approach to rehabilitation based on objective findings and measurements.
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Affiliation(s)
- Valentina Agostini
- PoliToBIOMedLab, Politecnico di Torino, Turin, Italy.,Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Marco Ghislieri
- PoliToBIOMedLab, Politecnico di Torino, Turin, Italy.,Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Samanta Rosati
- PoliToBIOMedLab, Politecnico di Torino, Turin, Italy.,Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Gabriella Balestra
- PoliToBIOMedLab, Politecnico di Torino, Turin, Italy.,Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Marco Knaflitz
- PoliToBIOMedLab, Politecnico di Torino, Turin, Italy.,Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
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19
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Robbins SM, Gomes SK, Huk OL, Zukor DJ, Antoniou J. The Influence of Lateral and Posterior Total Hip Arthroplasty Approaches on Muscle Activation and Joint Mechanics During Gait. J Arthroplasty 2020; 35:1891-1899.e5. [PMID: 32173617 DOI: 10.1016/j.arth.2020.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Lateral and posterior total hip arthroplasty (THA) approaches disrupt muscle function, which could impact gait. The objectives of this study were to compare muscle activation and joint mechanics during gait, and isometric strength between participants after lateral and posterior THA approaches and healthy adults. METHODS Participants 1 year post-THA from either lateral (n = 21) or posterior (n = 21) approaches, and healthy adults (n = 21) ambulated at self-selected speeds. Surface electromyography, optical motion capture, and force plates measured muscle activation and joint mechanics during gait. A dynamometer measured isometric torque. Gait characteristics and isometric torque were compared using analysis of variance and effect sizes (d). RESULTS Lateral THA group had higher gluteus medius amplitudes during gait compared to the healthy group (P < .01, d = -0.97). Posterior THA group had higher gluteus maximus amplitudes during loading response (P = .02, d = -0.94) and higher hamstring amplitudes during midstance (P = .02, d = 0.45-1.31) than the healthy group. Both THA groups had decreased hip flexion and adduction angle excursions during gait (d = 0.89-1.14), but increased medial rotation angle excursions (d = -1.06 to -0.91), compared to the healthy group. Lateral THA group had lower isometric hip abduction torque than the healthy group (P = .03, d = 0.74). There was no pelvic drop in the THA groups. CONCLUSION There were few differences in gait and isometric torque between lateral and posterior THA groups. The elevated muscle activation amplitudes in the lateral and posterior THA groups compared to healthy adults were likely due to muscle weakness. Despite these findings, there was no evidence of pelvic drop.
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Affiliation(s)
- Shawn M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Sharleen K Gomes
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, Montreal, Quebec, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Olga L Huk
- Division of Orthopaedic Surgery, SMBD Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - David J Zukor
- Division of Orthopaedic Surgery, SMBD Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - John Antoniou
- Division of Orthopaedic Surgery, SMBD Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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20
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Nelms NJ, Birch CE, Halsey DH, Blankstein M, McGinnis RS, Beynnon BD. Assessment of Early Gait Recovery After Anterior Approach Compared to Posterior Approach Total Hip Arthroplasty: A Smartphone Accelerometer-Based Study. J Arthroplasty 2020; 35:465-470. [PMID: 31629624 DOI: 10.1016/j.arth.2019.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The influence of total hip arthroplasty surgical approach on postoperative recovery is not well understood and often debated. This study compares anterior and posterior approach (PA) gait and patient-reported Hip Osteoarthritis Outcome scores (HOOS) in the early phases of recovery. METHODS A prospective study evaluated 20 control subjects, 35 direct anterior approach (DAA), and 34 PA total hip arthroplasty patients. Subjects were assessed preoperatively and at 1 and 4 months postoperatively with HOOS and smartphone gait assessments of gait speed, step length, cadence, step symmetry, and horizontal and vertical center of mass displacements. RESULTS The DAA and PA groups were not different in baseline HOOS or gait characteristics except for less horizontal center of mass displacement in the DAA group. At 1 month postoperatively, the DAA group had significantly faster gait speed at self-selected (P = .02) and fastest possible gait (P = .01) and longer step length at self-selected (P = .047) and fastest gait (P = .003) compared to the PA. At 4 months, there were no differences in DAA and PA gait measures. At 1 month postoperatively there were no significant differences in HOOS, but after 4 months HOOS were significantly higher in the DAA group. CONCLUSION There were minimal differences between the two approaches in the recovery of gait mechanics with some gait parameters particularly gait speed and step length recovery favoring the DAA at 1 month postsurgery in this nonrandomized study.
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Affiliation(s)
- Nathaniel J Nelms
- Department of Orthopaedics and Rehabilitation, University of Vermont, South Burlington, Vermont
| | - Christopher E Birch
- Department of Orthopaedics and Rehabilitation, University of Vermont, South Burlington, Vermont; Alta Orthopaedics, Santa Barbara, California
| | - David H Halsey
- Department of Orthopaedics and Rehabilitation, University of Vermont, South Burlington, Vermont
| | - Michael Blankstein
- Department of Orthopaedics and Rehabilitation, University of Vermont, South Burlington, Vermont
| | - Ryan S McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont
| | - Bruce D Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, South Burlington, Vermont
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Rosso V, Agostini V, Takeda R, Tadano S, Gastaldi L. Influence of BMI on Gait Characteristics of Young Adults: 3D Evaluation Using Inertial Sensors. SENSORS 2019; 19:s19194221. [PMID: 31569372 PMCID: PMC6806343 DOI: 10.3390/s19194221] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 12/30/2022]
Abstract
Overweight/obesity is a physical condition that affects daily activities, including walking. The main purpose of this study was to identify if there is a relationship between body mass index (BMI) and gait characteristics in young adults. 12 normal weight (NW) and 10 overweight/obese (OW) individuals walked at a self-selected speed along a 14 m indoor path. H-Gait system, combining seven inertial sensors (fixed on pelvis and lower limbs), was used to record gait data. Walking speed, spatio-temporal parameters and joint kinematics in 3D were analyzed. Differences between NW and OW and correlations between BMI and gait parameters were evaluated. Conventional spatio-temporal parameters did not show statistical differences between the two groups or correlations with the BMI. However, significant results were pointed out for the joint kinematics. OW showed greater hip joint angles in frontal and transverse planes, with respect to NW. In the transverse plane, OW showed a greater knee opening angle and a shorter length of knee and ankle trajectories. Correlations were found between BMI and kinematic parameters in the frontal and transverse planes. Despite some phenomena such as soft tissue artifact and kinematics cross-talk, which have to be more deeply assessed, current results show a relationship between BMI and gait characteristics in young adults that should be looked at in osteoarthritis prevention.
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Affiliation(s)
- Valeria Rosso
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Italy, Corso Duca degli Abruzzi 24, 10129 Torino, Italy.
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy.
| | - Ryo Takeda
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido 060-8628, Japan.
| | - Shigeru Tadano
- Division of Human Mechanical Systems and Design, Faculty of Engineering, Hokkaido University, Sapporo, Hokkaido 060-8628, Japan.
- National Institute of Technology, Hakodate College, Hakodate 042-8501, Japan.
| | - Laura Gastaldi
- Department of Mathematical Sciences, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy.
