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Background: Gait analysis is a vital tool for evaluating overall health and predicting outcomes such as mortality and cognitive decline. This study explores how normal and obese BMI categories impact gait dynamics, addressing gaps in understanding the effect of body composition on specific gait parameters. Research Question: The primary objective is to investigate differences in spatiotemporal gait parameters—specifically, gait speed, step length, cadence, and double support time—between normal and obese BMI groups to understand the effects of obesity on gait. Methods: This observational case-control study analyzed spatiotemporal gait metrics from 163 participants, using inertial measurement units (IMUs) to collect data on various gait parameters. Statistical analyses explored the relationship between BMI categories and these metrics. Results: No significant differences were found in gait speed, cadence, stride duration, or double support time between the normal and obese groups. However, significant differences were identified in age, hypertension prevalence, balance problems, and the incidence of falls, emphasizing the complex effects of obesity on factors influencing gait stability. Significance: This study contributes to our understanding of obesity's impact on gait by highlighting the need to consider associated health and stability parameters. These findings prompt a re-evaluation of how BMI is integrated into clinical gait assessments and emphasize the necessity for personalized healthcare strategies. This research highlights the importance of future studies with larger, more diverse populations and a wider array of biomechanical measures to dissect the relationship between BMI, body composition, and gait dynamics. [ABSTRACT FROM AUTHOR]

Background. Knee and hip arthroplasty are two of the most frequently performed procedures in orthopaedic surgery. They are associated with positive patient-reported outcomes and significant improvements in quality of life for patients. Despite this, there may be room for further progress by quantifying functional improvements with gait analysis. Our study therefore aims to characterise the disease-specific gait pattern of participants with knee and hip osteoarthritis undergoing total joint replacement using a single chest-based wearable sensor. Methods. Twenty-nine participants awaiting total hip replacement and 28 participants awaiting total knee replacement underwent three-dimensional motion analysis with inertial wearable sensors. These gait metrics were then compared with 28 healthy controls of similar ages. Differences in gait metrics were evaluated using a T-test. The participants were recruited through a single centre to participate in this cross-sectional observational study. Participants with osteoarthritis severity sufficient to warrant surgical intervention were considered for inclusion in our study. The participants were instructed to walk 15–120 m in a hospital environment while fitted with a chest-based wearable sensor. Results. In total, three domains were evaluated, including spatiotemporal, variability and asymmetry parameters. There were marked variations in the gait asymmetry parameters and step length variation in both the hip and knee osteoarthritis patients compared with the healthy controls. The magnitude of gait deterioration in terms of step length asymmetry was greater on average in the hip osteoarthritis group than the knee group. The hip osteoarthritis (+180%, p < 0.001) and knee osteoarthritis (+129%, p = 0.001) groups demonstrated marked differences in step length asymmetry. Discussion. A single chest-based sensor was found to be capable of detecting pathological gait signatures in osteoarthritis patients when compared with age-matched controls. Future studies should compare pre- and postoperative changes to disease-specific gait impairments to validate the use of wearable sensors as a clinical adjunct. [ABSTRACT FROM AUTHOR]

