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Ali F, Hogen CA, Miller EJ, Kaufman KR. Validation of Pelvis and Trunk Range of Motion as Assessed Using Inertial Measurement Units. Bioengineering (Basel) 2024; 11:659. [PMID: 39061741 PMCID: PMC11273649 DOI: 10.3390/bioengineering11070659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Trunk and pelvis range of motion (ROM) is essential to perform activities of daily living. The ROM may become limited with aging or with neuromusculoskeletal disorders. Inertial measurement units (IMU) with out-of-the box software solutions are increasingly being used to assess motion. We hypothesize that the accuracy (validity) and reliability (consistency) of the trunk and pelvis ROM during steady-state gait in normal individuals as measured using the Opal APDM 6 sensor IMU system and calculated using Mobility Lab version 4 software will be comparable to a gold-standard optoelectric motion capture system. Thirteen healthy young adults participated in the study. Trunk ROM, measured using the IMU was within 5-7 degrees of the motion capture system for all three planes and within 10 degrees for pelvis ROM. We also used a triad of markers mounted on the sternum and sacrum IMU for a head-to-head comparison of trunk and pelvis ROM. The IMU measurements were within 5-10 degrees of the triad. A greater variability of ROM measurements was seen for the pelvis in the transverse plane. IMUs and their custom software provide a valid and reliable measurement for trunk and pelvis ROM in normal individuals, and important considerations for future applications are discussed.
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Affiliation(s)
- Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Cecilia A. Hogen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (C.A.H.); (E.J.M.); (K.R.K.)
| | - Emily J. Miller
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (C.A.H.); (E.J.M.); (K.R.K.)
| | - Kenton R. Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA; (C.A.H.); (E.J.M.); (K.R.K.)
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Zhou H, Zhang Y, Agarwal A, Arnold G, Wang W. A preliminary study on analysis of lower limb energy during walking in the patients with knee replacement. Heliyon 2024; 10:e27960. [PMID: 38509893 PMCID: PMC10951602 DOI: 10.1016/j.heliyon.2024.e27960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Background Knee replacement surgeries are used to reduce pain and enhance functionality for individuals with knee arthritis. It is predicted that the annual volume of total knee replacement surgeries conducted in the US will surge by a substantial 673% by 2030. Though a lot of studies have done gait analysis on patients with knee replacement, little research is on energy changes in the lower limbs during gait. This study aimed to investigate the mechanical energy changes in the lower limbs for patients with total knee arthroplasty (TKA) and unicondylar knee arthroplasty (UKA), and ultimately to provide a specific tool to analyze limb energy during gait in clinical practice. Methods 10 TKA and 8 UKA patients were recruited for gait analysis. The control group consisted of 11 individuals without knee replacement surgery. Vicon motion capture system and Plug-in-Gait model were used to collect gait data to obtain marker coordinates and gait parameters. The kinetic energy, potential energy, and rotational energy for each segment in the lower limbs were calculated. The energies in the centre of pelvis were considered as the approximate to the centre of mass. The energy recovery coefficients were analysed for each segment during gait. SPSS was used to identify the differences between different groups. Results The results showed that during walking, the upper leg had the highest recovery coefficient, approximately 40%, followed by the foot at 10%, and the lowest recovery coefficient was observed in the lower leg, approximately 1-3%. However, the energy recovery coefficients at the centre of pelvis were significantly higher in the control group than the TKA and UKA groups by roughly 12%-15%. Conclusions The energy difference between the operative and non-operative sides is not significant regardless of the type of surgery. The TKA and UKA groups were more active in potential energy than control group. The upper leg has the highest recovery efficiency of kinetic and potential energy exchanges when walking. The control group used the energy for whole body is better than the patient groups. This study provides a new and useful way to analyze mechanical energy in the lower limbs during gait and could be applied in clinical practice.
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Affiliation(s)
- Haifei Zhou
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Yuying Zhang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Archit Agarwal
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
- Department of Orthopedics, S P Wahi ONGC Hospital, Dehradun, 248003, India
| | - Graham Arnold
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
| | - Weijie Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, United Kingdom
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Bleuel J, Komnik I, Mittendorfer I, Michel B, Willwacher S. Abnormal gait pattern in downhill hiking is related to muscular deficits of the knee flexors and extensors in active patients with total knee arthroplasty. Clin Biomech (Bristol, Avon) 2024; 111:106150. [PMID: 37979246 DOI: 10.1016/j.clinbiomech.2023.106150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND To assess the in-field walking mechanics during downhill hiking of patients with total knee arthroplasty five to 14 months after surgery and an age-matched healthy control group and relate them to the knee flexor and extensor muscle strength. METHODS Participants walked on a predetermined hiking trail at a self-selected, comfortable pace wearing an inertial sensor system for recording the whole-body 3D kinematics. Sagittal plane hip, knee, and ankle joint angles were evaluated over the gait cycle at level walking and two different negative slopes. The concentric and eccentric lower extremity muscle strength of the knee flexors and extensors isokinetically at 50 and 120°/s were measured. FINDINGS Less knee flexion angles during stance have been measured in patients in the operated limb compared to healthy controls in all conditions (level walking, moderate downhill, steep downhill). The differences increased with steepness. Muscle strength was lower in patients for both muscle groups and all measured conditions. The functional hamstrings to quadriceps ratio at 120°/sec correlated with knee angle during level and downhill walking at the moderate slope in patients, showing higher ratios with lower peak knee flexion angles. INTERPRETATION The study shows that even if rehabilitation has been completed successfully and complication-free, five to 14 months after surgery, the muscular condition was still insufficient to display a normal gait pattern during downhill hiking. The muscle balance between quadriceps and hamstring muscles seems related to the persistence of a stiff knee gait pattern after knee arthroplasty. LoE: III.
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Affiliation(s)
- Judith Bleuel
- Institute of Motion Analysis and Sports Medicine, endogap Clinic for Joint Replacement, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany.
| | - Igor Komnik
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Iris Mittendorfer
- Institute of Motion Analysis and Sports Medicine, endogap Clinic for Joint Replacement, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Björn Michel
- Institute of Motion Analysis and Sports Medicine, endogap Clinic for Joint Replacement, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany; Institute of Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
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Almonroeder TG, Friedrich JO, Hyoda H, Grabowski P, Jagim A, Dobbs W, Luedke J. Inter-limb kinetic asymmetries during sit-to-stand performance persist following unilateral total knee arthroplasty: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2023; 110:106103. [PMID: 37774467 DOI: 10.1016/j.clinbiomech.2023.106103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Kinetic asymmetries during sit-to-stand have been consistently observed early after total knee arthroplasty; however, the longer-term outcomes are less clear. The purpose of this systematic review and meta-analysis was to analyze the results of studies examining inter-limb kinetic symmetry during sit-to-stand performance among individuals who were at least one-year post unilateral total knee arthroplasty. METHODS PubMed, SPORTDiscus, CINAHL, and Health Source databases were searched. Studies were included if they were published in a peer-reviewed journal, included subjects who had undergone unilateral total knee arthroplasty at least one-year prior, and examined vertical ground reaction forces and/or knee extension moments for the involved and uninvolved limbs during sit-to-stand performance. Data were transformed into a limb symmetry index, which expressed the ratio of the peak forces/moments for the involved limb, relative to the uninvolved limb (1.0 reflects perfect symmetry). These ratios were meta-analyzed using the ratio of means method. FINDINGS Seven studies were deemed eligible for inclusion. Ground reaction force data was pooled from seven studies and knee extension moment data was pooled from two studies. For the peak vertical ground reaction forces, the pooled limb symmetry index was 0.96 (CI95% = [0.93, 0.99]). For the peak knee extension moments, the pooled limb symmetry index was 0.91 (CI95% = [0.84, 0.98]). In both cases this reflects greater limb/knee loading for the uninvolved limb, relative to the involved limb. INTERPRETATION Asymmetries in limb/knee loading persist beyond the one-year post-operative period following total knee arthroplasty, potentially contributing to degenerative changes for the uninvolved limb.
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Affiliation(s)
| | - Jan O Friedrich
- Interdepartmental Division of Critical Care and Department of Medicine, Temerty Faculty of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, Toronto, ON M5S 3H2, Canada; Unity Health Toronto - St. Michael's Hospital, 30 Bond St., Bond Wing, Room 4-015, Toronto, ON M5B 1W8, Canada.
| | - Haruka Hyoda
- Trine University, 1819 Carew St., Fort Wayne, IN 46805, USA.
| | - Patrick Grabowski
- University of Wisconsin-La Crosse, 1725 State St., La Crosse, WI 54601, USA.
| | - Andrew Jagim
- Mayo Clinic Health System, 700 West Ave. S., La Crosse, WI 54601, USA.
| | - Ward Dobbs
- University of Wisconsin-La Crosse, 1725 State St., La Crosse, WI 54601, USA.
| | - Joel Luedke
- Mayo Clinic Health System, 700 West Ave. S., La Crosse, WI 54601, USA.
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Dong M, Fan H, Yang D, Sun X, Yan C, Feng Y. Comparison of spatiotemporal, kinematic, and kinetic gait characteristics in total and unicompartmental knee arthroplasty during level walking: A systematic review and meta-analysis. Gait Posture 2023; 104:58-69. [PMID: 37321113 DOI: 10.1016/j.gaitpost.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/26/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE This meta-analysis was performed to compare the spatiotemporal, kinematic, and kinetic gait characteristics during level walking between total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). METHODS An electronic database literature search was performed to screen clinical trials which were included the studies evaluating not only spatiotemporal, kinematic, and kinetic gait parameters, but also knee range of motion and knee score (Knee Society Score and Oxford Knee Score, i.e., KSS and OKS). The data analysis was performed using statistical software Stata 14.0 and Review Manager 5.4. RESULTS Thirteen studies (369 knees) that met the criteria were eventually included in this meta-analysis. The results revealed significant differences between UKA and TKA with regard to walking speed (P = 0.04), stride length (P = 0.02), maximum knee flexion at loading (P = 0.001), the 1st peak of vert-GRF (P = 0.006), the 1st valley of vert-GRF (P = 0.007), knee internal rotational moment (P = 0.04), knee extension (P < 0.00001), and KSS Function score (P = 0.05). In contrast, there were no statistical differences in the remaining spatiotemporal, kinematic, and kinetic gait parameters. CONCLUSION Medial UKA design is superior to TKA design with regard to walking speed, stride length, maximum knee flexion at loading, the 1st peak and the 1st valley of vert-GRF, knee internal rotational moment, knee extension, and KSS Function score. And it could provide a stronger basis for physicians to make clinical decisions.
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Affiliation(s)
- Mingjie Dong
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Hao Fan
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Dinglong Yang
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Xiaoyu Sun
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Chaochao Yan
- Department of Orthopaedics, the Second Clinical Medical College of Shanxi Medical University, 030000 Taiyuan, China
| | - Yi Feng
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, 030000 Taiyuan, China.
