Measuring physiological and pathological femoral anteversion using a biplanar low-dose X-ray system: validity, reliability, and discriminative ability in cerebral palsy.

OBJECTIVE: The aims of this study were to evaluate the concurrent validity and reliability of a low-dose biplanar X-ray system (Ld-BPR) for the measurement of femoral anteversion (FA) by comparing Ld-BPR-based three-dimensional measures with CT-scan-based measures and to assess the discriminative ability of this method in children with cerebral palsy. MATERIALS AND METHODS: Fifty dry femora were scanned using both a CT scan and the Ld-BPR system. Ten femora were artificially modified to mimic a range of anteversion from -30° to +60° and scanned by both modalities. FA was quantified using the images from both modalities and statistically compared for concurrent validity. Intra- and inter-observer reliability of the Ld-BPR system was also determined. Further, Ld-BPR data from 16 hemiplegic and 22 diplegic children were analyzed for its discriminative ability. RESULTS: The concurrent validity between the Ld-BPR and CT-scan measures was excellent (R (2) = 0.83-0.84) and no significant differences were found. The intra- and inter-trial reliability were excellent (ICCs = 0.98 and 0.97) with limits of agreement of (-2.28°; +2.65°) and (-2.76°; +3.38°) respectively. Further, no significant effects of angle or method were found in the sample of modified femora. Ld-BPR measures for FA were significantly different between healthy and impaired femora. CONCLUSIONS: The excellent concurrent validity with the CT scan modality, the excellent reliability, and the ability to discriminate pathological conditions evaluated by this study make this radiological method suitable for a validated use across hospitals and research institutes.

Estimation of a midfoot joint center in typically developed adults using functional calibration methods.

BACKGROUND: There are detailed findings on hip and knee joint parameters determined via functional calibration methods for use in instrumented 3D-gait analysis but these methods have not yet been addressed to the foot. RESEARCH QUESTION: Are functional calibration methods feasible for determining foot joint parameters and may they help for clinical interpretation of foot deformities? METHODS: Rigid segments were formed by markers on forefoot and hindfoot via a least square method. The position of the midfoot joint articulating both foot segments was then determined via a functional calibration motion. This two-stage procedure was applied on a cohort of 17 typically developed adults and one subject with severe planovalgus foot deformity for determining the location of the midfoot joint and kinematics of hindfoot and forefoot. RESULTS: The position of the midfoot joint center could be estimated in the typically developed cohort and also in the demonstration case with planovalgus foot deformity. Depending on the choice of marker set for hindfoot and forefoot, the position of the joint center varied in the anatomic midfoot region with most robust results when addressing the marker on the navicular to the hindfoot. CONCLUSION: The presented method for joint center determination within the foot and the characteristic results of the foot joint angles appear promising for typically developed feet. However, further validation of the method is needed for application in clinical context.

The influence of hip muscle strength on gait in individuals with a unilateral transfemoral amputation.

INTRODUCTION: A unilateral transfemoral amputation (TFA) has a major impact on function. A leg-length discrepancy is the primary structural change, accompanied by the loss of lower-limb muscle volume and function. Prostheses can help individuals with a TFA to regain function, but such individuals still do not reach the functional level of unimpaired peers and exhibit gait deviations. This study gives insight into the causality between residual limb strength and gait deviations in individuals with a TFA. METHODS: A convenient sample of 13 male individuals with a TFA (38.0 ± 12.6y; 179.7cm ± 6.5cm; 82.9kg ± 12.4kg) was recruited for this study. One participant with TFA was excluded, as he differed from the rest of the cohort, in residual limb length and the use of walking aids. A cohort of 18 unimpaired subjects served as a reference group (REF; nine females; 44y ± 13y; 174cm ± 9cm; 71kg ± 12kg). All participants underwent a conventional clinical gait analysis using a marker based 3D motion capture system and force platforms. Kinematics and kinetics were determined utilizing standard modelling methods. All subjects underwent a strength test, using a custom-made device to determine isometric moments of the hip joint in abduction, adduction, extension, and flexion. Peak values for maximum isometric moments for each movement direction and selected kinematic and kinetic values were derived from the results. Differences between subjects with TFA and unimpaired were compared using a Mann-Whitney U Test and associations between groups by Spearman's rank correlation. RESULTS: The participants with a TFA showed a significantly lower maximum isometric moment for hip abduction (0.85 vs. 1.41 Nm/kg p < .001), adduction (0.87 vs. 1.37 Nm/kg p = .001) and flexion (0.93 vs. 1.63 Nm/kg p = .010) compared to the reference group. Typically reported gait deviations in people with a TFA were identified, i.e. significant lower cadence and increased step width. We further identified altered coronal plane hip and trunk kinematics, with significantly higher ranges of motion during involved side stance-phase. Gait kinetics of individuals with a TFA showed significantly lower peak values during stance for hip abduction, adduction and extension moments in comparison to the reference group. We identified a moderate negative correlation between maximum isometric moment for hip abduction and trunk obliquity range of motion (ρ = -0.45) for participants with a TFA, which was not significant (p = 0.14). CONCLUSION: We showed that there are strength deficits in individuals with TFA and, that there are moderate correlations between gait deviations, i.e. lateral trunk lean during involved side stance and isometric hip abductor moment. The relation between maximum moments during gait and the corresponding maximum isometric moment may therefore be helpful to detect strength related compensation mechanisms. However, the moderate, non-significant correlation between lateral trunk lean and isometric hip abductor moment was the only one which corresponded directly to a gait deviation. Thus results must be interpreted with care. This study suggests that gait deviations in individuals with TFA are multifactorial and cannot be exclusively explained by their strength deficits. Future studies should explore the relationship between strength with kinematics and kinetics during gait in this population.

