Relationship between motion, using the GaitSmartTM system, and radiographic knee osteoarthritis: an explorative analysis in the IMI-APPROACH cohort.

OBJECTIVES: To assess underlying domains measured by GaitSmartTMparameters and whether these are additional to established OA markers including patient reported outcome measures (PROMs) and radiographic parameters, and to evaluate if GaitSmart analysis is related to the presence and severity of radiographic knee OA. METHODS: GaitSmart analysis was performed during baseline visits of participants of the APPROACH cohort (n = 297). Principal component analyses (PCA) were performed to explore structure in relationships between GaitSmart parameters alone and in addition to radiographic parameters and PROMs. Logistic and linear regression analyses were performed to analyse the relationship of GaitSmart with the presence (Kellgren and Lawrence grade ≥2 in at least one knee) and severity of radiographic OA (ROA). RESULTS: Two hundred and eighty-four successful GaitSmart analyses were performed. The PCA identified five underlying GaitSmart domains. Radiographic parameters and PROMs formed additional domains indicating that GaitSmart largely measures separate concepts. Several GaitSmart domains were related to the presence of ROA as well as the severity of joint damage in addition to demographics and PROMs with an area under the receiver operating characteristic curve of 0.724 and explained variances (adjusted R2) of 0.107, 0.132 and 0.147 for minimum joint space width, osteophyte area and mean subchondral bone density, respectively. CONCLUSIONS: GaitSmart analysis provides additional information over established OA outcomes. GaitSmart parameters are also associated with the presence of ROA and extent of radiographic severity over demographics and PROMS. These results indicate that GaitsmartTM may be an additional outcome measure for the evaluation of OA.

Validation of inertial measurement units with optical tracking system in patients operated with Total hip arthroplasty.

BACKGROUND: Patient reported outcome measurement (PROMs) will not capture in detail the functional joint motion before and after total hip arthroplasty (THA). Therefore, methods more specifically aimed to analyse joint movements may be of interest. An analysis method that addresses these issues should be readily accessible and easy to use especially if applied to large groups of patients, who you want to study both before and after a surgical intervention such as THA. Our aim was to evaluate the accuracy of inertial measurement units (IMU) by comparison with an optical tracking system (OTS) to record pelvic tilt, hip and knee flexion in patients who had undergone THA. METHODS: 49 subjects, 25 males 24 females, mean age of 73 years (range 51-80) with THA participated. All patients were measured with a portable IMU system, with sensors attached lateral to the pelvis, the thigh and the lower leg. For validation, a 12-camera motion capture system was used to determine the positions of 15 skin markers (Oqus 4, Qualisys AB, Sweden). Comparison of sagittal pelvic rotations, and hip and knee flexion-extension motions measured with the two systems was performed. The mean values of the IMU's on the left and right sides were compared with OTS data. RESULTS: The comparison between the two gait analysis methods showed no significant difference for mean pelvic tilt range (4.9-5.4 degrees) or mean knee flexion range (54.4-55.1 degrees) on either side (p > 0.7). The IMU system did however record slightly less hip flexion on both sides (36.7-37.7 degrees for the OTS compared to 34.0-34.4 degrees for the IMU, p < 0.001). CONCLUSIONS: We found that inertial measurement units can produce valid kinematic data of pelvis- and knee flexion-extension range. Slightly less hip flexion was however recorded with the inertial measurement units which may be due to the difference in the modelling of the pelvis, soft tissue artefacts, and malalignment between the two methods or misplacement of the inertial measurement units. TRIAL REGISTRATION: The study has ethical approval from the ethical committee "Regionala etikprövningsnämnden i Göteborg" (Dnr: 611-15, 2015-08-27) and all study participants have submitted written approval for participation in the study.

Analysis of knee flexion characteristics and how they alter with the onset of knee osteoarthritis: a case control study.