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CORR Insights®: Gait Analysis Reveals that Total Hip Arthroplasty Increases Power Production in the Hip During Level Walking and Stair Climbing. Clin Orthop Relat Res 2019; 477:1848-1850. [PMID: 31335602 PMCID: PMC7000027 DOI: 10.1097/corr.0000000000000865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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van Hoeve S, Houben M, Verbruggen JPAM, Willems P, Meijer K, Poeze M. Gait analysis related to functional outcome in patients operated for ankle fractures. J Orthop Res 2019; 37:1658-1666. [PMID: 29920765 PMCID: PMC6618247 DOI: 10.1002/jor.24071] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 06/03/2018] [Indexed: 02/04/2023]
Abstract
Ankle fractures are among the most common lower limb fractures. Associations between postoperative radiographic results and clinical outcome have been found, but less is known about the relevant ankle biomechanics. This study analyzed ankle kinematics, radiographic findings, and patient-reported outcome measures (PROM) in patients treated for ankle fractures. The hypothesis was that patients after ankle fracture surgery had less flexion/extension in the ankle compared to healthy subjects and that fracture severity had significant influence on kinematics and patient satisfaction. Thirty-three patients (n = 33 feet) operated for ankle fractures were recruited. Ankle kinematics were analyzed using the Oxford Foot model, and results were compared with an age-matched healthy control group (11 patients, 20 feet). In addition, patients were divided by fracture (severity) classification and kinematic results were correlated with PROM and radiographic findings. Patients treated for ankle fracture showed lower walking speed (p < 0.001) when asked to walk in preferred normal speed. When compared at equal speed, significantly less range of motion (ROM) between the hindfoot and tibia in the sagittal plane (flexion/extension) during loading and push-off phases (p = 0.003 and p < 0.001) was found in patients after ankle fractures compared to healthy subjects. Lowest ROM and poorest PROM results were found for patients with trimalleolar ankle fractures. There was a significant correlation between ROM (flexion/extension) during the push-off phase and SF-36 physical functioning (r2 = 0.403, p = 0.027) and SF-36 general health (r2 = 0.473, p = 0.008). Fracture severity was significantly correlated with flexion/extension ROM in the ankle during both loading and push-off phases (r2 = -0.382, p = 0.005, and r2 = -0.568, p < 0.001) and was also significantly correlated with PROM. This study found that patients with ankle fractures had significantly altered ankle kinematics compared to healthy subjects. The poorest results were found among patients with trimalleolar fractures. Weak to strong significant correlations were found between fracture severity, ankle kinematics, and PROM. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:1658-1666, 2019.
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Affiliation(s)
- Sander van Hoeve
- Division of Trauma Surgery, Department of SurgeryMaastricht University Medical CenterP. Debyelaan 25, PO Box 5800Maastricht6202 AZThe Netherlands
| | - Michael Houben
- Division of Trauma Surgery, Department of SurgeryMaastricht University Medical CenterP. Debyelaan 25, PO Box 5800Maastricht6202 AZThe Netherlands
| | - Jan P. A. M. Verbruggen
- Division of Trauma Surgery, Department of SurgeryMaastricht University Medical CenterP. Debyelaan 25, PO Box 5800Maastricht6202 AZThe Netherlands
| | - Paul Willems
- Department of Movement SciencesMaastricht University Medical CenterP. Debyelaan 25, PO Box 616Maastricht6200 MDThe Netherlands,School for Nutrition and Translational Research in MetabolismNUTRIMPO Box 616Maastricht6200 MDThe Netherlands
| | - Kenneth Meijer
- Department of Movement SciencesMaastricht University Medical CenterP. Debyelaan 25, PO Box 616Maastricht6200 MDThe Netherlands,School for Nutrition and Translational Research in MetabolismNUTRIMPO Box 616Maastricht6200 MDThe Netherlands
| | - Martijn Poeze
- Division of Trauma Surgery, Department of SurgeryMaastricht University Medical CenterP. Debyelaan 25, PO Box 5800Maastricht6202 AZThe Netherlands,School for Nutrition and Translational Research in MetabolismNUTRIMPO Box 616Maastricht6200 MDThe Netherlands
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Neira A, Amenabar T, Cristi-Sánchez I, Rafols C, Monckeberg JE, Belemmi M, Neira M, Soldan M, Silvestre R. Evaluation of atraumatic hip instability measured by triaxial accelerometry during walking. J Hip Preserv Surg 2019; 6:134-139. [PMID: 31660198 PMCID: PMC6662898 DOI: 10.1093/jhps/hnz018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/22/2019] [Accepted: 05/05/2019] [Indexed: 11/12/2022] Open
Abstract
Hip joint instability has been targeted as an important issue that affects normal hip function. The diagnosis of hip instability could be very challenging and currently, there is no definitive diagnostic test. Hip instability results in an excessive amount of translation of femoroacetabular articulation, leading to changes on the dynamic loading of the hip. These changes in femoroacetabular translation could be evaluated by human movement analysis methods. The purpose of this study was to describe the triaxial and overall magnitude of acceleration in patients diagnosed with hip instability during gait cycle and compare those results with a control group. Our hypothesis was that acceleration values obtained from the instability group would be higher than asymptomatic controls. Ten patients with previously diagnosed hip instability were included and 10 healthy and asymptomatic subjects were enrolled as control group. Triaxial accelerometers attached bilaterally to the skin over the greater trochanter were used to record acceleration during walking on a treadmill. The overall magnitude of acceleration and the axial, anteroposterior and mediolateral accelerations (x/y/z) were obtained during gait. Mean overall magnitude of acceleration was higher in the hip instability group compared with the control group, 1.51 g (SD: 0.23) versus 1.07 g (SD: 0.16) (P = 0.022). The axial, anteroposterior and mediolateral accelerations significantly differed between the two groups. The axial and mediolateral accelerations showed to be higher for the hip instability group while the anteroposterior axis acceleration was lower.
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Affiliation(s)
- Alejandro Neira
- Laboratorio Ciencias del Ejercicio, Clínica MEDS, Santiago, Chile.,Escuela de Kinesiología, Facultad de Ciencias, Universidad Mayor, Chile
| | - Tomas Amenabar
- Traumatología y Ortopedia, Clínica MEDS, Santiago, Chile.,Instituto Trumatológico, Santiago, Chile
| | - Iver Cristi-Sánchez
- Laboratorio Ciencias del Ejercicio, Clínica MEDS, Santiago, Chile.,Escuela de Kinesiología, Facultad de Ciencias, Universidad Mayor, Chile
| | - Claudio Rafols
- Traumatología y Ortopedia, Clínica MEDS, Santiago, Chile
| | | | - Marcos Belemmi
- Traumatología y Ortopedia, Clínica MEDS, Santiago, Chile
| | - Mariano Neira
- Laboratorio Ciencias del Ejercicio, Clínica MEDS, Santiago, Chile
| | - Macarena Soldan
- Laboratorio Ciencias del Ejercicio, Clínica MEDS, Santiago, Chile
| | - Rony Silvestre
- Laboratorio Ciencias del Ejercicio, Clínica MEDS, Santiago, Chile
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Comparison of morphological changes of gluteus medius and abductor strength for total hip arthroplasty via posterior and modified direct lateral approaches. INTERNATIONAL ORTHOPAEDICS 2019; 43:2467-2475. [DOI: 10.1007/s00264-019-04331-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/31/2019] [Indexed: 12/25/2022]
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Brand A, Klöpfer-Krämer I, Böttger M, Kröger I, Gaul L, Wackerle H, Müßig JA, Dietrich A, Gabel J, Augat P. Gait characteristics and functional outcomes during early follow-up are comparable in patients with calcaneal fractures treated by either the sinus tarsi or the extended lateral approach. Gait Posture 2019; 70:190-195. [PMID: 30884444 DOI: 10.1016/j.gaitpost.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/01/2019] [Accepted: 03/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND To overcome the substantial functional loss after calcaneal fractures (CF), surgical treatment currently consists of two strategies, namely the commonly used extended lateral approach (ELA) and the less invasive sinus tarsi approach (STA). Despite the comparable anatomical restoration, the biomechanical and functional outcome of these strategies during early rehabilitation has not yet been investigated. RESEARCH QUESTION To evaluate changes in gait characteristics and functional development in patients with CF treated by either STA or ELA. METHODS A total of 56 patients with unilateral CF were included in this retrospective study. 26 patients were treated by ELA while 30 patients underwent surgery through the STA. Functional and biomechanical measurements were performed at follow-up periods of three and six months. Foot and ankle kinetics and kinematics were extracted using instrumented gait analysis with a multi segment foot model. Physical and mental components of the Short Form 36 (SF-36) and total scoring of the AOFAS hindfoot scale were used for functional evaluation. Statistical analysis was performed using Mann Whitney and Student's t-test. Effect sizes of group differences were calculated using Cohen's d. RESULTS Comparisons between ELA and STA showed no significant difference regarding the biomechanical and functional outcome. Within-group comparisons showed significant (p < 0.05) improvements from three to six month follow-up. Ankle joint and hindfoot kinematics showed increased mobility during walking of up to 34% and 26%, respectively. Maximum ankle joint moment also improved by up to 34% while vertical ground reaction force increased by 8%. Functional outcome only revealed significant changes in the physical component of SF-36. SIGNIFICANCE ELA and STA treatments revealed comparable functional improvements in patients with unilateral intraarticular calcaneal fractures during early rehabilitation. The less invasive STA provides adequate restoration of dynamic foot function and could serve as a viable alternative to the commonly used ELA.
