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Restoring walking after total knee arthroplasty: symmetries of 3D body centre of mass trajectory and mechanical work:Ripristino del cammino dopo artroplastica totale di ginocchio: traiettoria tridimensionale del centro di massa, simmetrie e lavoro meccanico


Reference:

Seminati, E., Pulici, L., Cazzola, D., Cabitza, P., Randelli, P. and Minetti, A. E., 2016. Restoring walking after total knee arthroplasty: symmetries of 3D body centre of mass trajectory and mechanical work:Ripristino del cammino dopo artroplastica totale di ginocchio: traiettoria tridimensionale del centro di massa, simmetrie e lavoro meccanico. Gait & Posture, 49 (1), S20-S21.

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http://dx.doi.org/10.1016/j.gaitpost.2016.07.052

Abstract

INTRODUCTION Osteoarthritis (OA) is a degenerative joint disease constantly increasing in elderly population and the knee is one of the most affected joints. It contributed together with other musculoskeletal disorders to the 2nd greatest cause of disability in the WHO Global Burden of Disease [1] and patients no more responding to conservative treatments undergo total knee-arthroplasty (TKA) to remove pain and permit an asymptomatic walking. Radiological reports and questionnaires are the current diagnostic tools employed both for the diagnosis and monitoring of OA progression. However, substantial discordance exists between current diagnostic outcomes using those tools and OA symptoms [2]. Further investigation need to identify more reliable biomarkers for early detection of the disease, correct timing for TKA and post-surgery monitoring. Therefore in this study we aim to describe quantitatively the gait of OA patients undergoing to the TKA, with a specific focus on the 3D body centre of mass (BcOM) trajectory (Locomotion 3D Lissajous Countours [3]). METHODS 7 patients with unilateral knee OA (68.9 ± 4.8 years, 69.1 ± 9.1 kg, 1.60 ± 0.07 m) were tested for 4 times: before surgery (PRE), after 2 months (POST2), after 6 months (POST6) and after 12 months (POST12) from TKA. Each time patients were asked to i) complete a WOMAC questionnaire, ii) walk on a 5-force plates (Bertec, Columbus, OH, U.S.A) corridor to estimate spontaneous velocity (vs), and iii) walk for 1 min on a treadmill at 3 selected velocities (vs, v1 and v2). Two velocities, lower than vs, were calculated starting from the Froude Number (Fr): v1 = -30% Fr and v2 = -15% Fr, respectively). A 18 marker model was used to calculate (VICON, Oxford UK) the 3D BCoM trajectory, its symmetries, stride frequency (SF), double contact (DC) time, right and left duty factor, mechanical external and internal work (Wext and Wint respectively), total work (Wtot) and energy recovery (RE). RESULTS WOMAC indices improved significantly already after 6 months and vs significantly increased from 0.89 ± 0.14 (PRE) to 1.13 ± 0.07 m/s (POST12). The figure shows the average BCoM profiles during walking (pointed arrows refer to vertical (z) and progression (x) axes), where upper boundary reaches a higher vertical position (3%) in the POST12 condition compared to the PRE condition and a more symmetrical shape, significantly in x and z directions. For the same walking speed SF decreased significantly already after two months from TKA, DC time decreased to 20% of the stride length and duty factor also assumed lower values after surgery. Patients after TKA improved their locomotor energy recovery mechanisms, reducing mechanical external work by 10%. WINT was constant along the months, while RE slightly increased after TKA. DISCUSSION The group of quantitatively analysed variables, suggest as patients with prosthesis tend to re-establish their natural locomotion pattern after TKA. Body centre of mass analysis during walking, including symmetry and mechanical energy evaluations, quantitatively assess osteoarthritis disease level and can be employed to monitor patients before and after pharmacological and surgical interventions. The same methodology could be applicable to neurological pathologies and to patients affected by other orthopaedic pathologies affecting other limb joints, like hip or ankle. The effects of different prosthesis or surgical techniques on a single pathology/joint could be equally investigated.

Details

Item Type Articles
CreatorsSeminati, E., Pulici, L., Cazzola, D., Cabitza, P., Randelli, P. and Minetti, A. E.
DOI10.1016/j.gaitpost.2016.07.052
DepartmentsFaculty of Humanities & Social Sciences > Health
Research CentresEPSRC Centre for Doctoral Training in Statistical Mathematics (SAMBa)
RefereedYes
StatusPublished
ID Code53083

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