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Mantashloo Z, Abbasi A, Tazji MK, Pedram MM. Lower body kinematics estimation during walking using an accelerometer. J Biomech 2023; 151:111548. [PMID: 36944294 DOI: 10.1016/j.jbiomech.2023.111548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
Measuring and predicting accurate joint angles are important to developing analytical tools to gauge users' progress. Such measurement is usually performed in laboratory settings, which is difficult and expensive. So, the aim of this study was continuous estimation of lower limb joint angles during walking using an accelerometer and random forest (RF). Thus, 73 subjects (26 women and 47 men) voluntarily participated in this study. The subjects walked at the slow, moderate, and fast speeds on a walkway, which was covered with 10 Vicon camera. Acceleration was used as input for a RF to estimate ankle, knee, and hip angles (in transverse, frontal, and sagittal planes). Pearson correlation coefficient (r) and Mean Square Error (MSE) were computed between the experimental and estimated data. Paired statistical parametric mapping (SPM) t-test was used to compare the experimental and estimated data throughout gait cycle. The results of this study showed that the MSE of joint angles between the experimental and estimated data ranged from 0.04 to 24.29 and r > 0.91. Moreover, the findings of SPM indicated that there was no significant difference between the experimental and estimated data of ankle, knee, and hip angles in all three planes throughout gait cycle. The results of our research developed a more accessible, portable procedure to quantifying lower limb joint angles by an accelerometer and RF. So, such wearable-based joint angles have the potential to be used in outside-laboratory settings to measure walking kinematics.
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Affiliation(s)
- Zahed Mantashloo
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Ali Abbasi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran.
| | - Mehdi Khaleghi Tazji
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sports Sciences, Kharazmi University, Tehran, Iran
| | - Mir Mohsen Pedram
- Department of Electrical and Computer Engineering, Faculty of Engineering, Kharazmi University, Tehran, Iran
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Naylor BH, Tarazi JM, Salem HS, Harwin SF, Mont MA. Wound Management following Total Knee Arthroplasty: An Updated Review. J Knee Surg 2023; 36:274-283. [PMID: 34261158 DOI: 10.1055/s-0041-1731740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Optimal wound closure techniques following total knee arthroplasty (TKA) have focused on enhancing healing potential, preventing infection, yielding satisfactory cosmesis, and allowing early ambulation and functionality. An appropriate layered closure and management of the TKA typically involves addressing the (1) deep fascial layer; (2) subdermal layer; (3) intradermal layer, including the subcuticular region; and (4) final application of a specific aseptic dressing, each of which are covered here in detail. This focused critical review of the literature discusses traditional techniques used in all layers of wound closure following TKA while introducing several emerging popular techniques. For example, absorbable barbed skin sutures and occlusive dressings have the potential to reduce operative time, limit the need for early postoperative visits, obviate the need for suture or staple removal, and safely promote patient communication via telemedicine. As novel wound closure techniques continue to emerge and traditional approaches are improved upon, future comparative studies will assist in elucidating the key advantages of various options. In an extremely important field that has tremendous variability, these efforts may enable the reaching of a classically elusive standard of care for these techniques.
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Affiliation(s)
- Brandon H Naylor
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
| | - John M Tarazi
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
| | - Hytham S Salem
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
| | - Steven F Harwin
- Department of Orthopaedic Surgery, Mount Sinai West Hospital, New York City, New York
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York City, New York
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Emmerzaal J, Van Rossom S, van der Straaten R, De Brabandere A, Corten K, De Baets L, Davis J, Jonkers I, Timmermans A, Vanwanseele B. Joint kinematics alone can distinguish hip or knee osteoarthritis patients from asymptomatic controls with high accuracy. J Orthop Res 2022; 40:2229-2239. [PMID: 35043466 DOI: 10.1002/jor.25269] [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: 03/30/2020] [Revised: 08/17/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
Osteoarthritis (OA) is one of the leading musculoskeletal disabilities worldwide, and several interventions intend to change the gait pattern in OA patients to more healthy patterns. However, an accessible way to follow up the biomechanical changes in a clinical setting is still missing. Therefore, this study aims to evaluate whether we can use biomechanical data collected from a specific activity of daily living to help distinguish hip OA patients from controls and knee OA patients from controls using features that potentially could be measured in a clinical setting. To achieve this goal, we considered three different classes of statistical models with different levels of data complexity. Class 1 is kinematics based only (clinically applicable), class 2 includes joint kinetics (semi-applicable under the condition of access to a force plate or prediction models), and class 3 uses data from advanced musculoskeletal modeling (not clinically applicable). We used a machine learning pipeline to determine which classification model was best. We found 100% classification accuracy for KneeOA-vs-Asymptomatic and 93.9% for HipOA-vs-Asymptomatic using seven features derived from the lumbar spine and hip kinematics collected during ascending stairs. These results indicate that kinematical data alone can distinguish hip or knee OA patients from asymptomatic controls. However, to enable clinical use, we need to validate if the classifier also works with sensor-based kinematical data and whether the probabilistic outcome of the logistic regression model can be used in the follow-up of patients with OA.
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Affiliation(s)
- Jill Emmerzaal
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Belgium.,REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Sam Van Rossom
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Belgium
| | - Rob van der Straaten
- REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Arne De Brabandere
- Declarative Languages and Artificial Intelligence Group, Department of Computer Science, KU Leuven, Belgium
| | - Kristoff Corten
- Department of Orthopaedics, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Liesbet De Baets
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Ixelles, Belgium
| | - Jesse Davis
- Declarative Languages and Artificial Intelligence Group, Department of Computer Science, KU Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Benedicte Vanwanseele
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Belgium
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Christensen JC, Stanley EC, Oro EG, Carlson HB, Naveh YY, Shalita R, Teitz LS. The validity and reliability of the OneStep smartphone application under various gait conditions in healthy adults with feasibility in clinical practice. J Orthop Surg Res 2022; 17:417. [PMID: 36104792 PMCID: PMC9476593 DOI: 10.1186/s13018-022-03300-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Primary purpose of this study was to determine the validity and reliability of the OneStep smartphone application in healthy adults. Secondary purpose was to determine the feasibility of measuring gait dysfunction, limitation in spatiotemporal characteristics, longitudinally in patients following total hip or knee arthroplasty.
Methods First objective, 20 healthy adults (mean age, 42.3 ± 19.7 years; 60% males; mean body mass index, 29.0 ± 5.2 kg/m2) underwent gait analysis under four gait conditions (self-selected gait speed, fixed gait speed at 0.8 m/s, fixed gait speed at 2.0 m/s and self-selected gait speed with dual task) for the validity and reliability of the smartphone to the motion laboratory. Reliability was determined by intraclass correlation coefficients. Validity was determined by Pearson correlations. Agreement was assessed by the Bland–Altman method. Second objective, 12 additional patients with total hip or knee arthroplasty (mean age, 58.7 ± 6.5 years; 58% males; mean body mass index, 28.9 ± 5.8 kg/m2) were measured at 2- and 10 weeks postoperatively. The smartphone application was used to evaluate change in gait dysfunction over time within the patients’ own environment using paired t test.
Results The smartphone application demonstrated moderate-to-excellent intraclass correlation coefficients for reliability between-system (ICC range, 0.56–0.99), -limb (ICC range, 0.62–0.99) and -device (ICC range, 0.61–0.96) for gait analysis of healthy adults. Pearson correlations were low-to-very high between methods (r range, 0.45–0.99). Bland–Altman analysis revealed relative underestimation of spatiotemporal variables by the smartphone application compared to the motion system. For patients following total hip or knee arthroplasty, gait analysis using the OneStep application demonstrated significant improvement (p < 0.001, Cohen’s d > 0.95) in gait dysfunction between 2- and 10 weeks postoperatively. Conclusion The smartphone application can be a valid, reliable and feasible alternative to motion laboratories in evaluating deficits in gait dysfunction in various environments and clinical settings.
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Sasaki R, Niki Y, Kaneda K, Yamada Y, Nagura T, Nakamura M, Jinzaki M. A novel anteroposterior axis of the tibia for total knee arthroplasty: An upright weight-bearing computed tomography analysis. Knee 2022; 36:80-86. [PMID: 35561561 DOI: 10.1016/j.knee.2022.04.009] [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: 08/13/2021] [Revised: 03/13/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The traditional anteroposterior (AP) axis (i.e., Akagi's line) has been widely used as the tibial component AP axis during total knee arthroplasty (TKA). However, this AP axis has been defined based on computed tomography (CT) in a non-weight-bearing supine position. In this study, AP axes of the tibial plateau from upright CT in weight-bearing and non-weight-bearing positions were determined and compared. METHODS This study included 43 knees from 23 healthy volunteers. CT images were obtained in weight-bearing and non-weight-bearing standing positions using a 320-detector row upright CT scanner. The line perpendicular to surgical transepicondylar axis projected onto the tibia plateau was determined as the AP axis in upright weight-bearing and non-weight-bearing conditions. Angular differences between these two conditions were measured. RESULTS The upright weight-bearing AP axis was positioned in a mean of 7.4 ± 4.3° of internal rotation relative to the traditional AP axis. Distance between the traditional and upright weight-bearing AP axis was 2.9 ± 1.6 mm at the edge of the tibial plateau. The upright non-weight-bearing AP axis was positioned in a mean of 3.5 ± 4.1° of internal rotation relative to the traditional AP axis. Mean angular difference between weight-bearing and non-weight-bearing conditions was 3.9 ± 4.1°. CONCLUSIONS The upright weight-bearing AP axis was positioned in 7.4° of internal rotation relative to the traditional AP axis, showing one-seventh of the tibial tuberosity away from the medial border of the tibial tubercle, which represents a practical landmark for the tibial component AP axis during TKA.
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Affiliation(s)
- Ryo Sasaki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan.
| | - Kazuya Kaneda
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo 160-8582, Japan
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Reliability and Validity of an Inertial Measurement System to Quantify Lower Extremity Joint Angle in Functional Movements. SENSORS 2022; 22:s22030863. [PMID: 35161609 PMCID: PMC8838175 DOI: 10.3390/s22030863] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023]
Abstract
The purpose of this research was to determine if the commercially available Perception Neuron motion capture system was valid and reliable in clinically relevant lower limb functional tasks. Twenty healthy participants performed two sessions on different days: gait, squat, single-leg squat, side lunge, forward lunge, and counter-movement jump. Seven IMUs and an OptiTrack system were used to record the three-dimensional joint kinematics of the lower extremity. To evaluate the performance, the multiple correlation coefficient (CMC) and the root mean square error (RMSE) of the waveforms as well as the difference and intraclass correlation coefficient (ICC) of discrete parameters were calculated. In all tasks, the CMC revealed fair to excellent waveform similarity (0.47–0.99) and the RMSE was between 3.57° and 13.14°. The difference between discrete parameters was lower than 14.54°. The repeatability analysis of waveforms showed that the CMC was between 0.54 and 0.95 and the RMSE was less than 5° in the frontal and transverse planes. The ICC of all joint angles in the IMU was general to excellent (0.57–1). Our findings showed that the IMU system might be utilized to evaluate lower extremity 3D joint kinematics in functional motions.