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Affiliation(s)
- Andreas Brand
- Institute of Biomechanics, BG Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria.
| | - Isabella Klöpfer-Krämer
- Institute of Biomechanics, BG Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Moritz Böttger
- Department of Foot and Ankle Surgery, BG Unfallklinik Murnau, Germany
| | - Inga Kröger
- Institute of Biomechanics, BG Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Leander Gaul
- Department of Foot and Ankle Surgery, BG Unfallklinik Murnau, Germany
| | - Hannes Wackerle
- Institute of Biomechanics, BG Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Janina Anna Müßig
- Institute of Biomechanics, BG Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
| | - Andrea Dietrich
- Department of Foot and Ankle Surgery, BG Unfallklinik Murnau, Germany
| | - Johannes Gabel
- Department of Foot and Ankle Surgery, BG Unfallklinik Murnau, Germany
| | - Peter Augat
- Institute of Biomechanics, BG Unfallklinik Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Austria
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Castagneri C, Agostini V, Rosati S, Balestra G, Knaflitz M. Asymmetry Index in Muscle Activations. IEEE Trans Neural Syst Rehabil Eng 2019; 27:772-779. [PMID: 30843847 DOI: 10.1109/tnsre.2019.2903687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gait asymmetry is typically evaluated using spatio-temporal or joint kinematics parameters. Only a few studies addressed the problem of defining an asymmetry index directly based on muscle activity, extracting parameters from surface electromyography (sEMG) signals. Moreover, no studies used the extraction of the muscle principal activations (activations that are necessary for accomplishing a specific motor task) as the base to construct an asymmetry index, less affected by the variability of sEMG patterns. The aim of this paper is to define a robust index to quantitatively assess the asymmetry of muscle activations during locomotion, based on the extraction of the principal activations. SEMG signals were analyzed combining statistical gait analysis (SGA) and a clustering algorithm that allows for obtaining the muscle principal activations. We evaluated the asymmetry levels of four lower limb muscles in: (1) healthy subjects of different ages (children, adults, and elderly); (2) different populations of orthopedic patients (adults with megaprosthesis of the knee after bone tumor resection, elderly subjects after total knee arthroplasty, and elderly subjects after total hip arthroplasty); and (3) neurological patients (children with hemiplegic cerebral palsy and elderly subjects affected by idiopathic normal pressure hydrocephalus). The asymmetry index obtained for each pathological population was then compared to that of age-matched controls. We found asymmetry levels consistent with the expected impact of the different pathologies on muscle activation during gait. This suggests that the proposed index can be successfully used in clinics for an objective assessment of the muscle activation asymmetry during locomotion.
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Zügner R, Tranberg R, Timperley J, Hodgins D, Mohaddes M, Kärrholm J. Validation of inertial measurement units with optical tracking system in patients operated with Total hip arthroplasty. BMC Musculoskelet Disord 2019; 20:52. [PMID: 30727979 PMCID: PMC6364439 DOI: 10.1186/s12891-019-2416-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 01/09/2019] [Indexed: 12/01/2022] Open
Abstract
Background Patient reported outcome measurement (PROMs) will not capture in detail the functional joint motion before and after total hip arthroplasty (THA). Therefore, methods more specifically aimed to analyse joint movements may be of interest. An analysis method that addresses these issues should be readily accessible and easy to use especially if applied to large groups of patients, who you want to study both before and after a surgical intervention such as THA. Our aim was to evaluate the accuracy of inertial measurement units (IMU) by comparison with an optical tracking system (OTS) to record pelvic tilt, hip and knee flexion in patients who had undergone THA. Methods 49 subjects, 25 males 24 females, mean age of 73 years (range 51–80) with THA participated. All patients were measured with a portable IMU system, with sensors attached lateral to the pelvis, the thigh and the lower leg. For validation, a 12-camera motion capture system was used to determine the positions of 15 skin markers (Oqus 4, Qualisys AB, Sweden). Comparison of sagittal pelvic rotations, and hip and knee flexion-extension motions measured with the two systems was performed. The mean values of the IMU’s on the left and right sides were compared with OTS data. Results The comparison between the two gait analysis methods showed no significant difference for mean pelvic tilt range (4.9–5.4 degrees) or mean knee flexion range (54.4–55.1 degrees) on either side (p > 0.7). The IMU system did however record slightly less hip flexion on both sides (36.7–37.7 degrees for the OTS compared to 34.0–34.4 degrees for the IMU, p < 0.001). Conclusions We found that inertial measurement units can produce valid kinematic data of pelvis- and knee flexion-extension range. Slightly less hip flexion was however recorded with the inertial measurement units which may be due to the difference in the modelling of the pelvis, soft tissue artefacts, and malalignment between the two methods or misplacement of the inertial measurement units. Trial registration The study has ethical approval from the ethical committee “Regionala etikprövningsnämnden i Göteborg” (Dnr: 611–15, 2015-08-27) and all study participants have submitted written approval for participation in the study.
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Affiliation(s)
- Roland Zügner
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University, 413 45, Göteborg, SE, Sweden. .,Lundberg Laboratory for Orthopaedic Research, Sahlgrenska University Hospital, Gröna stråket 12, SE-41345, Göteborg, Sweden.
| | - Roy Tranberg
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University, 413 45, Göteborg, SE, Sweden
| | - John Timperley
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | | | - Maziar Mohaddes
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University, 413 45, Göteborg, SE, Sweden
| | - Johan Kärrholm
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University, 413 45, Göteborg, SE, Sweden
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Pincheira PA, De La Maza E, Silvestre R, Guzmán-Venegas R, Becerra M. Comparison of total hip arthroplasty surgical approaches by Statistical Parametric Mapping. Clin Biomech (Bristol, Avon) 2019; 62:7-14. [PMID: 30639965 DOI: 10.1016/j.clinbiomech.2018.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/15/2018] [Accepted: 12/31/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The most common surgical approaches in use for total hip arthroplasty are the lateral and posterior. When comparing these approaches in terms of gait biomechanics, studies usually rely on pre-defined discrete variables related to the events of gait cycle. However, this analysis may miss differences in other parts of the movement pattern that are not explored. We applied Statistical Parametric Mapping to compare hip kinematics between patients who underwent arthroplasty using either a lateral or posterior approach, contrasting these results with discrete variable analysis. METHODS Twenty-two participants (11 lateral, 11 posterior; age between 50 and 80 years) underwent gait analysis before, 3 weeks and 12 weeks after hip arthroplasty. One-dimensional (e.g. time-varying) trajectories and zero-dimensional (e.g. peak extension) discrete variables were used to assess differences between groups in each plane of hip movement (sagittal, frontal, and transverse). FINDINGS One-dimensional and zero-dimensional analyses found no significant differences between groups. Statistical Parametric Mapping revealed that both groups presented significant changes over time in hip adduction at 11-43% of the gait cycle. Zero-dimensional analysis seems to overstate sagittal plane changes over time since no such changes were found by Statistical Parametric Mapping. INTERPRETATION Our results agreed with previous studies suggesting that surgical approach do not affect hip kinematics at the early post-operative stage after arthroplasty. However, Statistical Parametric Mapping revealed changes in frontal plane kinematics over time that were underestimated by the zero-dimensional variables. These findings suggest hip adduction impairment up to 12 weeks after arthroplasty.