Objective: To compare differences in recruitment and attrition between placebo control randomised trials of surgery, and trials of the same surgical interventions and conditions that used non-operative (non-placebo) controls., Design: Meta-epidemiological study., Data Sources: Randomised controlled trials were identified from an electronic search of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from their inception date to 21 November 2018., Study Selection: Placebo control trials evaluating efficacy of any surgical intervention and non-operative control trials of the same surgical intervention were included in this study. 25 730 records were retrieved from our systemic search, identifying 61 placebo control and 38 non-operative control trials for inclusion in analysis., Outcome Measures: Primary outcome measures were recruitment and attrition. These were assessed in terms of recruitment rate (number of participants enrolled, as a proportion of those eligible) and overall attrition rate (composite of dropout, loss to follow-up and cross-overs, expressed as proportion of total sample size). Secondary outcome measures included participant cross-over rate, dropout and loss to follow-up., Results: Unadjusted pooled recruitment and attrition rates were similar between placebo and non-operative control trials. Study characteristics were not significantly different apart from time to primary timepoint which was shorter in studies with placebo controls (365 vs 274 days, p=0.006). After adjusting for covariates (follow-up duration and number of timepoints), the attrition rate of placebo control trials was almost twice as high compared with non-operative controlled-trials (incident rate ratio (IRR) (95% CI) 1.8 (1.1 to 3.0), p=0.032). The incorporation of one additional follow-up timepoint (regardless of follow-up duration) was associated with reduced attrition in placebo control surgical trials (IRR (95% CI) 0.64 (0.52 to 0.79), p<0.001)., Conclusions: Placebo control trials of surgery have similar recruitment issues but higher attrition compared with non-operative (non-placebo) control trials. Study design should incorporate strategies such as increased timepoints for given follow-up duration to mitigate losses to follow-up and dropout., Prospero Registration Number: CRD42019117364., Competing Interests: Competing interests: RB has received royalties from UpToDate for authoring a chapter unrelated to this paper (Plantar Fasciitis). SA has received grants and/or research contracts from National Health and Medical Research Council, Avant Foundation and ANZ Musculoskeletal Clinical Trial Network as part of Sydney Partnership for Health, Education, Research and Enterprise., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To collate the current state of knowledge and explore differences in the spatiotemporal gait patterns of degenerative lumbar spine diseases: lumbar spinal stenosis (LSS), lumbar disc herniation (LDH) and low back pain (LBP)., Background: LBP is common presenting complaint with degenerative lumbar spine disease being a common cause. In particular, the gait patterns of LSS, LDH and mechanical-type (facetogenic and discogenic) LBP is not established., Methods: A search of the literature was conducted to determine the changes in spatial and temporal gait metrics involved with each type of degenerative lumbar spine disease. A search of databases including Medline, Embase and PubMed from their date of inception to April 18th, 2021 was performed to screen, review and identify relevant studies for qualitative synthesis. Seventeen relevant studies were identified for inclusion in the present review. Of these, 5 studies investigated gait patterns in LSS, 10 studies investigated LBP and 2 studies investigated LDH. Of these, 4 studies employed wearable accelerometry in LSS (2 studies) and LBP (2 studies)., Conclusions: Previous studies suggest degenerative diseases of the lumbar spine have unique patterns of gait deterioration. LSS is characterised by asymmetry and variability. Spatiotemporal gait deterioration in gait velocity, cadence with increased double-support duration and gait variability are distinguishing features in LDH. LBP involves marginal abnormalities in temporal and spatial gait metrics. Previous studies suggest degenerative diseases of the lumbar spine have unique patterns of gait deterioration. Gait asymmetry and variability, may be relevant metrics for distinguishing between the gait profiles of lumbar spine diseases., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-21-91/coif). The series “Objective Monitoring and Wearable Technologies including Sensor-Based Accelerometers and Mobile Health Applications for the Spine Patient” was commissioned by the editorial office without any funding or sponsorship. RJM served as the unpaid Guest Editor of the series and serves as the Editor-in-Chief of Journal of Spine Surgery. RDF and PN served as the unpaid Guest Editors of the series and serve as unpaid Assistant Managing Editors of Journal of Spine Surgery. The authors have no other conflicts of interest to declare., (2022 Journal of Spine Surgery. All rights reserved.)

Cortical bone trajectory (CBT) for posterior fixation with pedicle screws is considered a relatively new alternative trajectory that travels in the medio-lateral direction in the transverse plane and in the caudo-cephalad path in the sagittal plane. Various biomechanical studies have already validated its superior pullout strength and mechanical stability over the traditional trajectory of convergent pedicle screws. Due to the relatively medial starting point of this trajectory, the CBT also poses the clinical advantage of requiring a smaller surgical field of exposure, thus minimizing tissue and muscle injury while reducing operative time and intraoperative blood loss. The evolution of CBT through time has closely been linked to the unwavering philosophy of prioritizing patient outcomes, advancements in neuronavigational technology, and the mounting biomechanical, morphometric, and clinical evidence. In this historical review, we provide a unique perspective on how CBT surgical technique has developed through time, highlighting key milestones and attempting to explain its explosive rise in popularity., Competing Interests: Conflicts of Interest: The authors declare that there are no relevant conflicts of interest., (Copyright © 2022 by The Japanese Society for Spine Surgery and Related Research.)