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Yan SH, Liu YC, Li W, Zhang K. Gait phase detection by using a portable system and artificial neural network. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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13
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Mundt M, Koeppe A, David S, Bamer F, Potthast W, Markert B. Prediction of ground reaction force and joint moments based on optical motion capture data during gait. Med Eng Phys 2020; 86:29-34. [PMID: 33261730 DOI: 10.1016/j.medengphy.2020.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 08/10/2020] [Accepted: 10/04/2020] [Indexed: 11/27/2022]
Abstract
The standard camera- and force plate-based set-up for motion analysis suffers from the disadvantage of being limited to laboratory settings. Since adaptive algorithms are able to learn the connection between known inputs and outputs and generalise this knowledge to unknown data, these algorithms can be used to leverage motion analysis outside the laboratory. In most biomechanical applications, feedforward neural networks are used, although these networks can only work on time normalised data, while recurrent neural networks can be used for real time applications. Therefore, this study compares the performance of these two kinds of neural networks on the prediction of ground reaction force and joint moments of the lower limbs during gait based on joint angles determined by optical motion capture as input data. The accuracy of both networks when generalising to new data was assessed using the normalised root-mean-squared error, the root-mean-squared error and the correlation coefficient as evaluation metrics. Both neural networks demonstrated a high performance and good capabilities to generalise to new data. The mean prediction accuracy over all parameters applying a feedforward network was higher (r = 0.963) than using a recurrent long short-term memory network (r = 0.935).
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Affiliation(s)
- Marion Mundt
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany. http://www.iam.rwth-aachen.de
| | - Arnd Koeppe
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
| | - Sina David
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Franz Bamer
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Bernd Markert
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
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Youn IH, Leutzinger T, Youn JH, Zeni JA, Knarr BA. Self-Reported and Performance-Based Outcome Measures Estimation Using Wearables After Unilateral Total Knee Arthroplasty. Front Sports Act Living 2020; 2:569932. [PMID: 33345128 PMCID: PMC7739603 DOI: 10.3389/fspor.2020.569932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022] Open
Abstract
Total knee arthroplasty is a common surgical treatment to improve ambulatory function for individuals with end-stage osteoarthritis of the knee. Functional and self-reported measures are widely used to assess functional ability and impairment before and after total knee arthroplasty. However, clinical assessments have limitations and often provide subjective and limited information. Seamless gait characteristic monitoring in the real-world condition is a viable alternative to address these limitations, but the effectiveness of using wearable sensors for knee treatment is unclear. The purpose of this study was to determine if inertial gait variables from wearable sensors effectively estimate the questionnaire, performance (6-min walk test, timed up and go, and 30-s chair stand test), and isometric measure outcomes in individuals after unilateral total knee arthroplasty. Eighteen subjects at least 6 months post-surgery participated in the experiment. In one session, three tasks, including self-reported surveys, functional testing, and isometric tests were conducted. In another session, the participants' gait patterns were measured during a 1-min walking test at their self-selected gait speed with two accelerometers worn above the lateral malleoli. Session order was inconsistent between subjects. Significant inertial gait variables were selected using stepwise regressions, and the contributions of different categories of inertial gait variables were examined using hierarchical regressions. Our results indicate inertial gait variables were significantly correlated with performance test and questionnaire outcomes but did not correlate well with isometric strength measures. The findings demonstrate that wearable sensor-based gait analysis may be able to help predict clinical measures in individuals after unilateral knee treatment.
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Affiliation(s)
- Ik-Hyun Youn
- Division of Navigation and Information Systems, Mokpo National Maritime University, Mokpo, South Korea
| | - Todd Leutzinger
- Department of Biomechanics, College of Education, University of Nebraska Omaha, Omaha, NE, United States
| | - Jong-Hoon Youn
- Department of Computer Science, College of Information Science and Technology, University of Nebraska Omaha, Omaha, NE, United States
| | - Joseph A Zeni
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ, United States
| | - Brian A Knarr
- Department of Biomechanics, College of Education, University of Nebraska Omaha, Omaha, NE, United States
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van der Straaten R, Wesseling M, Jonkers I, Vanwanseele B, Bruijnes AKBD, Malcorps J, Bellemans J, Truijen J, De Baets L, Timmermans A. Functional movement assessment by means of inertial sensor technology to discriminate between movement behaviour of healthy controls and persons with knee osteoarthritis. J Neuroeng Rehabil 2020; 17:65. [PMID: 32430036 PMCID: PMC7236325 DOI: 10.1186/s12984-020-00694-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 05/07/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Apart from biomechanical alterations in movement patterns, it is known that movement limitations in persons with knee osteoarthritis (PwKOA) are related to an individual's perception and belief regarding pain and disability. To gain more insights into the functional movement behaviour of PwKOA in a clinical setting, inertial sensor technology can be applied. This study first aims to evaluate the ability of inertial sensors to discriminate between healthy controls (HC) and PwKOA. Secondly, this study aims to determine the relationship between movement behaviour, pain-related factors and disability scores. METHODS Twelve HC and 19 PwKOA were included. Five repetitions of six functional movement tasks (walking, forward lunge, sideward lunge, ascent and descent stairs, single leg squat and sit-to-stand) were simultaneously recorded by the inertial sensor system and a camera-based motion analysis system. Statistically significant differences in angular waveforms of the trunk, pelvis and lower limb joints between HC and PwKOA were determined using one-dimensional statistical parametric mapping (SPM1D). The Knee injury and Osteoarthritis Outcome Score and TAMPA scale for Kinesiophobia were used to evaluate the relationship between discriminating joint motion, pain-related factors and disability using spearman's correlation coefficients. RESULTS PwKOA had significantly less trunk rotation, internal pelvis rotation and knee flexion ROM during walking. Additionally, the reduced knee flexion (i.e. at the end of the stance phase and swing phase) was related to increased level of perceived pain. During the sideward lunge, PwKOA had significantly less knee flexion, ankle plantarflexion and hip abduction. This decreased hip abduction (i.e. during stance) was related to higher fear of movement. Finally, PwKOA had significantly less knee flexion during the forward lunge, single leg squat and during ascent and descent stairs. No significant correlations were observed with disability. CONCLUSIONS Inertial sensors were able to discriminate between movement characteristics of PwKOA and HC. Additionally, significant relationships were found between joint motion, perceived pain and fear of movement. Since inertial sensors can be used outside the laboratory setting, these results are promising as they indicate the ability to evaluate movement deviations. Further research is required to enable measurements of small movement deviations in clinically relevant tasks.
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Affiliation(s)
| | - Mariska Wesseling
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - Benedicte Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | | | - Jan Malcorps
- Department of Orthopaedic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Johan Bellemans
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Jan Truijen
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Liesbet De Baets
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
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van der Straaten R, Wesseling M, Jonkers I, Vanwanseele B, Bruijnes AKBD, Malcorps J, Bellemans J, Truijen J, De Baets L, Timmermans A. Discriminant validity of 3D joint kinematics and centre of mass displacement measured by inertial sensor technology during the unipodal stance task. PLoS One 2020; 15:e0232513. [PMID: 32407415 PMCID: PMC7224481 DOI: 10.1371/journal.pone.0232513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 04/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background The unipodal stance task is a clinical task that quantifies postural stability and alignment of the lower limb joints, while weight bearing on one leg. As persons with knee osteoarthritis (KOA) have poor postural and knee joint stability, objective assessment of this task might be useful. Objective To investigate the discriminant validity of three-dimensional joint kinematics and centre of mass displacement (COM) between healthy controls and persons with knee KOA, during unipodal stance using inertial sensors. Additionally, the reliability, agreement and construct validity are assessed to determine the reproducibility and accuracy of the discriminating parameters. Methods Twenty healthy controls and 19 persons with unilateral severe KOA were included. Five repetitions of the unipodal stance task were simultaneously recorded by an inertial sensor system and a camera-based system (gold standard). Statistical significant differences in kinematic waveforms between healthy controls and persons with severe knee KOA were determined using one-dimensional statistical parametric mapping (SPM1D). Results Persons with severe knee KOA had more lateral trunk lean towards the contralateral leg, more hip flexion throughout the performance of the unipodal stance task, more pelvic obliquity and COM displacement towards the contralateral side. However, for the latter two parameters the minimum detectable change was greater than the difference between healthy controls and persons with severe knee KOA. The construct validity was good (coefficient of multiple correlation 0.75, 0.83 respectively) and the root mean squared error (RMSE) was low (RMSE <1.5°) for the discriminant parameters. Conclusion Inertial sensor based movement analysis can discriminate between healthy controls and persons with severe knee KOA for lateral trunk lean and hip flexion, but unfortunately not for the knee angles. Further research is required to improve the reproducibility and accuracy of the inertial sensor measurements before they can be used to assess differences in tasks with a small range of motion.
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Affiliation(s)
- R. van der Straaten
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- * E-mail:
| | - M. Wesseling
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - I. Jonkers
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | - B. Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Leuven, Belgium
| | | | - J. Malcorps
- Department of Orthopaedic Surgery, Jessa Hospital, Hasselt, Belgium
| | - J. Bellemans
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - J. Truijen
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - L. De Baets
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - A. Timmermans
- REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
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Mendiolagoitia L, Rodríguez MÁ, Crespo I, del Valle M, Olmedillas H. Kinematic Gait Analysis After Primary Total Hip Replacement: A Systematic Review: Gait After Total Hip Replacement: A Systematic Review. Indian J Orthop 2020; 54:767-775. [PMID: 33133399 PMCID: PMC7573021 DOI: 10.1007/s43465-020-00101-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/28/2020] [Indexed: 02/04/2023]
Abstract
Total hip replacement (THR) is a surgical procedure indicated for patients affected by severe hip osteoarthritis. Although this technique has proved to be effective in relieving pain and restoring function, gait limitations may persist following this procedure. The objective of this systematic review was to evaluate gait kinematics after THR and compare the results with those of the pre-operative state and with healthy control individuals. PubMed/MEDLINE, Embase, Web of Science, CENTRAL and Scopus databases were searched until December 2019. Methodological quality and internal validity score of each study were assessed using the PEDro and the Newcastle-Ottawa scales. In all, ten studies met our inclusion criteria. Following THR, statistically significant improvements were seen in dynamic hip and knee range of motion of both the affected and the contralateral limb, single-limb support time symmetry, step length, stride length, walking speed and gait pattern. However, deficits were observed in all the previous parameters, as well as in hip adduction angle in comparison with healthy subjects. In conclusion, gait patterns improve after THR in comparison with the pre-operative state, although there are deficits relative to healthy individuals.
