Leg and lower limb dynamic joint stiffness during different walking speeds in healthy adults

BackgroundThe differences and relationship between joint stiffness and leg stiffness can be used to characterize the lower limb behavior during different walking speeds.Research questionThis study aimed to investigate the differences in whole leg and lower limb joint stiffness at different walking speeds and the interactions between leg and lower limb joint stiffness.MethodsTwenty-seven healthy adults, seventeen males (age: 19.6 ± 2.2 years, height: 176.0 ± 6.0 cm, mass: 69.7 ± 8.9 kg), and ten females (age: 19.1 ± 1.9 years, height: 164.0 ± 3.0 cm, mass: 59.6 ± 3.8 kg), were recruited. Dynamic leg and joint stiffness were calculated during eccentric loading from data recorded using 3D infrared motion analysis and force plates at slow, normal, and fast walking speeds. Differences in dynamic stiffness, joint angles and moments were explored between the walking speeds using Repeated Measures ANOVA with Sidak post-hoc tests. Correlations between leg, joint stiffness, and walking speed were also explored.ResultsThe results indicated that the leg dynamic stiffness is decreased by walking speed, however, hip and ankle joint stiffness were increased (p < 0.001) and knee stiffness was unaffected. Leg stiffness showed no correlation with hip, knee, or ankle stiffness. A positive significant correlation was seen between hip and ankle stiffness (p < 0.01) and between knee and ankle stiffness (p < 0.001), however, no correlation was seen between hip and knee stiffness.SignificanceThese results suggest leg stiffness is not associated with lower limb joint stiffness during eccentric loading. This provides new information on the responses of ankle, knee and hip joint stiffness to walking speed.     

Kinematic changes in patients with severe knee osteoarthritis are a result of reduced walking speed rather than disease severity

BackgroundKinematic changes in patients with knee osteoarthritis (OA) have been extensively studied. Concerns have been raised whether the measured spatiotemporal and kinematic alterations are associated with disease progression or merely a result of reduced walking speed.Research question: The purpose of this study was to investigate the effect of walking speed on kinematic parameters in patients with knee OA using statistical parametric mapping (SPM).MethodsTwenty-three patients with unilateral knee OA scheduled for a total knee replacement and 28 age matched control subjects were included in this study. Spatiotemporal parameters and sagittal plane kinematics were measured in the hip, knee, and ankle using the inertial sensors system RehaGait® while walking at a self-selected normal (patients and controls) and slow walking speed (controls) for a distance of 20 m. Gait parameters were compared between groups for self-selected walking speed and for matched walking speed using SPM with independent sample t tests.ResultsAt self-selected walking speed, patients had significantly lower knee flexion during stance (maximum difference, -6.8°) and during swing (-11.0°), as well as higher ankle dorsiflexion during stance phase (+12.5°) and lower peak hip extension at the end of stance compared to controls (+4.2°). At matched speed, there were no significant differences in joint kinematics between groups.SignificanceDifferences in sagittal plane gait kinematics between patients with knee OA and asymptomatic controls appear to be mainly a result of reduced walking speed. These results emphasize the importance of considering walking speed in research on gait kinematics in patients with knee OA and in clinical trials using gait parameters as outcome measures.     

Hip external rotation stiffness and midfoot passive mechanical resistance are associated with lower limb movement in the frontal and transverse planes during gait

BackgroundHip external rotation stiffness, midfoot passive mechanical resistance and foot alignment may influence on ankle, knee and hip movement in the frontal and transverse planes during gait.Research questionAre hip stiffness, midfoot mechanical resistance and foot alignment associated with ankle, knee and hip kinematics during gait?MethodsHip stiffness, midfoot mechanical resistance, and foot alignment of thirty healthy participants (18 females and 12 males) with average age of 25.4 years were measured. In addition, lower limb kinematic data during the stance phase of gait were collected with the Qualisys System (Oqus 7+). Stepwise multiple linear regressions were performed to identify if hip stiffness, midfoot torque, midfoot stiffness and foot alignment were associated with hip and knee movement in the transverse plane and ankle movement in the frontal plane with α = 0.05.ResultsReduced midfoot torque was associated with higher hip range of motion (ROM) in the transverse plane (r² = 0.18), reduced hip stiffness was associated with higher peak hip internal rotation (r² = 0.16) and higher ROM in the frontal plane (r² = 0.14), reduced midfoot stiffness was associated with higher peak knee internal rotation (r² = 0.14) and increased midfoot torque and midfoot stiffness were associated with higher peak knee external rotation (r² = 0.36).SignificanceThese findings demonstrated that individuals with reduced hip and midfoot stiffness have higher hip and knee internal rotation and higher ankle eversion during the stance phase of gait. On the other hand, individuals with increased midfoot torque and stiffness have higher knee external rotation. These relationships can be explained by the coupling between ankle movements in the frontal plane and knee and hip movements in the transverse plane. Finally, this study suggests that midfoot passive mechanical resistance and hip stiffness should be assessed in individuals presenting altered ankle, knee and hip movement during gait.     