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Affiliation(s)
- Patricio A Pincheira
- Facultad de Ciencias, Escuela de Kinesiología, Universidad Mayor, Camino la pirámide 5750, Huechuraba, Santiago, Chile; Facultad de Medicina, Escuela de Kinesiología, Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo (LIBFE), Universidad de los Andes, Mons. Álvaro del Portillo 12455, Las Condes, Santiago, Chile; School of Human Movement and Nutrition Sciences, Centre for Sensorimotor Performance, The University of Queensland, Blair Dr, Building 26b, St Lucia, Brisbane, Australia.
| | - Eduardo De La Maza
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martín 771, Santiago Centro, Santiago, Chile
| | - Rony Silvestre
- Unidad de Biomecánica Deportiva, Clínica Meds, Isabel La Católica 3740, Providencia, Santiago, Chile
| | - Rodrigo Guzmán-Venegas
- Facultad de Medicina, Escuela de Kinesiología, Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo (LIBFE), Universidad de los Andes, Mons. Álvaro del Portillo 12455, Las Condes, Santiago, Chile
| | - Manuel Becerra
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martín 771, Santiago Centro, Santiago, Chile
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Hall M, Diamond LE, Lenton GK, Pizzolato C, Saxby DJ. Immediate effects of valgus knee bracing on tibiofemoral contact forces and knee muscle forces. Gait Posture 2019; 68:55-62. [PMID: 30458429 DOI: 10.1016/j.gaitpost.2018.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/05/2018] [Accepted: 11/08/2018] [Indexed: 02/02/2023]
Abstract
Background Valgus knee braces have been reported to reduce the external knee adduction moment during walking. However, mechanistic investigations into the effects of valgus bracing on medial compartment contact forces using electromyogram-driven neuromusculoskeletal models are limited. Research question What are the immediate effects of valgus bracing on medial tibiofemoral contact forces and muscular loading of the tibiofemoral joint? Methods Sixteen (9 male) healthy adults (27.7 ± 4.4 years) performed 20 over-ground walking trials at self-selected speed both with and without an Ossür Unloader One® brace. Assessment order (i.e., with or without brace) was randomised and counterbalanced to prevent order effects. While walking, three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from eight lower-limb muscles were acquired. These data were used to calibrate an electromyogram-driven neuromusculoskeletal model of muscle and tibiofemoral contact forces (N), from which muscle and external load contributions (%) to those contact forces were determined. Results Although walking with the brace resulted in no significant changes in peak tibiofemoral contact forces at the group-level, individual responses were variable and non-uniform. At the group-level, wearing the brace resulted in a 2.35% (95% CI 0.46-4.24; p = 0.02) greater relative contribution of muscle to lateral compartment contact loading (54.2 ± 11.1%) compared to not wearing the brace (51.8 ± 12.1%) (p < 0.05). Average relative contributions of muscle and external loads to medial compartment loading were comparable between brace and no brace conditions (p ≥ 0.05). Significance Wearing a valgus knee brace did not immediately reduce peak tibiofemoral contact forces in healthy adults during normal walking. It appears this population may modulate muscle activation patterns to support brace-generated valgus moments, thereby maintaining normal walking knee moments and tibiofemoral contact forces. Future investigations are warranted to better understand effects of valgus knee brace in people with medial knee osteoarthritis using an electromyogram-driven neuromusculoskeletal model.
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Affiliation(s)
- Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Melbourne, The University of Melbourne, VIC, Australia
| | - Laura E Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia; Gold Coast Orthopaedic Research and Education Alliance (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Gavin K Lenton
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia; Gold Coast Orthopaedic Research and Education Alliance (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Claudio Pizzolato
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia; Gold Coast Orthopaedic Research and Education Alliance (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia; Gold Coast Orthopaedic Research and Education Alliance (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
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van Hoeve S, Stollenwerck G, Willems P, Witlox MA, Meijer K, Poeze M. Gait analysis and functional outcome in patients after Lisfranc injury treatment. Foot Ankle Surg 2018; 24:535-541. [PMID: 29409269 DOI: 10.1016/j.fas.2017.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Lisfranc injuries involve any bony or ligamentous disruption of the tarsometatarsal joint. Outcome results after treatment are mainly evaluated using patient-reported outcome measures (PROM), physical examination and radiographic findings. Less is known about the kinematics during gait. METHODS Nineteen patients (19 feet) treated for Lisfranc injury were recruited. Patients with conservative treatment and surgical treatment consisting of open reduction and internal fixation (ORIF) or primary arthrodesis were included. PROM, radiographic findings and gait analysis using the Oxford Foot Model (OFM) were analysed. Results were compared with twenty-one healthy subjects (31 feet). Multivariable logistic regression was used to determine factors influencing outcome. RESULTS Patients treated for Lisfranc injury had a significantly lower walking speed than healthy subjects (P<0.001). There was a significant difference between the two groups regarding the range of motion (ROM) in the sagittal plane (flexion-extension) in the midfoot during the push-off phase (p<0.001). The ROM in the sagittal plane was significantly correlated with the AOFAS midfoot score (r2=0.56, p=0.012), FADI (r2=0.47, p=0.043) and the SF-36-physical impairment score (r2=0.60, p=0.007) but not with radiographic parameters for quality of reduction. In a multivariable analysis, the best explanatory factors were ROM in the sagittal plane during the push-off phase (β=0.707, p=0.001), stability (β=0.423, p=0.028) and BMI (β=-0.727 p=<0.001). This prediction model explained 87% of patient satisfaction. CONCLUSIONS This study showed that patients treated for Lisfranc injury had significantly lower walking speed and significantly lower flexion/extension in the midfoot than healthy subjects. The ROM in these patients was significantly correlated with PROM, but not with radiographic quality of reduction. Most important satisfaction predictors were BMI, ROM in the sagittal plane during the push-off phase and fracture stability.
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Affiliation(s)
- S van Hoeve
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - G Stollenwerck
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - P Willems
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 616, 6200 MD Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - M A Witlox
- Department of Orthopaedics, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - K Meijer
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 616, 6200 MD Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - M Poeze
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Bernard J, Razanabola F, Beldame J, Van Driessche S, Brunel H, Poirier T, Matsoukis J, Billuart F. Electromyographic study of hip muscles involved in total hip arthroplasty: Surprising results using the direct anterior minimally invasive approach. Orthop Traumatol Surg Res 2018; 104:1137-1142. [PMID: 29753876 DOI: 10.1016/j.otsr.2018.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/05/2018] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The functional and clinical benefit of minimally invasive total hip arthroplasty (THA) is well-known, but the literature reports impaired gait and posture parameters as compared to the general population, especially following use of the anterior minimally invasive approach, which has more severe impact on posture than the posterior approach. The reasons for this impairment, however, remain unexplained. We therefore conducted a surface electromyography (sEMG) study of the hip muscles liable to be affected by arthroplasty surgery: gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S). The study addressed the following questions: (1) Is bipodal and unipodal GMed activity greater following anterior THA than in asymptomatic subjects? (2) Is a single manual test sufficient to assess maximal voluntary contraction (MVC) in hip abductors (GMax, GMed, TFL) and flexors (TFL, S)? HYPOTHESIS Bipodal and unipodal GMed activity is greater following anterior THA than in asymptomatic subjects. METHOD Eleven patients with anterior THA and 11 asymptomatic subjects, matched for age, gender and body-mass index, were included. Subjects underwent 3 postural tests: bipodal, eyes closed (BEC), unipodal on the operated side (UOP), and unipodal on the non-operated side (UnOP), with unipodal results averaged between both sides in the asymptomatic subjects. Data were recorded from 4-channel EMG and a force plate. EMG test activity was normalized as a ratio of MVC activity. RESULTS Postural parameters (mean center of pressure displacement speed) were poorer and sEMG activity higher in anterior THA than asymptomatic subjects (p<0.005). On the BEC test, GMax and GMed activity was higher on both operated and non-operated sides than in asymptomatic controls (respectively, 0.15±0.12 and 0.12±0.6 versus 0.07±0.06 for GMax, and 0.13±0.08 and 0.13±0.08 versus 0.08±0.05 for GMed; p<0.05). On unipodal tests, both UOP and UnOP GMed activities were higher than in controls (respectively, 0.51±0.3 and 0.48±0.27 versus 0.28±0.13; p<0.04); GMax and TFL activities were higher than in controls only on the UOP tests (respectively, 0.49±0.43 versus 0.24±0.18, and 0.23±0.17 versus 0.12±0.16; p<0.05). DISCUSSION sEMG activity in the hip abductors, which are the main stabilizing muscles for the pelvis, is increased following anterior THA, in parallel with impaired postural parameters. This finding may be due to intraoperative TFL and S neuromuscular spindle lesion. The present preliminary study is to be followed up by a comparison of all 3 common minimally invasive approaches (anterior, anterolateral and posterior) using the same study protocol. LEVEL OF EVIDENCE III, prospective case-control study.