Estimation of ankle joint parameters in typically developed adults using functional calibration methods.

BACKGROUND: Despite of many attempts to determine or correct hip and knee joint parameters via non-invasive techniques such as regression or functional methods, in conventional gait models the position of the ankle joint center still is assumed at the center point between malleoli. RESEARCH QUESTION: The aim of this study was to estimate the ankle joint parameters using a functional approach. METHODS: To this aim, we used data of 23 typically developed adults performing two different calibration motions. Subsequently, we applied functional approaches to determine the functional joint center and axis. RESULTS: The results show significant differences for ankle joint parameters in all directions for both calibration motions applied with respect to the malleoli line. Most prominently, we find a shift of the ankle joint center of 7 % of the foot length anteriorly to the malleoli mid-point when applying functional calibration. CONCLUSION: These significant alterations of the ankle joint center and axis indicate the importance of accurate determination of ankle joint parameters and consequently their influence on the clinical outcome.

Effects of gleno-humeral joint centre mislocation on gleno-humeral kinematics and kinetics.

The gleno-humeral (GH) rotation centre is typically estimated using predictive or functional methods, however these methods may lead to location errors. This study aimed at determining a location error threshold above which statistically significant changes in the values of kinematic and kinetic GH parameters occur. The secondary aims were to quantify the effects of the direction of mislocation (X, Y or Z axis) of the GH rotation centre on GH kinematic and kinetic parameters. Shoulder flexion and abduction movements of 11 healthy volunteers were recorded using a standard motion capture system (Vicon, Oxford Metrics Ltd, Oxford, UK), then GH kinematic and kinetic parameters were computed. The true position of the GH rotation centre was determined using a low dose x-ray scanner (EOS™ imaging, France) and this position was transferred to the motion data. GH angles and moments were re-computed for each position of the GH rotation centre after errors of up to ± 20 mm were added in increments of ± 5 mm to each axis. The three-dimensional error range was 5 mm to 34.65 mm. GH joint angle and moment values were significantly altered from 10 mm of three-dimensional error, and from 5 mm of error on individual axes. However, errors on the longitudinal and antero-posterior axes only caused very small alterations of GH joint angle and moment values respectively. Future research should develop methods of GH rotation centre estimation that produce three-dimensional location errors of less than 10 mm to reduce error propagation on GH kinematics and kinetics.

2-D-3-D frequency registration using a low-dose radiographic system for knee motion estimation.

In this paper, a new method is presented to study the feasibility of the pose and the position estimation of bone structures using a low-dose radiographic system, the entrepreneurial operating system (designed by EOS-Imaging Company). This method is based on a 2-D-3-D registration of EOS bi-planar X-ray images with an EOS 3-D reconstruction. This technique is relevant to such an application thanks to the EOS ability to simultaneously make acquisitions of frontal and sagittal radiographs, and also to produce a 3-D surface reconstruction with its attached software. In this paper, the pose and position of a bone in radiographs is estimated through the link between 3-D and 2-D data. This relationship is established in the frequency domain using the Fourier central slice theorem. To estimate the pose and position of the bone, we define a distance between the 3-D data and the radiographs, and use an iterative optimization approach to converge toward the best estimation. In this paper, we give the mathematical details of the method. We also show the experimental protocol and the results, which validate our approach.

Effect of the calculation methods on body moment of inertia estimations in individuals of different morphology.

Body segment moments of inertia (MOI) are estimated from data obtained from cadavers or living individuals. Though these methods can be valid for the general population, they usually are limited when applied to special populations (e.g., obese). The effect of two geometric methods, photogrammetry and two new methods, namely, inverse dynamics and angular momentum on the estimations of MOI in individuals of different body mass index (BMI) were compared to gain insight into their relative accuracy. The de Leva (1996) method was chosen as a criterion to determine how these methods behaved. MOI methods were not different in individuals with a normal BMI. On the average, MOI values obtained with inverse dynamics and angular momentum were respectively 13.2% lower for lean participants and 17.9% higher for obese subjects than those obtained from the de Leva method. The average Pearson coefficients of correlation between the MOI values, estimated by the de Leva method, and the other methods was 0.76 (+/-0.31). Since the proposed methods made no assumption on the mass distribution and segments' geometry, they appeared to be more sensitive to body morphology changes to estimate whole body MOI values in lean and obese subjects.