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Affiliation(s)
- Luis Mendiolagoitia
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | | | - Irene Crespo
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain ,Institute of Biomedicine, Universidad de León, León, Spain
| | - Miguel del Valle
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | - Hugo Olmedillas
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain ,Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
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Mundt M, Koeppe A, David S, Witter T, Bamer F, Potthast W, Markert B. Estimation of Gait Mechanics Based on Simulated and Measured IMU Data Using an Artificial Neural Network. Front Bioeng Biotechnol 2020; 8:41. [PMID: 32117923 PMCID: PMC7013109 DOI: 10.3389/fbioe.2020.00041] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/20/2020] [Indexed: 11/13/2022] Open
Abstract
Enhancement of activity is one major topic related to the aging society. Therefore, it is necessary to understand people's motion and identify possible risk factors during activity. Technology can be used to monitor motion patterns during daily life. Especially the use of artificial intelligence combined with wearable sensors can simplify measurement systems and might at some point replace the standard motion capturing using optical measurement technologies. Therefore, this study aims to analyze the estimation of 3D joint angles and joint moments of the lower limbs based on IMU data using a feedforward neural network. The dataset summarizes optical motion capture data of former studies and additional newly collected IMU data. Based on the optical data, the acceleration and angular rate of inertial sensors was simulated. The data was augmented by simulating different sensor positions and orientations. In this study, gait analysis was undertaken with 30 participants using a conventional motion capture set-up based on an optoelectronic system and force plates in parallel with a custom IMU system consisting of five sensors. A mean correlation coefficient of 0.85 for the joint angles and 0.95 for the joint moments was achieved. The RMSE for the joint angle prediction was smaller than 4.8° and the nRMSE for the joint moment prediction was below 13.0%. Especially in the sagittal motion plane good results could be achieved. As the measured dataset is rather small, data was synthesized to complement the measured data. The enlargement of the dataset improved the prediction of the joint angles. While size did not affect the joint moment prediction, the addition of noise to the dataset resulted in an improved prediction accuracy. This indicates that research on appropriate augmentation techniques for biomechanical data is useful to further improve machine learning applications.
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Affiliation(s)
- Marion Mundt
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
| | - Arnd Koeppe
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
| | - Sina David
- Institute of Biomechanics and Orthopeadics, German Sport University Cologne, Cologne, Germany
| | - Tom Witter
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
| | - Franz Bamer
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopeadics, German Sport University Cologne, Cologne, Germany
| | - Bernd Markert
- Institute of General Mechanics, RWTH Aachen University, Aachen, Germany
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Giorgini A, Zambianchi F, Lombardi M, Francioni E, Marcovigi A, Catani F. Mechanical alignment changes during flexion in total knee arthroplasty without affecting clinical outcomes. Clin Biomech (Bristol, Avon) 2020; 72:63-68. [PMID: 31838212 DOI: 10.1016/j.clinbiomech.2019.11.026] [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: 04/04/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Primary aim of this study is to investigate if Hip-Knee-Ankle angle, measured in the coronal plane, changes with knee flexion after total knee arthroplasty. The secondary aim is to assess the relationship between Hip-Knee-Ankle during knee flexion and clinical outcome at mid-term follow up. METHODS 334 computer assisted total knee arthroplasties were retrospectively evaluated. A total of 233 patients were available for assessment of clinical outcomes at last follow up (mean 35 months). Hip-Knee-Ankle angle at different degrees of knee flexion and components' alignment were recorded intraoperatively. FINDINGS Patients were stratified based on the preoperative alignment: 202 varus knees, 99 neutral knees, and 33 valgus knees. In the varus knee group, 146 patients (89%) maintained a neutral overall limb alignment when flexed to 20°, 118 (72%) remained neutrally aligned at 45° and 92 (54%) at 90°. In valgus knee group, 26 (90%) remained neutrally aligned at 20°, 22 (75%) at 45° and 16 (55%) at 90°. In neutrally-aligned knee group, 88 (96%) remained neutrally aligned at 20°, 73 (79%) at 45° and 61 (66%) at 90°. Femoral component external rotation was correlated with varus alignment in flexion. Good outcomes were reported in 181 (78%) cases, fair results in 28 (12%) cases, poor results in 24 (10%) of cases. Poor results were not correlated to Hip-Knee-Ankle angle at different knee flexion angles. INTERPRETATION This study demonstrates that intraoperative Hip-Knee-Ankle angle changes as the knee moves into deeper flexion. However, neutral Hip-Knee-Ankle through the range of motion does not correlate with superior outcomes.
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Affiliation(s)
- Andrea Giorgini
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy.
| | - Francesco Zambianchi
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Martina Lombardi
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Elena Francioni
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Andrea Marcovigi
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy
| | - Fabio Catani
- Policlinico di Modena, Department of Orthopaedic and Traumatology, Via del Pozzo 71, Modena, Italy.
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Komaris DS, Govind C, Clarke J, Ewen A, Jeldi A, Murphy A, Riches P. Identifying car ingress movement strategies before and after total knee replacement. Int Biomech 2020; 7:9-18. [PMID: 33998386 PMCID: PMC8130714 DOI: 10.1080/23335432.2020.1716847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Post-operative performance of knee bearings is typically assessed in activities of daily living by means of motion capture. Biomechanical studies predominantly explore common tasks such as walking, standing and stair climbing, while overlooking equally demanding activities such as embarking a vehicle. Aims: The aim of this work is to evaluate changes in the movement habits of patients after total knee arthroplasty surgery in comparison to healthy age-matched control participants. Methods: A mock-up car was fabricated based on the architecture of a common vehicle. Ten control participants and 10 patients with severe osteoarthritis of the knee attended a single- and three-motion capture session(s), respectively. Participants were asked to enter the car and sit comfortably adopting a driving position. Three trials per session were used for the identification of movement strategies by means of hierarchical clustering. Task completion time was also measured. Results: Patients’ movement behaviour didn’t change significantly following total knee arthroplasty surgery. Control participants favoured different movement strategies compared to patients post-operatively. Group membership, height and sidedness of the affected joint were found to be non-significant in task completion time. Conclusion: This study describes an alternative movement identification technique for the analysis of the ingress movement that may be used to clinically assess knee bearings and aid in movement simulations and vehicle design.
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Affiliation(s)
| | - Cheral Govind
- Department of Biomedical Engineering, University of Strathclyde , Glasgow, Scotland
| | - Jon Clarke
- Orthopaedic Department, Golden Jubilee National Hospital , Glasgow, Scotland
| | - Alistair Ewen
- Orthopaedic Department, Golden Jubilee National Hospital , Glasgow, Scotland
| | - Artaban Jeldi
- Orthopaedic Department, Golden Jubilee National Hospital , Glasgow, Scotland
| | - Andrew Murphy
- Department of Biomedical Engineering, University of Strathclyde , Glasgow, Scotland
| | - Philip Riches
- Department of Biomedical Engineering, University of Strathclyde , Glasgow, Scotland
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Junior PRF, Moura RCFD, Oliveira CS, Politti F. Use of wearable inertial sensors for the assessment of spatiotemporal gait variables in children: A systematic review. MOTRIZ: REVISTA DE EDUCACAO FISICA 2020. [DOI: 10.1590/s1980-6574202000030139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ro DH, Kang T, Han DH, Lee DY, Han HS, Lee MC. Quantitative evaluation of gait features after total knee arthroplasty: Comparison with age and sex-matched controls. Gait Posture 2020; 75:78-84. [PMID: 31627118 DOI: 10.1016/j.gaitpost.2019.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait function after total knee arthroplasty (TKA) is suboptimal. However, quantified analysis with comparing a control group is lacking. RESEARCH QUESTION The aims of this study were 1) to compare the gait before and after TKA and 2) to compare postoperative gait to that of an age-sex matched control group. METHODS This study consisted of 46 female and 38 male patients with end-stage knee osteoarthritis who underwent bilateral TKA, and 84 age- and sex-matched controls without knee pain and osteoarthritis. Seven gait parameters, including lower extremity alignment, knee adduction moment (KAM), knee flexion angle, external knee flexion moment, hip adduction angle, external hip adduction moment, and the varus-valgus arc during the stance phase, were collected using a commercial opto-electric gait analysis system. Principal component analysis was used for data processing and the standardized mean differences (SMDs) of the principal component scores were compared. RESULTS The most significant gait change after TKA was the alignment (SMD 1.62, p < 0.001). The average stance phase alignment changed from varus 7.3° to valgus 0.5°. The second significant change was a decrease of the KAM (SMD 1.08, p < 0.001). These two features were closely correlated (r = 0.644, p < 0.001). The gait feature that differed most from the controls was the varus-valgus arc during the stance phase (SMD 1.68, p < 0.001), which was constrained by 31% after TKA (p < 0.001) and was only 37% compared to the controls (p < 0.001). SIGNIFICANCE Improvement in gait after TKA was obtained through alignment correction. However, TKA significantly constrained coronal knee motion. TKA improved gait suboptimally; the gait was significantly different from that of controls.
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Affiliation(s)
- Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Taehoon Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Do Hwan Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Dong Yeon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Myung Chul Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
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Mundt M, Thomsen W, Witter T, Koeppe A, David S, Bamer F, Potthast W, Markert B. Prediction of lower limb joint angles and moments during gait using artificial neural networks. Med Biol Eng Comput 2019; 58:211-225. [DOI: 10.1007/s11517-019-02061-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/02/2019] [Indexed: 12/28/2022]
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Komnik I, David S, Haberer C, Weiss S, Potthast W. Does hamstrings co-contraction constrain knee internal rotation in patients with knee endoprosthesis during decline slope walking? Clin Biomech (Bristol, Avon) 2019; 67:134-141. [PMID: 31103963 DOI: 10.1016/j.clinbiomech.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/22/2018] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Medial and lateral hamstrings are known for their capacity to promote internal or external rotation of the knee. Apart from implant geometry, increased co-contraction to a larger share of either the medial or lateral hamstrings has the potential to contribute to the restricted knee internal rotation especially under consideration of cruciate ligament substituting compared to cruciate ligament retaining knee endoprosthesis designs. Hence, the purpose of the study was to evaluate, whether increased co-contraction of the hamstrings contribute to the impaired knee internal rotation in total and unicondylar knee arthroplasty patients during level and decline walking. METHODS Knee joint angles were calculated using an inverse kinematics model in Anybody. Muscle activity was examined of the semitendinosus and biceps femoris. FINDINGS Knee internal rotation was constraint in the operated compared to the non-operated limb only in the total knee arthroplasty group during decline slope walking. Co-contraction values revealed no statistically significant differences between the operated and non-operated limb during the limited knee internal rotation period of time (59-94% of stance). Biceps femoris activity was significantly reduced (69-71% of stance) in the operated limb in the total knee arthroplasty group during decline slope walking. INTERPRETATION Contrary to the proposed mechanism, aspects other than co-contraction between semitendinosus and biceps femoris are involved in the impaired transverse plane knee motion. These include implant congruency and probably friction. Unexpectedly, the biceps femoris did not compensate the absence of the anterior cruciate ligament with increased muscular activity in the operated limb of the total knee arthroplasty group.
