Gait analysis and synthesis: Biomechanics, orthotics, prosthetics

Comparative analysis of gait: Similar coronal but different sagittal effects between closing-wedge and opening-wedge high tibial osteotomy

BACKGROUND

High tibial osteotomy is an established surgical option for medial compartment osteoarthritis of the knee with varus alignment. It can be divided into open wedge and closing wedge by operative technique. Although they have fundamental differences, little is known about the biomechanical consequences of the two surgical methods.

METHODS

Thirty-eight patients with medial compartment osteoarthritis who underwent high tibial osteotomy (19 open-wedge and 19 closing-wedge) were retrospectively reviewed. Clinical scores and radiological measurements were assessed until postoperative two years. Gait analysis was performed preoperatively and again at postoperative one year.

FINDINGS

Varus alignment was corrected in both groups without a significant difference between them (p = 0.543). However, posterior tibial slope was higher, and the Blackburne-Peel ratio was lower in the open wedge osteotomy group after surgery (both p < 0.001). Reduction of dynamic knee varus and knee adduction moment were observed in both groups without significant differences. However, after surgery, average knee range of motion (63.3° vs 57.3°, p < 0.001) and the magnitude of knee flexion moment was significantly lower (p = 0.005) in the closing wedge group. There were no significant differences in the Kujala Anterior Knee Pain Scale and the occurrence of patellofemoral arthritis between the groups postoperatively.

INTERPRETATION

After osteotomy, a smaller average knee range of motion in the sagittal plane and a higher knee flexion moment were observed in the open wedge osteotomy group, suggesting quadriceps muscle avoidance. However, no differences in clinical scores or the short-term occurrence of patellofemoral arthritis were noted between the two surgical techniques.

The Existence of Shared Muscle Synergies Underlying Perturbed and Unperturbed Gait Depends on Walking Speed

Muscle synergy theory assumes that the central nervous system generates a wide range of complex motor outputs by recruiting muscle synergies with different strengths and timings. The current understanding is that a common set of muscle synergies underlies unperturbed as well as perturbed walking at self-selected speeds. However, it is not known whether this is the case for substantially slower walking. The aim of this study was to investigate whether a shared set of muscle synergies underlies balance recovery responses following inward- and outward-directed perturbations in the mediolateral direction at various perturbation onsets and walking speeds. Twelve healthy subjects walked at three walking speeds (0.4, 0.6, and 0.8 m/s) on a treadmill while perturbations were applied to the pelvis using the balance assessment robot. A set of sixteen EMG signals, i.e., eight muscles per leg, was measured and decomposed into muscle synergies and weighting curves using non-negative matrix factorization. The muscles included were left and right tibialis anterior, soleus, gastrocnemius medialis, gastrocnemius lateralis, rectus femoris, hamstring, gluteus medius, and gluteus maximus. In general, four muscle synergies were needed to adequately reconstruct the data. Muscle synergies were similar for unperturbed and perturbed walking at a high walking speed (0.8 m/s). However, the number of similar muscle synergies between perturbed and unperturbed walking was significantly lower for low walking speeds (0.4 and 0.6 m/s). These results indicate that shared muscle synergies underlying perturbed and unperturbed walking are less present during slow walking compared to fast walking.

How prosthetic design influences knee kinematics: a narrative review of tibiofemoral kinematics of healthy and joint-replaced knees

INTRODUCTION

To improve the total knee arthroplasty (TKA) prosthesis design, it is essential to study the kinematics of the tibiofemoral joint. Many studies have been conducted in this area; however, conflicting results and incomparable testing methods make it difficult to draw definitive conclusions or compare research from studies. The goal of this article is to introduce what is known about both healthy and prosthetic tibiofemoral joint kinematics.

AREAS COVERED

Healthy tibiofemoral joint kinematics are reviewed in vivo by different activities, and the kinematics of existing knee prosthetic design features are considered separately. These features include but are not limited to cruciate retaining, posterior cruciate substituting, mobile-bearing, and high flexion.

EXPERT COMMENTARY

The type of activity that is being performed has a great influence on the kinematics of healthy knees, and the influences of different TKA prosthetic design features on the kinematics are complex and varied. Moreover, the TKA postoperative functional performance is influenced by many factors, and prosthetic design is among them, but not the only one that defines the performance.