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Affiliation(s)
- Jules Bernard
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - Fredson Razanabola
- Département de chirurgie orthopédique, centre hospitalier régional d'Orléans La Source, 45100 Orléans, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | | | - Helena Brunel
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - Thomas Poirier
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France.
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De Pieri E, Lund ME, Gopalakrishnan A, Rasmussen KP, Lunn DE, Ferguson SJ. Refining muscle geometry and wrapping in the TLEM 2 model for improved hip contact force prediction. PLoS One 2018; 13:e0204109. [PMID: 30222777 PMCID: PMC6141086 DOI: 10.1371/journal.pone.0204109] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 09/04/2018] [Indexed: 11/29/2022] Open
Abstract
Musculoskeletal models represent a powerful tool to gain knowledge on the internal forces acting at the joint level in a non-invasive way. However, these models can present some errors associated with the level of detail in their geometrical representation. For this reason, a thorough validation is necessary to prove the reliability of their predictions. This study documents the development of a generic musculoskeletal model and proposes a working logic and simulation techniques for identifying specific model features in need of refinement; as well as providing a quantitative validation for the prediction of hip contact forces (HCF). The model, implemented in the AnyBody Modeling System and based on the cadaveric dataset TLEM 2.0, was scaled to match the anthropometry of a patient fitted with an instrumented hip implant and to reproduce gait kinematics based on motion capture data. The relative contribution of individual muscle elements to the HCF and joint moments was analyzed to identify critical geometries, which were then compared to muscle magnetic resonance imaging (MRI) scans and, in case of inconsistencies, were modified to better match the volumetric scans. The predicted HCF showed good agreement with the overall trend and timing of the measured HCF from the instrumented prosthesis. The average root mean square error (RMSE), calculated for the total HCF was found to be 0.298*BW. Refining the geometries of the muscles thus identified reduced RMSE on HCF magnitudes by 17% (from 0.359*BW to 0.298*BW) over the whole gait cycle. The detailed study of individual muscle contributions to the HCF succeeded in identifying muscles with incorrect anatomy, which would have been difficult to intuitively identify otherwise. Despite a certain residual over-prediction of the final hip contact forces in the stance phase, a satisfactory level of geometrical accuracy of muscle paths has been achieved with the refinement of this model.
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Affiliation(s)
- Enrico De Pieri
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- * E-mail:
| | | | | | | | - David E. Lunn
- Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2018; 26:847-863. [PMID: 29474993 DOI: 10.1016/j.joca.2018.02.897] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the change in walking gait biomechanics after total hip arthroplasty (THA) for osteoarthritis (OA) compared to the pre-operative gait status, and to compare the recovery of gait following THA with healthy individuals. METHODS Systematic review with meta-analysis of studies investigating changes in gait biomechanics after THA compared to (1) preoperative levels and (2) healthy individuals. Data were pooled at commonly reported time points and standardised mean differences (SMDs) were calculated in meta-analyses for spatiotemporal, kinematic and kinetic parameters. RESULTS Seventy-four studies with a total of 2,477 patients were included. At 6 weeks postoperative, increases were evident for walking speed (SMD: 0.32, 95% confidence intervals (CI) 0.14, 0.50), stride length (SMD: 0.40, 95% CI 0.19, 0.61), step length (SMD: 0.41, 95% CI 0.23, 0.59), and transverse plane hip range of motion (ROM) (SMD: 0.36, 95% CI 0.05, 0.67) compared to pre-operative gait. Sagittal, coronal and transverse hip ROM was significantly increased at 3 months (SMDs: 0.50 to 1.07). At 12 months postoperative, patients demonstrated deficits compared with healthy individuals for walking speed (SMD: -0.59, 95% CI -1.08 to -0.11), stride length (SMD: -1.27, 95% CI -1.63, -0.91), single limb support time (SMD: -0.82, 95% CI -1.23, -0.41) and sagittal plane hip ROM (SMD: -1.16, 95% CI -1.83, -0.49). Risk of bias scores ranged from seven to 24 out of 26. CONCLUSIONS Following THA for OA, early improvements were demonstrated for spatiotemporal and kinematic gait patterns compared to the pre-operative levels. Deficits were still observed in THA patients compared to healthy individuals at 12 months.
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Parkinson S, Wills A, Tabor G, Williams J. Effect of water depth on muscle activity of dogs when walking on a water treadmill. COMPARATIVE EXERCISE PHYSIOLOGY 2018. [DOI: 10.3920/cep170031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Evidence-informed practice is currently lacking in canine hydrotherapy. This study aimed to investigate if the estimated workload of the gluteus medius (GM) and longissimus dorsi (LD) increased in dogs at different water depths when walking on a water treadmill. Seven dogs were walked for 2 min continuously on a water treadmill at depths of no submersion (depth 1), mid-tarsal (depth 2), between lateral malleolus and lateral epicondyle (depth 3) and between the lateral epicondyle and greater trochanter (depth 4). Continuous electromyographic data from the right and left sides of GM and LD were collected simultaneously during exercise. Friedman’s analyses with post-hoc Wilcoxon tests established if significant differences in GM and LD muscle activity occurred between the water depths for mean estimated-workload. Significant differences occurred in estimated-workload in GM and LD between water depths (P<0.05). Mean estimated-workload decreased in the right and left GM between depths 2 (mid-tarsal) and 3 (between lateral malleolus and epicondyle) (P<0.007) and depths 2 and 4 (between lateral epicondyle and greater trochanter) (P<0.001), a pattern which was repeated for left and right LD (P<0.007). Right GM mean estimated-workload increased between depth 1 (no submersion) and depth 2 only (P<0.013). Water depth influences GM and LD activity in dogs walking on a water treadmill. Increasing knowledge of canine locomotion in water treadmills could be used to inform individualised rehabilitation regimes for dogs undertaking hydrotherapy.