BACKGROUND: The purpose of this study was to examine the differences in gait profile between patients with knee osteoarthritis (OA) and healthy control and to create motion characteristics that will differentiate between them. METHODS: Twenty three patients diagnosed with knee OA and 21 healthy matched controls underwent a gait test using a sensor system (gaitWALK). Gait parameters evaluated were: stride duration, knee flexion range of motion (ROM) in swing and stance. T-Test was used to evaluate significant differences between groups (P < 0.05). RESULTS: Patients with knee OA had significant lower knee flexion ROM (10.3° ± 4.0°) during stance than matched controls (18.0° ± 4.0°) (p < 0.001). Patients with knee OA had significant lower knee flexion ROM (54.8° ± 5.5°) during swing than matched controls (61.2° ± 6.1) (p = 0.003). Patients with knee OA also had longer stride duration (1.12 s ± 0.09 s) than matched controls (1.06 s ± 0.11 s), but this was not statistically significant (p = 0.073). Motion characteristics differentiate between a patient with knee OA and a healthy one with a sensitivity of 0.952 and a specificity of 0.783. CONCLUSIONS: Significant differences were found in the gait profile of patients with knee OA compared to matched control and motion characteristics were identified. This test might help clinicians identify and evaluate a knee problem in a simple gait test.

The importance of measuring human gait.

Clinical research has identified clear links between human gait characteristics and different medical conditions. However, there have been no sensor systems available to provide a reliable and quantifiable method of monitoring these parameters in a normal environment. The different technologies that can now be applied to a variety of medical applications are discussed.

Developments in functional electrical stimulation systems.

It is estimated that more than 750,000 people suffer a stroke each year in Europe. An implantable neurostimulator is being developed to improve impaired upper limb function that results from stroke. Its mode of operation and early clinical trial results are reported.

Biocompatible materials developments for new medical implants.

Recent work on modifying silicone rubber to improve water permeability and biocompatibility is described. In addition, modifications to the interface between an active implanted device and the body are reported, which have led to reduced power consumption and improved device performance.

Working on the design of new medical implants.

This report on work currently underway on innovative implants describes the progress being made with wireless communication and the lessons learned after one year of development of an artificial sphincter and an intracranial pressure sensor.

Implantable medical devices: current status and future developments within the healthy-aims project.

This paper describes the current situation concerning medical implants and suggests why the number of available devices is so limited. It then goes on to describe how a consortium was established from an EU network focussing specifically on Medical Devices. This consortium was successful in obtaining EU funding for the development of a range of medical implants that will help patients with specific disabilities relating to the nervous system, including deafness, blindness, lack of limb motion and urinary incontinence.

Developing innovative implantable medical devices.

The market for electronically driven implantable devices is set to expand significantly. This article examines the current potential and some of the products under development.

A three-axis accelerometer.

The development of a three-axis accelerometer that can simultaneously measure acceleration in all three directions is to be utilised in a range of emerging applications.

Inertial sensor-based knee flexion/extension angle estimation.

A new method for estimating knee joint flexion/extension angles from segment acceleration and angular velocity data is described. The approach uses a combination of Kalman filters and biomechanical constraints based on anatomical knowledge. In contrast to many recently published methods, the proposed approach does not make use of the earth's magnetic field and hence is insensitive to the complex field distortions commonly found in modern buildings. The method was validated experimentally by calculating knee angle from measurements taken from two IMUs placed on adjacent body segments. In contrast to many previous studies which have validated their approach during relatively slow activities or over short durations, the performance of the algorithm was evaluated during both walking and running over 5 minute periods. Seven healthy subjects were tested at various speeds from 1 to 5 mile/h. Errors were estimated by comparing the results against data obtained simultaneously from a 10 camera motion tracking system (Qualysis). The average measurement error ranged from 0.7 degrees for slow walking (1 mph) to 3.4 degrees for running (5 mph). The joint constraint used in the IMU analysis was derived from the Qualysis data. Limitations of the method, its clinical application and its possible extension are discussed.