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Background: Instrumented treadmills are potentially useful tools for the assessment of gait parameters in orthopaedic clinical settings, but their measurement properties remain uncertain., Research Question: What is the discriminant validity and reproducibility of spatiotemporal and kinetic gait parameters measured by a pressure-instrumented treadmill at different speeds and inclinations in patients with knee osteoarthritis (KOA)?, Methods: A total of 54 patients with unilateral KOA and 23 healthy controls took part in the study. Step length, single-limb support duration and ground reaction force were recorded during level and uphill walking at 3 and 4 km/h using a commercially-available treadmill instrumented with an integrated pressure platform. We examined discriminant validity (difference between involved and uninvolved side as well as against healthy controls) and test-retest reproducibility (reliability and agreement)., Results: Significant side differences were observed for single-limb support duration and ground reaction force at touchdown in all conditions (P < 0.05). All the investigated gait parameters showed acceptable reliability and agreement, except step length at 4 km/h uphill., Significance: We conclude that the pressure-instrumented treadmill used in this study may have good clinical utility for quantitative gait analysis in patients with KOA under different experimental conditions., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Video-fluoroscopic analysis can provide important insights for the evaluation of outcome and functionality after total knee arthroplasty, allowing the in vivo assessment of tibiofemoral kinematics without soft tissue artefacts. To enable measurement of the knee throughout activities of daily living such as gait, robotic systems like the moving fluoroscope have been developed that follow the knee movement and maintain the joint in front of the image intensifier. Since it is unclear whether walking while being accompanied by moving fluoroscope affects normal gait, the objective of this study was to investigate its influence on gait characteristics in healthy subjects. In addition, the impact of the motors' noise was analysed. By means of skin markers analysis (VICON MX system, Oxford Metrics Group, UK) and simultaneous measurement of ground reaction forces (Kistler force plates, Kistler, Switzerland), gait characteristics when walking with and without the moving fluoroscope as well as with and without ear protectors in combination with the moving fluoroscope, were obtained in young (n = 10, 24.5y ± 3.0y) and elderly (n = 9, 61.6y ± 5.3y) subjects during level gait and stair descent. Walking with the moving fluoroscope significantly decreased gait velocity in level gait and stair descent over the respective movement without the fluoroscope. Statistical analysis, including gait velocity as a covariate, resulted in no differences on the ground reaction force parameters. However, some kinematic parameters (ankle, knee and hip ranges of motion, minimal knee angle in late stance phase, maximal knee angles in stance and swing phase) seemed to be modified by the presence of the moving fluoroscope, but statistical comparison was limited due to velocity differences between the conditions. Wearing ear protectors to avoid the influence of motor sound during walking with the moving fluoroscope caused no significant difference. Walking with the moving fluoroscope has been shown to decrease gait velocity and small alterations in kinematic parameters were observed. Therefore, gait and movement alterations due to the moving fluoroscope cannot completely be excluded. However, based on the absence of differences in ground reaction force parameters (when adjusted for velocity within ANCOVA), as well as based on the comparable shape of the angular curves to the slow control condition, it can be concluded that changes in gait when walking with the moving fluoroscope are small, especially in comparison to natural slow walking. In order to allow assessment of joint replacement with the moving fluoroscope, including an understanding of the effects of joint pain, clinical analyses can only be compared to gait activities showing similarly reduced velocities. Importantly, the reduced gait speeds observed in this study are similar to those observed after total knee arthroplasty, suggesting that analyses in such subjects are appropriate. However, the moving fluoroscope would likely need to be optimized in order to detect natural gait characteristics at the higher gait velocities of healthy young subjects. The moving fluoroscope can be applied for comparisons between groups measured with the moving fluoroscope, but care should be taken when comparing data to subjects walking at self-selected speed without the moving fluoroscope., Competing Interests: The authors have declared that no competing interests exist.

Background: Haglund exostosis–related heel pain may be surgically treated with dorsal closing wedge calcaneal osteotomy (DCWCO). Recent reports on this technique show good clinical and self-reported outcomes. However, uncertainty about functional consequences related to ankle muscle strength and gait function due to a shortened Achilles tendon lever arm exists. Methods: Fifteen patients (15 feet) with Haglund exostosis–related heel pain were surgically treated with DCWCO and evaluated before and 1 year after surgery. Isometric plantar flexion and dorsiflexion strength was quantified for both the involved and the uninvolved limb. Gait analysis was performed at a self-selected walking speed using a 3D motion capture system including force plates. Self-reported outcomes (Foot Function Index and Global Treatment Outcome) were also assessed. Results: Before surgery, as well as after surgery, plantar flexion strength of the involved limb was significantly lower compared to the uninvolved limb while dorsiflexion strength did not differ between limbs at both time points. Step length and time, ankle flexion angles, power generation, and propulsive impulses during gait did not differ between limbs both before and after surgery. Propulsive impulse and step length of the involved limb increased from pre- to postsurgery with an effect size of 1.04 and 0.48, respectively, revealing a general improvement in gait dynamics. Total Foot Function Index improved by 48% after surgery, and 80% of patients rated their surgery as "helped" or "helped a lot" (Global Treatment Outcome). Conclusion: In this relatively small cohort, we found that patients treated for Haglund exostosis–related heel pain with DCWCO surgery had minor interlimb differences in gait kinematics and kinetics and generally improved gait dynamics and self-reported function at 1-year follow-up. Level of Evidence: Level II, observational prospective cohort study. [ABSTRACT FROM AUTHOR]