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Affiliation(s)
- S. Parkinson
- Animal Welfare Research Group, University Centre Hartpury, Hartpury, Gloucestershire, GL19 3BE, United Kingdom
| | - A.P. Wills
- Animal Welfare Research Group, University Centre Hartpury, Hartpury, Gloucestershire, GL19 3BE, United Kingdom
| | - G. Tabor
- Animal Welfare Research Group, University Centre Hartpury, Hartpury, Gloucestershire, GL19 3BE, United Kingdom
| | - J.M. Williams
- Animal Welfare Research Group, University Centre Hartpury, Hartpury, Gloucestershire, GL19 3BE, United Kingdom
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Inter-joint coordination of kinematics and kinetics before and after total hip arthroplasty compared to asymptomatic subjects. J Biomech 2018; 72:180-186. [DOI: 10.1016/j.jbiomech.2018.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 11/22/2022]
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Stief F, Schmidt A, van Drongelen S, Lenarz K, Froemel D, Tarhan T, Lutz F, Meurer A. Abnormal loading of the hip and knee joints in unilateral hip osteoarthritis persists two years after total hip replacement. J Orthop Res 2018; 36:2167-2177. [PMID: 29536559 DOI: 10.1002/jor.23886] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 02/22/2018] [Indexed: 02/04/2023]
Abstract
A total hip replacement (THR) is a common and routine procedure to reduce pain and restore normal activity. Gait analysis can provide insights into functional characteristics and dynamic joint loading situation not identifiable by clinical examination or static radiographic measures. The present prospective longitudinal study tested whether 2 years after surgery a THR would restore dynamic loading of the knee and hip joints in the frontal plane to normal. Instrumented gait analysis was performed shortly before surgery and approximately 2 years after THR on 15 unilateral hip osteoarthritis (OA) patients. 15 asymptomatic matched individuals were recruited as healthy controls. Results showed that abnormal joint loading persisted 2 years after THR. The 2nd external knee adduction moment in terminal stance in the affected (-34%, p = 0.002, d = 1.22) and non-affected limb (-25%, p = 0.035, d = 0.81) was lower compared to controls and thus indicated a shift in the knee joint load distribution from medial to lateral. A correlation analysis revealed that a smaller hip range of motion explained 46% of 2nd knee adduction moment alterations. In contrast, the 2nd external hip adduction moment in terminal stance was postoperatively higher in the affected (+22%, p = 0.007, d = 1.04) and non-affected limb (+22%, p = 0.005, d = 1.05). Here, 51% of 2nd hip adduction moment alterations can be explained with a greater hip adduction angle. Patients with a THR may therefore be at higher risk for abnormal joint loading and thus for the development of OA in other joints of the lower extremities. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Felix Stief
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - André Schmidt
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - Stefan van Drongelen
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - Katharina Lenarz
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - Dara Froemel
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - Timur Tarhan
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - Frederick Lutz
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
| | - Andrea Meurer
- Orthopedic University Hospital Friedrichsheim gGmbH, Marienburgstraße 2, 60528 Frankfurt/Main, Germany
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Bernard J, Beldame J, Van Driessche S, Brunel H, Poirier T, Guiffault P, Matsoukis J, Billuart F. Does hip joint positioning affect maximal voluntary contraction in the gluteus maximus, gluteus medius, tensor fasciae latae and sartorius muscles? Orthop Traumatol Surg Res 2017; 103:999-1004. [PMID: 28789998 DOI: 10.1016/j.otsr.2017.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Minimally invasive total hip arthroplasty (THA) is presumed to provide functional and clinical benefits, whereas in fact the literature reveals that gait and posturographic parameters following THA do not recover values found in the general population. There is a significant disturbance of postural sway in THA patients, regardless of the surgical approach, although with some differences between approaches compared to controls: the anterior and anterolateral minimally invasive approaches seem to be more disruptive of postural parameters than the posterior approach. Electromyographic (EMG) study of the hip muscles involved in surgery [gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S)] could shed light, the relevant literature involves discordant methodologies. We developed a methodology to assess EMG activity during maximal voluntary contraction (MVC) of the GMax, GMed, TFL and sartorius muscles as a reference for normalization. A prospective study aimed to assess whether hip joint positioning and the learning curve on an MVC test affect the EMG signal during a maximal voluntary contraction. HYPOTHESIS Hip positioning and the learning curve on an MVC test affect EMG signal during MVC of GMax, GMed, TFL and S. METHODS Thirty young asymptomatic subjects participated in the study. Each performed 8 hip muscle MVCs in various joint positions recorded with surface EMG sensors. Each MVC was performed 3 times in 1 week, with the same schedule every day, controlling for activity levels in the preceding 24h. EMG activity during MVC was expressed as a ratio of EMG activity during unipedal stance. Non-parametric tests were applied. RESULTS Statistical analysis showed no difference according to hip position for abductors or flexors in assessing EMG signal during MVC over the 3 sessions. Hip abductors showed no difference between abduction in lateral decubitus with hip straight versus hip flexed: GMax (19.8±13.7 vs. 14.5±7.8, P=0.78), GMed (13.4±9.0 vs. 9.9±6.6, P=0.21) and TFL (69.5±61.7 vs. 65.9±51.3, P=0.50). Flexors showed no difference between hip flexion/abduction/lateral rotation performed in supine or sitting position: TFL (70.6±45.9 vs. 61.6±45.8, P=0.22) and S (101.1±67.9 vs. 72.6±44.6, P=0.21). The most effective tests to assess EMG signal during MVC were for the hip abductors: hip abduction performed in lateral decubitus (36.7% for GMax, 76.7% for GMed), and for hip flexors: hip flexion/abduction/lateral rotation performed in supine decubitus (50% for TFL, 76.7% for S). DISCUSSION The study hypothesis was not confirmed, since hip joint positioning and the learning curve on an MVC test did not affect EMG signal during MVC of GMax, GMed, TFL and S muscles. Therefore, a single session and one specific test is enough to assess MVC in hip abductors (abduction in lateral decubitus) and flexors (hip flexion/abduction/lateral rotation in supine position). This method could be applied to assess muscle function after THA, and particularly to compare different approaches. LEVEL OF EVIDENCE III, case-matched study.
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Affiliation(s)
- J Bernard
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - J Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - S Van Driessche
- Clinique de Montargis, 46, rue de la Quintaine, 45200 Montargis, France
| | - H Brunel
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - T Poirier
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France
| | - P Guiffault
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - J Matsoukis
- Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - F Billuart
- Laboratoire d'analyse du mouvement, Institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France.
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van Hoeve S, Verbruggen J, Willems P, Meijer K, Poeze M. Vertical ground reaction forces in patients after calcaneal trauma surgery. Gait Posture 2017; 58:523-526. [PMID: 28961549 DOI: 10.1016/j.gaitpost.2017.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 09/16/2017] [Accepted: 09/22/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Vertical ground reaction forces (VGRFs) are altered in patients after foot trauma. It is not known if this correlates with ankle kinematics. The aim of this study was to analyze VGRFs in patients after calcaneal trauma and correlate them to patient-reported outcome measures (PROMs), radiographic findings and kinematic analysis, using a multi-segment foot model. In addition, we determined the predictive value of VGRFs to identify patients with altered foot kinematics. METHODS Thirteen patients (13 feet) with displaced intra-articular calcaneal fractures, were included an average of two years after trauma surgery. PROMs, radiographic findings on postoperative computed tomography scans, gait analysis using the Oxford foot model and VGRFs were analysed during gait. Results were compared with those of 11 healthy subjects (20 feet). Speed was equal in both groups, with healthy subjects walking at self-selected slow speed (0.94±0.18m/s) and patients after surgery walking at self-selected normal speed (0.94±0.29m/s). ROC curves were used to determine the predictive value. RESULTS Patients after calcaneal surgery showed a lower minimum force during midstance (p=0.004) and a lower maximum force during toe-off (p=0.011). This parameter correlated significantly with the range of motion in the sagittal plane during the push-off phase (r 0.523, p=0.002), as well as with PROMs and with postoperative residual step-off (r 0.423, p=0.016). Combining these two parameters yielded a cut-off value of 193% (p<0.001), area under the curve 0.93 (95%confidence interval 0.84-1.00). CONCLUSION Patients after calcaneal fracture showed lower minimum force during midstance and lower maximum force during toe-off compared to healthy subjects. This lower maximum force during push-off correlated significantly with PROMs, range of motion in the sagittal plane during push-off and radiographic postoperative residual step-off in the posterior facet of the calcaneal bone. VGRFs are a valuable screening tool for identifying patients with altered gait patterns.