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Affiliation(s)
- Igor Komnik
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Sina David
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Christine Haberer
- ARCUS Clinics Pforzheim, Rastatter Str. 17-19, 75179 Pforzheim, Germany.
| | - Stefan Weiss
- ARCUS Clinics Pforzheim, Rastatter Str. 17-19, 75179 Pforzheim, Germany.
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
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De Vroey H, Staes F, Weygers I, Vereecke E, Van Damme G, Hallez H, Claeys K. Hip and knee kinematics of the forward lunge one year after unicondylar and total knee arthroplasty. J Electromyogr Kinesiol 2019; 48:24-30. [PMID: 31200343 DOI: 10.1016/j.jelekin.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 01/07/2023] Open
Abstract
Patients with unicondylar knee arthroplasty (UKA) report higher functionality compared to those with total knee arthroplasty (TKA). However, these patients should also be assessed during more demanding tasks in order to appreciate their true functionality. The forward lunge (FL) is a motor task commonly used in clinics to evaluate functional recovery after knee replacement surgery. Unfortunately, clear evidence comparing FL kinematics between patients with UKA and TKA is still missing. The purpose of this study was to compare hip and knee joint kinematics during the FL between patients with UKA, TKA and controls. Twenty subjects (8 TKA, 6 UKA, 6 controls) underwent 3D motion analysis during a FL. Differences in hip and knee kinematics between groups were identified using statistical parametric mapping. We concluded that patients with TKA demonstrated reduced knee and hip flexion angles during the loaded phase of the FL, which could have been an attempt to unload the knee joint. This is in contrast to patients with UKA, who showed similar knee and hip joint kinematics compared to controls throughout the entire FL. It seems that retaining the cruciate ligaments is beneficial for the execution of a complex motor task such as the FL.
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Affiliation(s)
- Henri De Vroey
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium.
| | - Filip Staes
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
| | - Ive Weygers
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium
| | - Evie Vereecke
- Department of Development and Regeneration, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium
| | - Geert Van Damme
- Department of Orthopaedic Surgery, AZ Sint-Lucas, Sint-Lucaslaan 29, 8310 Bruges, Belgium
| | - Hans Hallez
- Department of Computer Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium
| | - Kurt Claeys
- Department of Rehabilitation Sciences, KU Leuven Campus Bruges, Spoorwegstraat 12, 8200 Bruges, Belgium; Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3001 Heverlee, Belgium
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Agarwal A, Miller S, Hadden W, Johnston L, Wang W, Arnold G, Abboud RJ. Comparison of gait kinematics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl 2019; 101:391-398. [PMID: 31155888 DOI: 10.1308/rcsann.2019.0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study is aimed to compare kinematic gait data of patients who have undergone total and unicondylar knee replacement. MATERIALS AND METHODS This single-surgeon retrospective cohort study evaluated 13 patients with unilateral total knee arthroplasty (TKA) and 14 unicondylar knee arthroplasty (UKA). Gait analysis was carried out using a Vicon motion analysis system. The limits of knee flexion during stance phase, at heel strike and at loading response were measured. RESULTS The total range of motion of the UKA knees was significantly greater than the TKA knees. UKA knees exhibited significantly greater knee extension during the stance phase than the TKA knees. Unlike TKA, UKA knees demonstrated improved knee flexion during the gait cycle when compared to the contralateral non-operated knee. The hips also demonstrated near normal hip flexion in UKA patients. Predictably, UKA knees had significantly greater varus compared with TKA in the coronal plane. Spatiotemporal variables demonstrated similar walking speed and step length to aid a fair comparison between knee replacement groups. CONCLUSIONS The UKA knees moved more physiologically in the sagittal plane with a greater range of motion during gait. Despite having a stiff gait pattern, the patients undergoing TKA demonstrated a more neutral alignment in the coronal plane. Neither type of knee arthroplasty restored knee kinematics to those of the non-operated side.
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Affiliation(s)
- A Agarwal
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - S Miller
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - W Hadden
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - L Johnston
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - W Wang
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - G Arnold
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
| | - R J Abboud
- Institute of Motion Analysis & Research (IMAR), Department of Orthopaedics & Trauma Surgery, TORT Centre, Ninewells Hospital & Medical School, University Of Dundee , Dundee DD19SY , UK
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Comparison of 2 Forms of Kinetic Biofeedback on the Immediate Correction of Knee Extensor Moment Asymmetry Following Total Knee Arthroplasty During Decline Walking. J Orthop Sports Phys Ther 2019; 49:105-111. [PMID: 30124352 DOI: 10.2519/jospt.2019.7800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with total knee arthroplasty (TKA) display interlimb knee extensor moment (KEM) asymmetry during level walking that is exacerbated as task demands are increased. Studies using biofeedback to correct interlimb KEM asymmetry following TKA have reported mixed results. OBJECTIVE To compare the immediate effect of 2 forms of real-time kinetic biofeedback-vertical ground reaction force (vGRF) or KEM-on improving interlimb peak KEM symmetry during the weight-acceptance phase of decline walking in persons who have undergone TKA. METHODS In this cross-sectional, controlled laboratory study, 30 participants (17 men; mean ± SD age, 61.9 ± 8.5 years; body mass index, 28.4 ± 3.7 kg/m2) were allocated to either a vGRF or KEM real-time biofeedback group. Peak KEM interlimb asymmetry was obtained during both nonbiofeedback and biofeedback decline walking trials 3 months following TKA. RESULTS Significant interlimb asymmetry in peak KEM was observed in both groups during the nonbiofeedback condition (KEM, P = .02; vGRF, P<.01). The KEM biofeedback group demonstrated an immediate improvement in peak KEM asymmetry (P = .42). No change in peak KEM asymmetry was observed in the vGRF biofeedback group (P = .01). CONCLUSION Knee extensor moment biofeedback has an immediate effect on improving peak KEM asymmetry 3 months post TKA. J Orthop Sports Phys Ther 2019;49(2):105-111. Epub 20 Aug 2018. doi:10.2519/jospt.2019.7800.
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28
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Christensen JC, Mizner RL, Foreman KB, LaStayo PC, Peters CL, Pelt CE. Preoperative quadriceps weakness preferentially predicts postoperative aberrant movement patterns during high-demand mobility following total knee arthroplasty. Knee 2019; 26:79-87. [PMID: 30600199 PMCID: PMC6377852 DOI: 10.1016/j.knee.2018.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/01/2018] [Accepted: 12/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Nearly all patients with total knee arthroplasty show aberrant movement patterns during tasks requiring greater joint demand compared to matched peers. Greater movement compensation leads to increased loading onto other joints, decreased functional capacity and limited reserve for independence later in life. Understanding how preoperative predictors contribute to postoperative aberrant movement patterns is needed to make better decisions for patients considering total knee arthroplasty. METHODS Forty-seven patients were tested preoperatively and six months following primary total knee arthroplasty. Demographic (age, sex, body mass), self-reported (knee pain, perception of physical performance, physical activity level), physical performance (quadriceps strength, lower limb power and timed stair climbing) and surgical metrics were collected as predictor variables. Three-dimensional models based on joint mechanic asymmetry during a decline walking task were collected at six months postoperatively. Decline walking is a preferred means to assess the surgical knee's contribution to limb performance during high-demand tasks. Bootstrap inclusion fraction was employed to compare the stability of each predictor variable prior to the final regression model. RESULTS Preoperative quadriceps strength (β = 0.33; p = 0.04) showed a significant relationship with knee extensor angular impulse during loading phase. No other predictor variable had any meaningful relationship with aberrant movement patterns (p > 0.05). CONCLUSION Our findings highlight patients' preoperative quadriceps strength as a meaningful predictor of postoperative performance. Preoperative quadriceps strength should be addressed when considering the knee's ability to contribute to higher demanding mobility tasks following surgery.
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Affiliation(s)
- Jesse C. Christensen
- University of Colorado, Department of Physical Medicine and Rehabilitation, 13001 E. 17th Pl., Aurora, CO, USA, 80045
| | - Ryan L. Mizner
- University of Montana, School of Physical Therapy & Rehabilitation Science, 32 Campus Dr., Missoula, MT
| | - K. Bo Foreman
- University of Utah, Department of Physical Therapy & Athletic Training, 520 Wakara Way, Salt Lake City, UT 84108
| | - Paul C. LaStayo
- University of Utah, Department of Physical Therapy & Athletic Training, 520 Wakara Way, Salt Lake City, UT 84108
| | - Christopher L. Peters
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
| | - Christopher E. Pelt
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
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Northon S, Boivin K, Laurencelle L, Hagemeister N, de Guise JA. Quantification of joint alignment and stability during a single leg stance task in a knee osteoarthritis cohort. Knee 2018; 25:1040-1050. [PMID: 30415977 DOI: 10.1016/j.knee.2018.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/01/2018] [Accepted: 08/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Knee osteoarthritis alters joint stability but its kinematics during functional weight-bearing tasks remain unclear. We propose and validate an assessment technique for the quantification of knee alignment and stability in patients during a short single leg stance task. METHODS Three-dimensional knee kinematics were acquired non-invasively from 31 knee osteoarthritis patients (subdivided as moderate or severe) and 15 asymptomatic individuals during six short single-leg stance tasks. Data of participants achieving ≥3 trials were retained. From flexion-extension signals, a data treatment method compared the average between-trial root-mean-square error (RMSE) across trial triplets, and the average within-trial range of movement (RoM) for two data windows. From secondary knee motions (ab/adduction and int/external rotations, anteroposterior and mediolateral translations), we extracted measures characterizing alignments (mean), largest deviations (maximum, minimum), and extent of micro-adjustments (RoM, length of knee excursion). Their sensitivity to disease and severity was determined using an ANOVA, and between-trial repeatability using ICC2,3. RESULTS Ninety-four percent of patients achieved ≥3 trials. The retained trial triplet and window reduced the RMSE (2.15 to 1.54) and RoM (4.9° to 1.77°) for flexion-extension. Mean, minimum, and maximum measures were sensitive to disease for anteroposterior translations, and to severity for ab/adduction (P < 0.05). High repeatability was found for those measures (ICC ≥0.84). RoM and length of knee excursion, although sensitive to disease for anteroposterior translations, had lower ICC. CONCLUSION The proposed technique is feasible and exposed measures of knee alignment sensitive to knee osteoarthritis, for instance, an anterior femoral shift and an increased adduction malalignment with greater severity.