Redistribution of joint moments and work in older women with and without hallux valgus at two walking speeds

BackgroundHallux valgus (HV) is a highly prevalent foot deformity in older women. Differences in lower extremity joint function of older women with and without HV during walking at slower and faster speeds are unknown.Research questionDoes walking speed affect lower extremity joint range of motion (ROM) and net extensor joint moment and associated work in older women with and without HV?MethodsThirteen older women with HV and 13 controls completed five walking trials at 1.1 and 1.3 m·s⁻¹ as kinematic marker position and ground reaction force data were collected. Net ankle, knee, and hip joint moments were computed using inverse dynamics during the stance phase. Positive joint work was calculated by integrating hip power in early stance, knee power in mid stance, and ankle power in late stance.ResultsAverage ankle ROM and plantarflexor moment did not increase with walking speed in the HV group, while in the control group these variables were greater for the faster compared to the slower speed (p < 0.05). The magnitude of increase in ankle joint work with speed was 12 % lesser in the HV compared to the control group (p = 0.008). The hip ROM, extensor moment, and associated work was greater in the HV compared to the control group (p < 0.05). Knee and hip joint ROM, extensor moments, and work increased with walking speed in both groups (p < 0.05).SignificanceOlder women with HV compared to older women without HV demonstrate a distal-to-proximal redistribution by increasing hip motion and effort to compensate for reduced ankle contribution during walking.     

Trunk flexion during walking in people with knee osteoarthritis

BackgroundOver 50% of the body’s mass is concentrated within the head, arms and trunk. Thus, small deviations in the orientation of the trunk, during normal walking, could influence the position of the centre of mass relative to the lower limb joint centres and impact on lower limb biomechanics. However, there are minimal data available on sagittal kinematics of the trunk in people with knee osteoarthritis (OA) during walking.Research questionDo people with knee OA have altered kinematic patterns of the trunk, pelvis or hip compared with healthy control participants during walking?MethodsStatistical parametric mapping was used to compare sagittal and frontal plane kinematic patterns, during walking, between a healthy group and cohort of people with knee OA.ResultsIndividuals with knee OA walked with a mean increase in trunk flexion of 2.6°. Although this difference was more pronounced during early stance, it was maintained across the whole of stance phase. There were no differences, between the groups, in sagittal plane pelvic or hip kinematics. There were also no differences in trunk, pelvic or hip kinematics in the frontal plane.SignificanceMost previous gait research investigating trunk motion in people with knee OA has focused on the frontal plane. However, our data suggest that an increase in sagittal trunk flexion may be a clinical hallmark of people with this disease. Altered trunk flexion could affect joint moments and muscle patterns and therefore our results motivate further research in this area.     

Gait outcomes following proximal tibial tumor resection and endoprosthetic reconstruction

BackgroundDespite the proximal tibia being a common site of primary malignant bone tumors, there is limited information about gait function following proximal tibial tumor resection and endoprosthetic reconstruction (PTR).Research questionWhat is the impact of PTR on gait and quality of life?MethodsThis was a cross-sectional study of patients ≥18 years old who were ≥2 years post-PTR compared to a control group of similar age and sex distribution. Eighteen participants (9 PTR, 9 Control) were recruited. Gait spatial-temporal data, joint kinematics and kinetics were collected at preferred and fast walking speeds. Community walking cadence, health-related quality of life (SF-36) and knee joint torque were assessed. Comparisons were performed using one-way ANOVAs with Bonferroni corrections for multiple comparisons. Nonparametric tests were used for data not normally distributed.ResultsMean age was 31 years for each group (PTR range = 18–42 yrs, Control range = 18–44 yrs). Compared to both control and nonsurgical limbs, the surgical limb exhibited significantly decreased % single limb support time, reduced heel rise during terminal stance and an absence of normally occurring knee flexion angles, extensor moments and power generation during initial double limb support. Additionally, a reduced peak plantar flexor moment was found for the surgical as compared to the control limb. The number of gait abnormalities increased during fast walking. Significantly reduced surgical knee extensor torque on isokinetic testing and weakness of the knee and ankle on clinical examination support gait findings. During community walking, the number of low frequency strides was an average of 5.3 % greater for the PTR group (p < 0.05). Norm-based PTR group SF-36 component scores were within normal values (53.4 physical, 56.5 mental).SignificanceGait abnormalities were consistent with ankle muscle resection and transposition and knee extensor mechanism disruption. Despite these deficits, walking speed and quality of life were relatively normal.     