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Affiliation(s)
- S van Hoeve
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - J Verbruggen
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - P Willems
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25, PO Box 616, 6200 MD Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - K Meijer
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25, PO Box 616, 6200 MD Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - M Poeze
- Department of Surgery, Division of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands; NUTRIM, School for Nutrition, Toxicology and Metabolism, PO Box 616, 6200 MD Maastricht, The Netherlands
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Rosati S, Castagneri C, Agostini V, Knaflitz M, Balestra G. Muscle contractions in cyclic movements: Optimization of CIMAP algorithm. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:58-61. [PMID: 29059810 DOI: 10.1109/embc.2017.8036762] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
During cyclic movements, the number of muscle activations and their timing are different from cycle to cycle. In a previous study, the CIMAP algorithm was proposed for grouping cycles showing similar EMG activation intervals, using dendrogram clustering. Even if the algorithm demonstrated good performances on a healthy population, the intra-cluster variability decreased when applied to datasets from pathological subjects. In this work we propose an optimized version of the CIMAP, comparing the performances of 8 different combinations of parameters used for the dendrogram construction. The cut-off point is also modified. The new and the original version of the algorithm are compared, in terms of intra-cluster variability, considering a population of 60 subjects, both healthy and pathological. The results show that the new CIMAP allows for obtaining clusters with lower variability with respect to the original version of the algorithm (p <; 0.001).
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Di Nardo F, Mengarelli A, Strazza A, Agostini V, Knaflitz M, Burattini L, Fioretti S. A new parameter for quantifying the variability of surface electromyographic signals during gait: The occurrence frequency. J Electromyogr Kinesiol 2017; 36:25-33. [PMID: 28688293 DOI: 10.1016/j.jelekin.2017.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 05/23/2017] [Accepted: 06/29/2017] [Indexed: 11/30/2022] Open
Abstract
Natural variability of myoelectric activity during walking was recently analyzed considering hundreds of strides. This allowed assessing a parameter seldom considered in classic surface EMG (sEMG) studies: the occurrence frequency, defined as the frequency each muscle activation occurs with, quantified by the number of strides when a muscle is recruited with that specific activation modality. Aim of present study was to propose the occurrence frequency as a new parameter for assessing sEMG-signal variability during walking. Aim was addressed by processing sEMG signals acquired from Gastrocnemius Lateralis, Tibialis Anterior, Rectus Femoris and Biceps femoris in 40 healthy subjects in order to: (1) show that occurrence frequency is not correlated with ON/OFF instants (Rmean=0.11±0.07; P>0.05) and total time of activation (Rmean=0.15±0.08; P>0.05); (2) confirm the above results by two handy examples of application (analysis of gender and age) which highlighted that significant (P<0.05) gender-related and age-related differences within population were detected in occurrence frequency, but not in temporal sEMG parameters. In conclusion, present study demonstrated that occurrence frequency is able to provide further information, besides those supplied by classical temporal sEMG parameters and thus it is suitable to complement them in the evaluation of variability of myoelectric activity during walking.
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Affiliation(s)
- Francesco Di Nardo
- Department of Information Engineering, Università Politecnica delle Marche, 60131 Ancona, Italy.
| | - Alessandro Mengarelli
- Department of Information Engineering, Università Politecnica delle Marche, 60131 Ancona, Italy
| | - Annachiara Strazza
- Department of Information Engineering, Università Politecnica delle Marche, 60131 Ancona, Italy
| | - Valentina Agostini
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Marco Knaflitz
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Laura Burattini
- Department of Information Engineering, Università Politecnica delle Marche, 60131 Ancona, Italy
| | - Sandro Fioretti
- Department of Information Engineering, Università Politecnica delle Marche, 60131 Ancona, Italy
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Agostini V, Di Nardo F, Fioretti S, Burattini L, Rosati S, Balestra G, Knaflitz M. Frequency-of-occurrence of myoelectric patterns to evaluate gait motor control strategies after hip replacement surgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:387-390. [PMID: 28268355 DOI: 10.1109/embc.2016.7590721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gait alterations are observed even years after hip replacement surgery. Such long-lasting alterations may arise from a global change of the motor control strategies. The aim of this work is to investigate the changes in gait motor control strategies of patients after hip replacement surgery by analyzing the frequency of occurrence (OF) of myoelectric activation patterns. We studied five lower limb muscles during gait, in hip prosthesis patients and controls. We found that patients adopt a motor control strategy that tends to prefer "simplified" myoelectric patterns, showing a smaller number of activations within the gait cycle. This altered motor control was present both on the prosthesis and the sound side, and did not improve during the 12-month follow-up. The reduced number of activations is even more evident in lateral hamstrings and gluteus medius, which are the muscles more affected by hip replacement surgery. Furthermore, this study demonstrated that the OF is a sensitive parameter able to discover subtle changes in motor control strategies. Its use can be extended to other studies involving motor coordination, motor learning and motor control adaptations.
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Foucher KC. Preoperative gait mechanics predict clinical response to total hip arthroplasty. J Orthop Res 2017; 35:366-376. [PMID: 27147554 DOI: 10.1002/jor.23282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/29/2016] [Indexed: 02/04/2023]
Abstract
Some patients do not have an adequate clinical response to total hip arthroplasty (THA) for reasons that are not fully understood. Identifying modifiable factors that are associated with nonresponse could lead to new ways to identify and treat potential nonresponders. This study investigated whether any preoperative gait characteristics were associated with THA clinical response, and whether or not there were corresponding postoperative gait differences in THA nonresponders compared to responders. A secondary analysis was conducted of 124 subjects (age 61 ± 10 years; 64 female/60 male), evaluated before and 1 year after primary unilateral THA, using quantitative gait analysis and Harris Hip Scores (HHS). Responders and nonresponders were identified using the OMERACT-OARSI responder criteria, modified for use with the HHS. Pre- and postoperative dynamic sagittal plane range of motion (ROM) and 3D peak external moments were compared, for responders and nonresponders, using t-tests and logistic regression. 11.3% of subjects were nonresponders. Before surgery, the ROM was 26% higher for nonresponders than responders, but the peak external rotation moment was 30% lower (p = 0.003-0.043). Preoperative gait and HHS predicted response with a sensitivity of 71.4% and a specificity of 99.1%. There were persistent postoperative deficits in the peak external rotation moment in nonresponders compared to responders (p = 0.028). This study showed that gait analysis, where available, can augment clinical scores in predicting THA response. Moreover, it suggests that further analysis of the subtle role of transverse plane hip mechanics could lead to interventions to promote better THA response. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:366-376, 2017.
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Affiliation(s)
- Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor St., 650 AHSB, Chicago, Illinois, 60612
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Rosati S, Agostini V, Knaflitz M, Balestra G. Muscle activation patterns during gait: A hierarchical clustering analysis. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gait abnormalities before and after total hip arthroplasty differ in men and women. J Biomech 2016; 49:3582-3586. [DOI: 10.1016/j.jbiomech.2016.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/18/2016] [Accepted: 09/07/2016] [Indexed: 11/22/2022]
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The Effect of Hip Arthroplasty on Osteoarthritic Gait: A Blinded, Prospective and Controlled Gait Study at Fast Walking Speeds. J Arthroplasty 2016; 31:2337-41. [PMID: 27062351 DOI: 10.1016/j.arth.2016.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/27/2016] [Accepted: 03/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Painful unilateral cox arthrosis results in excessive forces passing through the "good leg." The impact of hip arthroplasty on contralateral leg gait has not been fully explored. We measured patients gait before and after arthroplasty, to answer 3 questions: (1) Are peak forces for the good legs outside the normal range? (2) Does arthroplasty protect contralateral limbs by reducing peak forces? and (3) Does arthroplasty result in a more symmetric and normal gait at fast walking speeds? METHODS This prospective, controlled study, assessed ground reaction forces before and 13 months (range, 6-21 months) after hip arthroplasty. RESULTS Peak ground reaction force in contralateral hips fell (1.45-1.38 times body weight, P = .04), whereas symmetry index maximum weight acceptance improved postoperatively (12.2 ± 11 vs 1.3 ± 6, P < .001). CONCLUSION Although gait becomes more symmetrical, patients still experience higher peak loads than matched controls. These high forces may offer an explanation to the progression of arthrosis in lower limbs.