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Affiliation(s)
- Stéphane Northon
- Département des sciences de l'activité physique de l'Université du Québec à Trois-Rivières, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche sur les affections neuro-musculo-squelettiques, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada
| | - Karine Boivin
- Département des sciences de l'activité physique de l'Université du Québec à Trois-Rivières, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada; Groupe de recherche sur les affections neuro-musculo-squelettiques, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada.
| | - Louis Laurencelle
- Département des sciences de l'activité physique de l'Université du Québec à Trois-Rivières, 3351, boul. des Forges, Trois-Rivières, Québec G9A 5H7, Canada
| | - Nicola Hagemeister
- Laboratoire en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, 900, rue Saint-Denis, Pavillon R, Montréal, Québec H2X 0A9, Canada; École de technologie supérieure, Département de génie de la production automatisée, 1100, rue Notre-Dame Ouest, Montréal, Québec H3C 1K3, Canada
| | - Jacques A de Guise
- Laboratoire en imagerie et orthopédie, Centre de recherche du Centre hospitalier de l'Université de Montréal, 900, rue Saint-Denis, Pavillon R, Montréal, Québec H2X 0A9, Canada; École de technologie supérieure, Département de génie de la production automatisée, 1100, rue Notre-Dame Ouest, Montréal, Québec H3C 1K3, Canada
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Komnik I, David S, Funken J, Haberer C, Potthast W, Weiss S. Compromised knee internal rotation in total knee arthroplasty patients during stair climbing. PLoS One 2018; 13:e0205492. [PMID: 30304032 PMCID: PMC6179266 DOI: 10.1371/journal.pone.0205492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022] Open
Abstract
Due to the significant role of rotational properties for normal knee function, this study aimed to investigate transverse plane kinematics and kinetics in total knee arthroplasty and unicondylar knee arthroplasty patients during activities of daily living compared to a healthy control group, including stair ascent and descent. The study participants consisted of a total knee arthroplasty group including posterior cruciate retaining and posterior stabilized designs as well as a unicondylar knee arthroplasty group and a healthy control group. Three-dimensional kinematics and kinetics were captured using a Vicon system and two Kistler force plates embedded in the floor and another two in a staircase. Inverse dynamics of the lower limbs was computed in Anybody™ Modeling System. Transverse plane joint angles and joint moments were analyzed utilizing the statistical non-parametric mapping approach, considering the entire curve shape for statistical analysis. The patients with total knee arthroplasty exhibited significantly reduced knee internal rotation of the operated knee compared to the control group and the patients’ unimpaired limb, especially during the stair climbing tasks. Both unicondylar and total knee arthroplasty patients were found to have similar reduced internal rotation motion time series in stair descent. In conclusion, potential kinematic and kinetic benefits of unicondylar knee arthroplasty over total knee arthroplasty could not be proven in the current study. Aside from the usually mentioned reasons inducing constrained knee internal rotation in total knee arthroplasty patients, future studies should investigate to what extent co-contraction may contribute to this functional impairment in patients after knee arthroplasty surgery.
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Affiliation(s)
- Igor Komnik
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
- * E-mail:
| | - Sina David
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Johannes Funken
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | | | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stefan Weiss
- ARCUS Clinics Pforzheim, Pforzheim, Baden-Württemberg, Germany
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Straaten RVD, Timmermans A, Bruijnes AKBD, Vanwanseele B, Jonkers I, Baets LD. Reliability of 3D Lower Extremity Movement Analysis by Means of Inertial Sensor Technology during Transitional Tasks. SENSORS 2018; 18:s18082638. [PMID: 30103512 PMCID: PMC6111309 DOI: 10.3390/s18082638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 11/20/2022]
Abstract
This study assesses the reliability and agreement of trunk and lower limb joints’ 3D kinematics, measured by inertial measurement units, during walking and more demanding movement tasks. For data analysis, tasks were divided in open and closed chain phases. Twenty healthy participants were included. On day one, measurements were conducted by “Operator 1” and “Operator 2” to determine between-operator reliability/agreement. On day two, the measurements were conducted by Operator 1, in order to determine within-session reliability/agreement. Furthermore, between-session reliability/agreement was assessed based on data from Operator 1, captured on day one and two. Within-session reliability/agreement was high, and better than between-session and between-operator results for all tasks. The results for walking were generally better than for other movement tasks, for all joint kinematics, and for both open and closed chain phases. Only for the ab/adduction and flexion/extension angles during forward and sideward lunge, reliability and agreement results were comparable to walking, for both the open and closed chain phases. The fact that lunges show similar reliability results than walking for open and closed chain phases, but require more motor control to perform, indicates that the performance of lunges might be interesting to use in further research aiming to identify kinematic differences between populations.
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Affiliation(s)
- Rob van der Straaten
- REVAL Rehabilitation Research Center, Hasselt University, Agoralaan building A, 3560 Diepenbeek, Belgium.
| | - Annick Timmermans
- REVAL Rehabilitation Research Center, Hasselt University, Agoralaan building A, 3560 Diepenbeek, Belgium.
| | - Amber K B D Bruijnes
- Department of Orthopaedics, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
| | - Benedicte Vanwanseele
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Ilse Jonkers
- Department of Movement Sciences, Human Movement Biomechanics, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium.
| | - Liesbet De Baets
- REVAL Rehabilitation Research Center, Hasselt University, Agoralaan building A, 3560 Diepenbeek, Belgium.
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Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1629-1635. [PMID: 29204861 DOI: 10.1007/s00167-017-4788-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/27/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Knee adduction moment (KAM) has been recognized as a good clinical surrogate for medial tibiofemoral joint loading and is associated with implant durability after total knee arthroplasty (TKA). This study aimed to examine the effects of joint line obliquity in kinematically aligned TKA (KA-TKA) on KAM during gait. METHODS The study enrolled 21 knees from 18 patients who underwent cylindrical axis reference KA-TKA and a matched group of 21 knees from 18 patients who underwent mechanically aligned (MA)-TKA as controls. Gait analyses were performed the day before TKA and at an overall mean of 2.6 years postoperatively. First peak KAM and variables associated with frontal knee kinetics were determined and compared between groups. RESULTS In KA-TKA, the proximal tibia was resected with 3.4° ± 1.5° of varus in relation to the mechanical axis, and the final femorotibial shaft axis was 176.7° ± 3.8° with KA-TKA and 174.4° ± 3.0° with MA-TKA. KAM was significantly smaller with KA-TKA than with MA-TKA (p < 0.032). Regarding variables affecting KAM, significant differences were evident between the two TKAs for knee adduction angle (p = 0.0021), lever arm (p = 0.028), and Δlever arm (p = 0.0001). CONCLUSIONS In KA-TKA, joint line obliquity reduced peak KAM during gait, despite slight varus limb alignment, and this reduced KAM in KA-TKA can tolerate constitutional varus alignment. In clinical settings, KA-TKA thus represents a promising technical option for patients with large coronal bowing of the shaft carrying a risk of increased KAM after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yasuo Niki
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Takeo Nagura
- Department of Clinical Biomechanics, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Katsuya Nagai
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan
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Youn IH, Youn JH, Zeni JA, Knarr BA. Biomechanical Gait Variable Estimation Using Wearable Sensors after Unilateral Total Knee Arthroplasty. SENSORS 2018; 18:s18051577. [PMID: 29762541 PMCID: PMC5982146 DOI: 10.3390/s18051577] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 11/16/2022]
Abstract
Total knee arthroplasty is a common surgical treatment for end-stage osteoarthritis of the knee. The majority of existing studies that have explored the relationship between recovery and gait biomechanics have been conducted in laboratory settings. However, seamless gait parameter monitoring in real-world conditions may provide a better understanding of recovery post-surgery. The purpose of this study was to estimate kinematic and kinetic gait variables using two ankle-worn wearable sensors in individuals after unilateral total knee arthroplasty. Eighteen subjects at least six months post-unilateral total knee arthroplasty participated in this study. Four biomechanical gait variables were measured using an instrumented split-belt treadmill and motion capture systems. Concurrently, eleven inertial gait variables were extracted from two ankle-worn accelerometers. Subsets of the inertial gait variables for each biomechanical gait variable estimation were statistically selected. Then, hierarchical regressions were created to determine the directional contributions of the inertial gait variables for biomechanical gait variable estimations. Selected inertial gait variables significantly predicted trial-averaged biomechanical gait variables. Moreover, strong directionally-aligned relationships were observed. Wearable-based gait monitoring of multiple and sequential kinetic gait variables in daily life could provide a more accurate understanding of the relationships between movement patterns and recovery from total knee arthroplasty.
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Affiliation(s)
- Ik-Hyun Youn
- Division of Navigation & Information Systems, Mokpo National Maritime University, Mokpo 58628, Korea.
| | - Jong-Hoon Youn
- Department of Computer Science, University of Nebraska Omaha, Omaha, NE 68182, USA.
| | - Joseph A Zeni
- Department of Physical Therapy, University of Delaware, Newark, DE 19716, USA.
| | - Brian A Knarr
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE 68182, USA.
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Miller S, Agarwal A, Haddon WB, Johnston L, Arnold G, Wang W, Abboud RJ. Comparison of gait kinetics in total and unicondylar knee replacement surgery. Ann R Coll Surg Engl 2018; 100:267-274. [PMID: 29484928 PMCID: PMC5958845 DOI: 10.1308/rcsann.2017.0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to compare kinetical data from gait analysis of patients who have undergone total and uni-condylar knee replacement. Materials and methods Thirteen patients with unilateral total knee arthroplasty (TKA) and 13 unicondylar knee arthroplasty (UKA), were included, all performed by the same surgeon more than one year prior. The Vicon gait analysis system was used. Statistical power was calculated using SPSS. Results No significant difference was found in the spatiotemporal parameters of gait and survival years of the knee prosthesis between the two groups. The UKA group was found to have significantly larger moments than the TKA group in knee adduction on the operated side and knee flexion moment on the unoperated side during the loading phase. The maximum and minimum sagittal plane moments of the operated sides in the TKA group were significantly lower than the unoperated side. The difference was most significant at pre-swing. The maximum and minimum moments on the operated sides in the UKA group were significantly lower for the knee flexion and adduction moments when compared with the unoperated side and were most prevalent during the loading phase. Conclusions These results are relevant in terms of prosthesis wear. The TKA knees had smaller magnitude moments than the UKA knees in the sagittal and coronal planes. This could explain the higher revision rates for UKA. In both groups, the non-operated knees had significantly larger moments than the operated knees, which implies that after unilateral knee replacement of either type, the non-operated knee is being put under greater stress.