Modified conventional gait model vs. Six degrees of freedom model: A comparison of lower limb kinematics and associated error

BackgroundThe conventional gait model (CGM) is commonly utilised within clinical motion analysis but has a number of inherent limitations. To overcome some of these limitations modifications have been made to the CGM and six-degrees of freedom models (6DoF) have been developed.Research QuestionHow comparable are lower limb kinematics calculated using modified CGM and 6DoF models and what is the error associated with the output of each model during walking?MethodsTen healthy males attended two gait analysis sessions, in which they walked at a self-selected pace, while a 10-camera motion capture system recorded lower limb kinematics. Hip, knee and ankle joint kinematics in all three anatomical planes were calculated using a modified CGM, with medial anatomical markers and a three-dimensional foot added, and 6DoF. Mean absolute differences were calculated on a point-by-point basis over the walking gait cycle and interpreted relative to a 5° threshold to explore the comparability of model outputs. The standard error of the measurement (SEM) was also calculated on a point-by-point basis over the walking gait cycle for each model.ResultsMean absolute differences above 5° were reported between the two model outputs in 58–86% of the walking gait cycle at the knee in the frontal plane, and over the entire walking gait cycle at the hip and knee in the transverse plane. SEM was typically larger for the modified CGM compared to the 6DoF, with the highest SEM values reported at the knee in the frontal plane, and the hip and the knee in the transverse plane.SignificanceCaution should be taken when looking to compare findings between studies utilising modified CGM and 6DoF outside of the sagittal plane, especially at the hip and knee. The reduced SEM associated with the 6DoF suggests this modelling approach may be preferable.     

Fatigue matters: An intense 10 km run alters frontal and transverse plane joint kinematics in competitive and recreational adult runners

BackgroundFatigue is an essential component of distance running. Still, little is known about the effects of running induced fatigue on three-dimensional lower extremity joint movement, in particular in the frontal and transverse planes of motion.Research questionHow are non-sagittal plane lower extremity joint kinematics of runners altered during a 10 km treadmill run with near-maximum effort?MethodsIn a cross-sectional study design, we captured three-dimensional kinematics and kinetics at regular intervals throughout a 10 km treadmill run in 24 male participants (subdivided into a competitive and recreational runner group) at a speed corresponding to 105 % of their season-best time. We calculated average and peak joint angles at the hip, knee and ankle during the stance phase.ResultsWe observed peak deviations of 3.5°, 3° and 5° for the hip (more adduction), knee (more abduction) and ankle (more eversion) in the frontal plane when comparing the final (10 km) with the first (0 km) measurement. At the end of the run peak knee internal rotation angles increased significantly (up to 3° difference). Running with a more abducted knee joint and with a higher demand for hip abductor muscles in the unfatigued state was related to greater fatigue-induced changes of joint kinematics at the knee and hip.SignificanceThe fatigue related change of non-sagittal joint kinematics needs to be considered when addressing risk factors for running-related injuries, when designing shoe interventions as well as strengthening and gait retraining protocols for runners. We speculate that strengthening ankle invertors and hip abductors and monitoring the dynamic leg axis during running appear to be promising in preventing fatigue induced alterations of non-sagittal joint kinematics.     