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Normative EMG patterns of ankle muscle co-contractions in school-age children during gait. Gait Posture 2016; 46:161-6. [PMID: 27131195 DOI: 10.1016/j.gaitpost.2016.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 02/25/2016] [Accepted: 03/03/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The study was designed to assess the co-contractions of tibialis anterior (TA) and gastrocnemius lateralis (GL) in healthy school-age children during gait at self-selected speed and cadence, in terms of variability of onset-offset muscular activation and occurrence frequency. METHODS Statistical gait analysis, a recent methodology performing a statistical characterization of gait by averaging spatio-temporal and sEMG-based parameters over numerous strides, was performed in 100 healthy children, aged 6-11 years. Co-contractions were assessed as the period of overlap between activation intervals of TA and GL. RESULTS On average, 165±27 strides were analyzed for each child, resulting in approximately 16,500 strides. Results showed that GL and TA act as pure agonist/antagonists for ankle plantar/dorsiflexion (no co-contractions) in only 19.2±10.4% of strides. In the remaining strides, statistically significant (p<0.05) co-contractions appear in early stance (46.5±23.0% of the strides), mid-stance (28.8±15.9%), pre-swing (15.2±9.2%), and swing (73.2±22.6%). This significantly increased complexity in muscle recruitment strategy beyond the activation as pure ankle plantar/dorsiflexors, suggests that in healthy children co-contractions are likely functional to further physiological tasks as balance improvement and control of joint stability. CONCLUSIONS This study represents the first attempt for the development in healthy children of a normative dataset for GL/TA co-contractions during gait, achieved on an exceptionally large number of strides in every child and in total. The present reference frame could be useful for discriminating physiological and pathological behavior in children and for designing more focused studies on the maturation of gait.
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Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement. Physiotherapy 2016; 103:283-288. [PMID: 27126617 DOI: 10.1016/j.physio.2016.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 01/04/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND At present, there is an insufficient evidence base to evaluate the effectiveness of physiotherapy following total hip replacement (THR). This study evaluated the effectiveness of a physiotherapy-supervised functional exercise programme between 12 and 18 weeks following THR. These time-points coincide with increased functional demand in patients. DESIGN Adequately powered assessor-blinded randomised controlled trial. SETTING Patients were recruited at a pre-operative assessment clinic and randomised following surgery. PARTICIPANTS Sixty-three subjects were randomised to either the usual care group (control, n=31) or the functional exercise+usual care group (n=32). INTERVENTIONS Patients in the functional exercise group attended a physiotherapy-supervised functional exercise class twice weekly from 12 to 18 weeks following THR. Patients in the control group followed the usual care protocol with no exercise intervention. MAIN OUTCOME MEASUREMENT The main outcome measurement tool was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, and the secondary outcomes included walking speed, hip abduction dynamometry, Short Form 12 physical and mental health scores, and visual analogue pain scale score. RESULTS At 18 weeks post surgery, WOMAC function and walking speed improved significantly more in the functional exercise group [mean difference -4.0, 95% confidence interval (CI) -7.0 to 1.0 (P<0.01); mean difference 21.9m, 95% CI 0.60 to 43.3 (P<0.04)] than the control group, but there was no significant difference in hip abductor strength. CONCLUSION This study demonstrated that patients who undertake a physiotherapy-led functional exercise programme between 12 and 18 weeks after THR may gain significant functional improvement compared with patients receiving usual care. Clinical trial registration number NCT01683201.
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Gommans LNM, Smid AT, Scheltinga MRM, Brooijmans FAM, van Disseldorp EMJ, van der Linden FTPM, Meijer K, Teijink JAW. Altered joint kinematics and increased electromyographic muscle activity during walking in patients with intermittent claudication. J Vasc Surg 2016; 63:664-72. [PMID: 26781076 DOI: 10.1016/j.jvs.2015.09.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with intermittent claudication (IC) tend to walk at a slower pace, have less lower leg muscle strength, and consume approximately 40% more oxygen during walking compared with healthy individuals. An unfavorable locomotion pattern has been suggested to explain this metabolic inefficiency. However, knowledge on gait patterns in IC is limited. Muscle activity patterns during walking measured using surface electromyography (EMG) have not been investigated in this patient population. METHODS In this cross-sectional study, gait pattern of patients newly diagnosed with IC and age-matched controls were evaluated using kinematic parameters and medial gastrocnemius (MG) and tibialis anterior (TA) muscles activity patterns. The protocol included pain-free and painful (only IC patients) treadmill walking sessions. RESULTS A total of 22 IC patients and 22 healthy control subjects were included. Patients walked 1.4 km/h slower (3.2 km/h vs 4.6 km/h; P < .001) than control subjects, coinciding with a 10% slower cadence (110 steps/min vs 122 steps/min; P < .001). The kinematic analysis resulted in a patient's ankle plantar flexion reduction of 45% during the propulsion phase, and ankle dorsal flexion reduction of 41% at initial contact. No additional kinematic changes were observed when claudication pain presented. Interestingly, kinematic differences did not influence the muscle activity duration during walking, because equal duration of muscle activity was found in IC patients and healthy controls. However, the amount of muscle activity in microvolts did significantly increase in IC patients when claudication pain presented (TA: Δ23%; P < .001; MG: Δ54%; P = .007). CONCLUSIONS Patients with IC show significant kinematic changes during walking. These alterations did not affect EMG activity duration of MG and TA muscles. However, EMG amplitude of both muscles did significantly increase during painful walking in IC patients.
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Affiliation(s)
- Lindy N M Gommans
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Annemieke T Smid
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc R M Scheltinga
- Department of Vascular Surgery, Maxima Medisch Centrum, Veldhoven, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | | | | | - Fred T P M van der Linden
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Vascular Surgery, St. Anna Hospital Geldrop, Geldrop, The Netherlands
| | - Kenneth Meijer
- Department of Human Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
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Di Nardo F, Agostini V, Knaflitz M, Mengarelli A, Maranesi E, Burattini L, Fioretti S. The occurrence frequency: A suitable parameter for the evaluation of the myoelectric activity during walking. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6070-3. [PMID: 26737676 DOI: 10.1109/embc.2015.7319776] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many studies have recently addressed the quantification of the natural variability of myoelectric activity during walking, considering hundreds of strides. The availability of so many strides allows assessing a parameter seldom considered in classic surface EMG (sEMG) studies: the occurrence frequency, defined as the frequency each muscle activation occurs with, quantified by the number of strides in which a muscle is recruited with that specific activation modality. Aim of this study is to point out the occurrence frequency as a suitable parameter for the evaluation of the variability of the myoelectric activity during walking. This goal was pursued by means of the statistical gait analysis of sEMG signal acquired from Gastrocnemius Lateralis (GL) in six healthy subjects, with different characteristics. Results show that among these six subjects relevant differences were not detected in the temporal parameters, i.e., activation onset/offset instant and activation duration. In the same subjects, the values of the occurrence frequency ranged from 3% to 74% in the different activation modalities, indicating a large variability of this parameter. These findings show that occurrence frequency is able to provide further and different information with respect to classical temporal parameters. Thus, the occurrence frequency is proposed as a suitable parameter to support the classic temporal parameters in the evaluation of variability of myoelectric activity during walking.
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