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Affiliation(s)
- S Miller
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - A Agarwal
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - WB Haddon
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - L Johnston
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - G Arnold
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - W Wang
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
| | - RJ Abboud
- Department of Orthopaedics, TORT Centre, Ninewells Hospital, University of Dundee, Dundee, UK
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Christensen JC, LaStayo PC, Mizner RL, Marcus RL, Pelt CE, Stoddard GJ, Foreman KB. Joint mechanical asymmetries during low- and high-demand mobility tasks: Comparison between total knee arthroplasty and healthy-matched peers. Gait Posture 2018; 60:104-110. [PMID: 29175639 DOI: 10.1016/j.gaitpost.2017.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/23/2017] [Accepted: 11/19/2017] [Indexed: 02/02/2023]
Abstract
Chronic inter-limb joint mechanical asymmetry has been reported following total knee arthroplasty (TKA) during low-demand mobility tasks such as level walking. However, no study has compared the inter-limb asymmetry during a high-demand mobility task such as decline walking. The objective of this cross-sectional study was to compare inter-limb asymmetry differences during both level and decline walking tasks at six months following TKA compared to asymmetry present in an age, gender, body mass index and activity level matched healthy cohort. Kinetic and kinematic gait analysis was conducted on 42 patients with TKA and 15 healthy-matched peers. Our inter-limb asymmetry results demonstrated significantly (p<0.05) greater combined limb support moment (MS) (mean differences [MD]=0.17; 95% CI=0.07, 0.22), knee extensor moment (MK) (MD=0.05; 95% CI=0.02, 0.09) and vertical ground reaction force (vGRF) (MD=0.03; 95% CI=0.01, 0.08) differences during decline walking compared to level walking in patients with TKA. Greater MS (MD=0.24; 95% CI=0.13, 0.35), MK (MD=0.08; 95% CI=0.03, 0.18), vGRF (MD=0.04; 95% CI=0.01, 0.08) and knee joint angle (MD=2.4; 95% CI=0.37, 3.80) differences were present in patients with TKA compared to healthy-matched peers during decline walking. Greater MS (MD=0.13; 95% CI=0.05, 0.20) and plantarflexor moment (MD=0.06; 95% CI=0.04, 0.16) differences were present in patients with TKA compared to healthy-matched peers during level walking. Post-TKA inter-limb asymmetry during level walking worsens as the physical demands of the task are increased. Thus, even patients with good self-reported outcomes after TKA exhibit substantial deficits in their mobility reserves that could limit their independence and community mobility as they age.
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Affiliation(s)
- Jesse C Christensen
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States; University of Colorado, Department of Physical Medicine and Rehabilitation, Aurora, CO, United States.
| | - Paul C LaStayo
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States; University of Utah, Department of Physical Therapy & Athletic Training, Salt Lake City, UT, United States
| | - Ryan L Mizner
- University of Montana, School of Physical Therapy & Rehabilitation Science, Missoula, MT, United States
| | - Robin L Marcus
- University of Utah, Department of Physical Therapy & Athletic Training, Salt Lake City, UT, United States
| | - Christopher E Pelt
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States
| | - Gregory J Stoddard
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States
| | - K Bo Foreman
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States; University of Utah, Department of Physical Therapy & Athletic Training, Salt Lake City, UT, United States
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Benjamin B, Pietrzak JRT, Tahmassebi J, Haddad FS. A functional comparison of medial pivot and condylar knee designs based on patient outcomes and parameters of gait. Bone Joint J 2018; 100-B:76-82. [PMID: 29292344 PMCID: PMC6424433 DOI: 10.1302/0301-620x.100b1.bjj-2017-0605.r1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 07/07/2017] [Indexed: 02/05/2023]
Abstract
Aims The outcome of total knee arthroplasty (TKA) is not always satisfactory.
The purpose of this study was to identify satisfaction and biomechanical
features characterising the gait of patients who had undergone TKA
with either an anatomical single radius design or a medial pivot
design. We hypothesised that the latter would provide superior function. Patients and Methods This is a study of a subset of patients recruited into a prospective
randomised study of a single radius design versus a
medial pivot design, with a minimum follow-up of one year. Outcome
measurements included clinical scores (Knee Society Score (KSS)
and Oxford Knee Score (OKS)) and gait analysis using an instrumented
treadmill. Results There was no statistically significant difference between the
two groups for both the KSS and OKS. There was also no statistical
significance in cadence, walking speed, stride length and stance
time, peak stride, mid support and push-off forces. Conclusion This study corroborates a previous study by the same authors
that showed equally good results in clinical outcome and gait between
the conventional single radius and medial pivot designs under stringent
testing conditions. Cite this article: Bone Joint J 2018;(1 Supple
A)100-B:76–82.
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Affiliation(s)
- B Benjamin
- University College London Hospitals, 235 Euston Road, NW1 2BU, London, UK
| | - J R T Pietrzak
- University College London Hospitals, 235 Euston Road, NW1 2BU, London, UK
| | - J Tahmassebi
- University College London Hospitals, 235 Euston Road, NW1 2BU, London, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK and NIHR University College London Hospitals Biomedical Research Centre, UK
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van der Straaten R, De Baets L, Jonkers I, Timmermans A. Mobile assessment of the lower limb kinematics in healthy persons and in persons with degenerative knee disorders: A systematic review. Gait Posture 2018; 59:229-241. [PMID: 29096266 DOI: 10.1016/j.gaitpost.2017.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 02/02/2023]
Abstract
Inertial sensor systems are increasingly used in the assessment of persons with knee osteoarthritis (KOA) and total knee replacement (TKR). This systematic review aims to (1) investigate the application of inertial sensor systems and kinematics derived from these systems, and (2) assess if current assessment protocols consist of tasks which are, according to the International Classification of Functioning, Disability and Health (ICF) for KOA, relevant for persons with KOA and TKR. A search was conducted in six electronic databases (ACM, CINAHL, EMBASE, IEEE, PubMed, Web of Science) to include papers assessing the knee and one or more adjacent joints by means of inertial sensors in healthy persons or persons with KOA or TKR. Two reviewers checked the methodological quality. Twenty-three papers were included: 18 in healthy persons and five in persons with KOA or TKR. In healthy persons, 11 tasks were related to metrics of the ICF-function and ICF-activity level. In persons with KOA, only walking was assessed. Apart from walking, four additional tasks were related to the ICF-function and ICF-activity level in persons with TKR. In healthy persons, joints located proximally and distally to the knee were assessed, while in persons with KOA and TKR, only the knee and ankle were assessed. This is a shortcoming since hip and trunk motion potentially contain clinically relevant information, in terms of identifying (mal)adaptive compensatory movement strategies. Additionally, physically more demanding tasks should be evaluated as these might be superior in detecting compensatory movement strategies. Former considerations warrant attention in future research.
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Affiliation(s)
- R van der Straaten
- REVAL Rehabilitation Research Center, Hasselt University,Agoralaan building A, 3560 Diepenbeek, Belgium.
| | - L De Baets
- REVAL Rehabilitation Research Center, Hasselt University,Agoralaan building A, 3560 Diepenbeek, Belgium.
| | - I Jonkers
- Department of Kinesiology, Human Movement Biomechanics, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium.
| | - A Timmermans
- REVAL Rehabilitation Research Center, Hasselt University,Agoralaan building A, 3560 Diepenbeek, Belgium.
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Christensen JC, LaStayo PC, Marcus RL, Stoddard GJ, Bo Foreman K, Mizner RL, Peters CL, Pelt CE. Visual knee-kinetic biofeedback technique normalizes gait abnormalities during high-demand mobility after total knee arthroplasty. Knee 2018; 25:73-82. [PMID: 29305025 DOI: 10.1016/j.knee.2017.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/14/2017] [Accepted: 11/24/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abnormal knee mechanics frequently follow total knee arthroplasty (TKA) surgery with these deficits amplifying as task demands increase. Knee-kinetic biofeedback could provide a means of attenuating gait abnormalities. The purposes of this study were as follows: (1) to describe the gait characteristic differences between patients with TKA and non-TKA adults during level (low-demand) and decline (high-demand) walking; and (2) where differences existed, to determine the impact of knee-kinetic biofeedback on normalizing these abnormalities. METHODS Twenty participants six months following a primary TKA and 15 non-TKA peers underwent gait analysis testing during level and decline walking. Knee-kinetic biofeedback was implemented to patients with TKA to correct abnormal gait characteristics if observed. RESULTS Patients with TKA had lower knee extensor angular impulse (p<0.001), vGRF (p=0.001) and knee flexion motion (p=0.005) compared to the non-TKA group during decline walking without biofeedback. Patients with TKA normalized their knee extensor angular impulse (p=0.991) and peak vGRF (p=0.299) during decline walking when exposed to biofeedback. No between-group differences were observed during level walking. Groups were similar in age, gender, body mass index, physical activity level, pain interference and depression scores (p>0.05). CONCLUSION Patients with TKA demonstrate abnormal gait characteristics during a high-demand walking task when compared to non-TKA peers. Our findings indicate that knee-kinetic biofeedback can induce immediate improvements in gait characteristics during a high-demand walking task. There may be a potential role for the use of visual knee-kinetic biofeedback techniques to improve gait abnormalities during high-demand tasks following TKA.
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Affiliation(s)
- Jesse C Christensen
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States; University of Colorado, Department of Physical Medicine and Rehabilitation, Aurora, CO, United States.
| | - Paul C LaStayo
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States; University of Utah, Department of Physical Therapy & Athletic Training, Salt Lake City, UT, United States.
| | - Robin L Marcus
- University of Utah, Department of Physical Therapy & Athletic Training, Salt Lake City, UT, United States.
| | - Gregory J Stoddard
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States.
| | - K Bo Foreman
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States; University of Utah, Department of Physical Therapy & Athletic Training, Salt Lake City, UT, United States.
| | - Ryan L Mizner
- University of Montana, School of Physical Therapy & Rehabilitation Science, Missoula, MT, United States.
| | - Christopher L Peters
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States.
| | - Christopher E Pelt
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, United States.
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Caldas R, Mundt M, Potthast W, Buarque de Lima Neto F, Markert B. A systematic review of gait analysis methods based on inertial sensors and adaptive algorithms. Gait Posture 2017; 57:204-210. [PMID: 28666178 DOI: 10.1016/j.gaitpost.2017.06.019] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 02/02/2023]
Abstract
The conventional methods to assess human gait are either expensive or complex to be applied regularly in clinical practice. To reduce the cost and simplify the evaluation, inertial sensors and adaptive algorithms have been utilized, respectively. This paper aims to summarize studies that applied adaptive also called artificial intelligence (AI) algorithms to gait analysis based on inertial sensor data, verifying if they can support the clinical evaluation. Articles were identified through searches of the main databases, which were encompassed from 1968 to October 2016. We have identified 22 studies that met the inclusion criteria. The included papers were analyzed due to their data acquisition and processing methods with specific questionnaires. Concerning the data acquisition, the mean score is 6.1±1.62, what implies that 13 of 22 papers failed to report relevant outcomes. The quality assessment of AI algorithms presents an above-average rating (8.2±1.84). Therefore, AI algorithms seem to be able to support gait analysis based on inertial sensor data. Further research, however, is necessary to enhance and standardize the application in patients, since most of the studies used distinct methods to evaluate healthy subjects.