The success of kinematic analysis that relies on inertial measurement units (IMUs) heavily depends on the performance of the underlying algorithms. Quantifying the level of uncertainty associated with the models and approximations implemented within these algorithms, without the complication of soft-tissue artefact, is therefore critical. To this end, this study aimed to assess the rotational errors associated with controlled movements. Here, data of six total knee arthroplasty patients from a previously published fluoroscopy study were used to simulate realistic kinematics of daily activities using IMUs mounted to a six-degrees-of-freedom joint simulator. A model-based method involving extended Kalman filtering to derive rotational kinematics from inertial measurements was tested and compared against the ground truth simulator values. The algorithm demonstrated excellent accuracy (root-mean-square error ≤ 0.9 °, maximum absolute error ≤ 3.2 °) in estimating three-dimensional rotational knee kinematics during level walking. Although maximum absolute errors linked to stair descent and sit-to-stand-to-sit rose to 5.2° and 10.8°, respectively, root-mean-square errors peaked at 1.9° and 7.5°. This study hereby describes an accurate framework for evaluating the suitability of the underlying kinematic models and assumptions of an IMU-based motion analysis system, facilitating the future validation of analogous tools. [ABSTRACT FROM AUTHOR]

Background: Paradoxical anterior translation in midflexion is reduced in total knee arthroplasties (TKAs) with a gradually reducing femoral radius, when compared to a 2-radii design. This reduction has been shown in finite element model simulations, in vitro tests, intraoperatively, and recently also in vivo during a lunge and unloaded flexion-extension. However, TKA kinematics are task dependent and this reduction has not been tested for gait activities.Methods: Thirty good outcome subjects (≥1 year postoperatively) with a unilateral cruciate-retaining TKA with a gradually reducing (n = 15) or dual (n = 15) femoral radius design were assessed during 5 complete cycles of level walking, stair descent (0.18-m steps), deep knee bend, and sitting down onto and standing up from a chair, using a moving fluoroscope (25 Hz, 1 ms shutter time). Kinematic data were extracted by 2D/3D image registration.Results: Tibiofemoral ranges of motion for flexion-extension, abduction-adduction, internal-external rotation, and anteroposterior (AP) translation were similar for both groups, whereas the pattern of AP translation-flexion-coupling differed. The subjects with the dual-radii design showed a sudden change in direction of AP translation around 30° of flexion, which was not present in the subjects with the gradually reducing femoral radius design.Conclusion: Through the unique ability of moving fluoroscopy, the present study confirmed that the gradually reducing femoral radii eliminated the paradoxical sudden anterior translation at 30° present in the dual-radii design in vivo during daily activities, including gait and stair descent. [ABSTRACT FROM AUTHOR]

Before conclusions can be drawn with respect to the quality of adaptations in human gait, the day-to-day consistency of the variables of interest must be known. The present study estimated the day-to-day consistency of kinematic variables collected during barefoot walking and running. Sixteen healthy subjects performed two gait analysis sessions based on skin markers. Test sessions were at least 1 week apart. In total, 48 ranges of motion were monitored for the hip, knee, ankle, and midfoot joint. Based on differences between the repeated gait analysis sessions, the day-to-day consistency was estimated. It was found that the day-to-day consistency was of the magnitude of 3 to 4 degrees for almost all ranges of motion independently of the test condition, the investigated joints, or the cardinal body plane. It was concluded that future studies on effects of interventions or on the characterization of pathological versus normative gait should consider the provided values of day-to-day consistency to improve their interpretation and conclusions. [ABSTRACT FROM AUTHOR]

Abstract: The goal of this study was to compare selected parameters of vertical ground reaction forces (GRF) of good outcome patients with different prosthesis designs with a matched control group during level walking, stair ascent and descent. Forty subjects, 29 with three main implant designs (including four subjects with a passive knee flexion restriction), and 11 healthy controls were measured with 8–10 repetitions. Vertical ground reaction forces were measured during two consecutive steps with force plates embedded in the walkway and the staircase. Defined parameters of the force signals were used to compare the results of the test groups. The results show, that, postoperatively, good outcome patients produce gait patterns of the vertical ground reaction force which are comparable to normal healthy subjects with the exception of a few distinct differences: a significant reduction (p <0.05) in the vertical loading on the operated side during level walking at take-off, at weight acceptance and take-off during stair ascent of the normal stair. During stair descent, the patients did not reduce load on the operated side, but increased load variation and side-to-side asymmetry; thus, the mechanical loads on the implants were high, which may be important information with respect to loading protocols of knee implant simulators. No systematic differences in any of the test parameters were found between posterior cruciate-retaining (LCS MB and Innex CR) versus non-retaining (LCS RP and Innex UCOR) implant designs. The restricted group showed significant reductions (p <0.05) of several loading parameters as well as an increased side-to-side asymmetry. About one third of the force parameters of the good outcome patients showed a side-to-side asymmetry between two consecutive steps, which was over a proposed level of acceptance. [Copyright &y& Elsevier]