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Affiliation(s)
- Rafael Caldas
- Institute of General Mechanics, RWTH Aachen University, Germany.
| | - Marion Mundt
- Institute of General Mechanics, RWTH Aachen University, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Germany
| | | | - Bernd Markert
- Institute of General Mechanics, RWTH Aachen University, Germany
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Nagura T, Niki Y, Harato K, Mochizuki T, Kiriyama Y. Analysis of the factors that correlate with increased knee adduction moment during gait in the early postoperative period following total knee arthroplasty. Knee 2017; 24:250-257. [PMID: 28173989 DOI: 10.1016/j.knee.2016.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 11/15/2016] [Accepted: 11/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Analysis of dynamic knee loading during gait is essential to prevent mechanical failures following total knee arthroplasty. External knee adduction moment during gait is the primary factor producing medial joint reaction force, and an increase in the moment is directly related to an increase in the medial compartment load on the knee. METHODS Knee adduction moment during gait in 39 knees of 32 female patients following a posterior stabilized knee replacement with a single surgeon was evaluated at 1.3months following surgery. A cut-off moment was determined as mean+1 standard deviation (SD) of the moment from 10 healthy subjects, and patients' knees were divided into high- and normal-moment groups. Significant differences in clinical assessments and gait parameters between the two groups were assessed. RESULTS Based on the cut-off moment, 23 knees were grouped into normal knees and 16 knees were grouped into high-moment knees. High-moment knees showed identical femorotibial angles and knee society scores but had greater toe-out angles and medially directed ground reaction forces compared to normal-moment knees. High-moment knees showed strong correlations between peak moment and knee adduction angle, and frontal plain moment arm. CONCLUSIONS The clinical significance of a high knee adduction moment following total knee arthroplasty remains unclear, but dynamic frontal alignment during gait is one of the key factors for residual high-moment knees following surgery.
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Affiliation(s)
- Takeo Nagura
- Department of Clinical Biomechanics, Keio University, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan.
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | | | - Yoshimori Kiriyama
- Department of Mechanical Systems Engineering, Kogakuin University, Tokyo, Japan
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41
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Naili JE, Iversen MD, Esbjörnsson AC, Hedström M, Schwartz MH, Häger CK, Broström EW. Deficits in functional performance and gait one year after total knee arthroplasty despite improved self-reported function. Knee Surg Sports Traumatol Arthrosc 2017; 25:3378-3386. [PMID: 27436196 PMCID: PMC5644684 DOI: 10.1007/s00167-016-4234-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The current literature lacks sufficient information about improvements in gait patterns and function after total knee arthroplasty (TKA) and whether patients return to full function. This study evaluated change in gait, performance-based function, and self-reported function 1 year after TKA in patients with symptomatic knee osteoarthritis and how these aspects interrelate. METHODS A total of 28 patients (64 % female) with knee osteoarthritis, with a mean age of 66 (±7) years, and 25 age- and gender-matched controls participated in this prospective cohort study. Three-dimensional gait analysis generated comprehensive measures of kinematic and kinetic gait deviations, respectively. Participants completed the Five Times Sit-to-Stand (5STS) test, and the self-reported questionnaire Knee Injury and Osteoarthritis Outcome Score (KOOS), at baseline prior to surgery and 1 year after TKA. RESULTS Kinetic gait deviations of both the operated and non-operated limb persisted in patients with knee osteoarthritis at 1 year after surgery, while kinematic gait patterns were comparable to controls. Performance on the 5STS and KOOS scores in patients with knee osteoarthritis improved significantly 1 year after surgery (effect size 0.5-1.5), but did not reach the level of controls. Ten patients with knee osteoarthritis (36 %) exceeded the minimally detectable change on the 5STS. CONCLUSION Measures of overall gait patterns and the 5STS revealed improvements in function 1 year after TKA, but were not restored to the level of healthy controls. Based on change in 5STS performance, we identified patients with substantial improvements in gait patterns. Self-reported measures of function could not detect differences between patients improving in 5STS performance and those who did not. These findings highlight the use of the 5STS in clinical practice since improvement on this test seems to follow the reduction in gait pattern deviations. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Josefine E. Naili
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Maura D. Iversen
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden ,Department of Physical Therapy, Movement & Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, Boston, MA USA ,Division of Rheumatology, Immunology, and Allergy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Anna-Clara Esbjörnsson
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Hedström
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden ,Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Michael H. Schwartz
- Gillette Children’s Specialty Healthcare, St Paul, MN USA ,Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN USA ,Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN USA
| | - Charlotte K. Häger
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Eva W. Broström
- Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Komnik I, Peters M, Funken J, David S, Weiss S, Potthast W. Non-Sagittal Knee Joint Kinematics and Kinetics during Gait on Level and Sloped Grounds with Unicompartmental and Total Knee Arthroplasty Patients. PLoS One 2016; 11:e0168566. [PMID: 28002437 PMCID: PMC5176302 DOI: 10.1371/journal.pone.0168566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 12/04/2016] [Indexed: 11/19/2022] Open
Abstract
After knee arthroplasty (KA) surgery, patients experience abnormal kinematics and kinetics during numerous activities of daily living. Biomechanical investigations have focused primarily on level walking, whereas walking on sloped surfaces, which is stated to affect knee kinematics and kinetics considerably, has been neglected to this day. This study aimed to analyze over-ground walking on level and sloped surfaces with a special focus on transverse and frontal plane knee kinematics and kinetics in patients with KA. A three-dimensional (3D) motion analysis was performed by means of optoelectronic stereophogrammetry 1.8 ± 0.4 years following total knee arthroplasty (TKA) and unicompartmental arthroplasty surgery (UKA). AnyBody™ Modeling System was used to conduct inverse dynamics. The TKA group negotiated the decline walking task with reduced peak knee internal rotation angles compared with a healthy control group (CG). First-peak knee adduction moments were diminished by 27% (TKA group) and 22% (UKA group) compared with the CG during decline walking. No significant differences were detected between the TKA and UKA groups, regardless of the locomotion task. Decline walking exposed apparently more abnormal knee frontal and transverse plane adjustments in KA patients than level walking compared with the CG. Hence, walking on sloped surfaces should be included in further motion analysis studies investigating KA patients in order to detect potential deficits that might be not obvious during level walking.
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Affiliation(s)
- Igor Komnik
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Markus Peters
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Johannes Funken
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Sina David
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Stefan Weiss
- ARCUS Clinics Pforzheim, Pforzheim, Baden-Württemberg, Germany
| | - Wolfgang Potthast
- Institute for Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Nordrhein-Westfalen, Germany
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Alnahdi AH, Zeni JA, Snyder-Mackler L. Quadriceps strength asymmetry predicts loading asymmetry during sit-to-stand task in patients with unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2016; 24:2587-94. [PMID: 26450826 DOI: 10.1007/s00167-015-3827-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 09/29/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to examine interlimb differences in muscle strength and sit-to-stand (STS) kinetics in persons who underwent unilateral total knee arthroplasty (TKA) and to determine whether knee pain, quadriceps or hip abductor weakness contributes to altered STS performance. It was hypothesized that the operated limb would have weaker muscles, lower mechanical loading and that operated knee pain and muscle strength symmetry would predict loading symmetry between limbs during STS. METHODS One hundred and forty-two patients, 6 or 12 months post-unilateral TKA, underwent 3D motion analysis (VICON) of the STS task and isometric strength testing of the quadriceps and hip abductors. Knee pain was also quantified using a question from the Knee Outcome Survey-Activities of Daily Living Scale. RESULTS The operated limb had weaker quadriceps (P < 0.001), lower hip (P = 0.004) and knee extension moments (P < 0.001), and lower vertical ground reaction forces (P < 0.001). Operated knee pain and quadriceps strength symmetry were related to symmetry in knee extension moment (P < 0.04), and vertical ground reaction forces (P < 0.02) 6 months after surgery, while quadriceps strength symmetry was related to symmetry in vertical ground reaction forces (P = 0.03), 1 year after surgery. CONCLUSION Patients with unilateral TKA unload the operated limb and shift the mechanical load to the joints of the contralateral limb even 1 year after surgery. Knee pain and quadriceps strength asymmetry may play a role in the asymmetrical loading during STS post-TKA. Clinicians should consider addressing these modifiable impairments to resolve the loading asymmetry. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ali H Alnahdi
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia.
| | - Joseph A Zeni
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Knee Extensor Strength and Gait Characteristics After Minimally Invasive Unicondylar Knee Arthroplasty vs Minimally Invasive Total Knee Arthroplasty: A Nonrandomized Controlled Trial. J Arthroplasty 2016; 31:1711-6. [PMID: 26979765 DOI: 10.1016/j.arth.2016.01.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/04/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In light of the existing lack of evidence, it was the aim of this study to compare gait characteristics and knee extensor strength after medial unicondylar knee arthroplasty (MUKA) with those after total knee arthroplasty (TKA), given the same standardized minimally invasive surgery (MIS) approach in both groups. METHODS Patients scheduled for MIS-MUKA or MIS-TKA as part of clinical routine were invited to participate. A posterior cruciate ligament-retaining total knee design was used for all MIS-TKA. A 3-dimensional gait analysis was performed preoperatively with a VICON system and at 8 weeks postoperative to determine temporospatial parameters, ground reaction forces, joint angles, and joint moments. At the same 2 times, isokinetic tests were performed to obtain peak values of knee extensor torque. A multivariate analysis of variance was conducted and included the main effects time (before and after surgery) and surgical group and the group-by-time interaction effect. RESULTS Fifteen MIS-MUKA patients and 17 MIS-TKA patients were eligible for the final analysis. The groups showed no differences regarding age, body mass index, sex, side treated, or stage of osteoarthritis. We determined neither intergroup differences nor time × group interactions for peak knee extensor torque or any gait parameters (temporospatial, ground reaction forces, joint angles, and joint moments). CONCLUSION It is concluded that MUKA is not superior to TKA with regard to knee extensor strength or 3-dimensional gait characteristics at 8 weeks after operation. As gait characteristics and knee extensor strength are only 2 of the various potential outcome parameters (knee scores, activity scores…) and quadriceps strength might take a longer time to recover, our findings should be interpreted with caution.
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Sanford BA, Williams JL, Huffman KD, Zucker-Levin AR, Mihalko WM. Tibiofemoral Rotation During Sit-to-Stand Activity After TKA. Orthopedics 2016; 39:S41-4. [PMID: 27219726 DOI: 10.3928/01477447-20160509-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 02/03/2023]
Abstract
The objective of this study was to describe how tibiofemoral internal/external rotation varies in patients after total knee arthroplasty (TKA) when compared with control participants during a sit-to-stand (STS) maneuver. Motion analysis was used to measure internal/external knee rotation during STS in the control and TKA groups. Fourteen participants were included in the study. Six patients with 7 TKA knees (6 posterior stabilized and 1 cruciate-retaining TKA) were compared with 8 control participants with 8 knees from the current authors' laboratory database. Participants performed 3 STS maneuvers, and the average internal/external rotation of the femur with respect to the tibia was compared. All control participants and 2 TKA participants had internal rotation of the femur with respect to the tibia, whereas 4 TKA participants had external rotation, and 1 had no rotation during STS. Further investigation into the surgical and patient- and implant-related factors that affect this resulting reverse kinematic profile seems to be warranted. [Orthopedics. 2016; 39(3):S41-S44.].
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