Compensatory mechanisms in below-knee amputee gait in response to increasing steady-state walking speeds

Compensatory mechanisms in below-knee amputee gait are necessary due to the functional loss of the ankle muscles, especially at higher walking speeds when the mechanical energetic demands of walking are greater. The objective of this study was to examine amputee anterior/posterior (A/P) ground reaction force (GRF) impulses and joint kinetics across a wide range of steady-state walking speeds to further understand the compensatory mechanisms used by below-knee amputees. We hypothesized that amputees would rely more on their intact leg to generate greater propulsion relative to the residual leg, which would result in greater GRF asymmetry between legs as walking speed increased. Amputee and control subject kinematic and kinetic data were collected during overground walking at four different speeds. Group (n = 14) average amputee data showed no significant differences in braking or propulsive GRF impulse ratios, except the propulsive ratio at 0.9 m/s, indicating that the subjects maintained their initial levels of GRF asymmetry when walking faster. Therefore, our hypothesis was not supported (i.e., walking faster does not increase GRF loading asymmetry). The primary compensatory mechanism was greater positive residual leg hip joint power and work in early stance, which led to increased propulsion from the residual leg as walking speed increased. In addition, amputees had reduced residual leg positive knee work in early stance, suggesting increased output from the biarticular hamstrings. Thus, increasing residual leg hip extensor strength and output may be a useful mechanism to reduce GRF loading asymmetry between the intact and residual legs.     

Effect of walking speed during gait in water of healthy elderly

BackgroundWalking in water (WW) is frequently used as an aquatic exercise in rehabilitation programs for the elderly. Understanding gait characteristics of WW is of primary importance to effectively design specific water-based rehabilitation programs. Moreover, as walking speed in water is reduced with a possible effect on gait parameters, the age- and environment-related changes during WW have to be investigated considering the effects of instantaneous walking speed. Research question: how do gait kinematic characteristics differ in healthy elderly between WW and on land walking condition (LW)? Do elderly show different walking patterns compared to young adults? Can these kinematic changes be accounted only by the different environment/age or are they also related to walking speed?MethodsNine healthy elderly participants (73.5 ± 5.8 years) were acquired during walking in WW and LW at two different speeds. Kinematic parameters were assessed with waterproofed inertial magnetic sensors using a validated protocol. The influence of environment, age and walking speed on gait parameters was investigated with linear mixed models.ResultsShorter stride distances and longer stride durations were observed in WW compared to LW. In the sagittal plane, hip and knee joint showed larger flexion in WW (>10deg over the whole stride and ∼28deg at foot strike, respectively). Furthermore, lower walking speeds and stride distances were observed in elderly compared to young adults. In the sagittal plane, a slightly more flexed hip joint and a less plantarflexed ankle joint (∼9 deg) were observed in the elderly. Significance: The results showed the importance of assessing the walking speed during WW, as gait parameters can vary not only for the effect environment but also due to different walking speeds.     

The effects of direction and speed on treadmill walking in typically developing children

BackgroundBackward walking and fast walking have distinctive gait patterns in adults; however, there is minimal literature describing these gait modifications in typically developing children. Additionally, most of previous research focused on overground backward walking, but not on a treadmill.Research questionHow do typically developing children adapt their gait patterns, including spatiotemporal parameters, joint kinematics, and muscle activation, to changes in direction and speed during treadmill walking?MethodsWe recruited 19 children (10 M/9 F) aged 6–12 years. Treadmill conditions included forward and backward walking at three speeds: slow (75 % of normal speed), normal speed, and fast (125 % of normal speed). Subjects completed a 2-minute trial under each condition. Spatiotemporal, kinematic, kinetic and electromyography data were collected and analyzed. Correlations between forward and time-reversed backward walking were calculated for joint angles and vertical ground reaction force.ResultsDuring backward walking, children (a) decreased step lengths and increased step widths and foot clearance, (b) decreased peak hip and knee flexion and increased peak ankle dorsiflexion, and (c) increased muscle activity at the vastus lateralis, rectus femoris, and tibialis anterior. At faster speeds, children increased step lengths and inconsistently increased overall muscle activity. Both the hip and knee showed high correlation between forward and time-reversed backward walking, while correlation at the ankle was low.SignificanceOverall, children adapt their gait to changes in direction and speed of treadmill walking in similar ways to adults. However, notable differences emerged in that children limited their ankle range of motion. Our results suggest that, while many aspects of gait are mature enough by this age to adapt to backward walking on a treadmill, neuromuscular control at the ankle may still be lacking in children while walking backward on a treadmill.     

Gait patterns after anterior cruciate ligament reconstruction

The aim of this study is to analyse the changes in select gait parameters following anterior cruciate ligament (ACL) reconstruction. The study was performed on 15 subjects who underwent ACL reconstruction by the bone-patellar tendon-bone technique. Gait analysis was performed using the Elite three-dimensional (3D) optoelectronic system (BTS), a Kistler force platform and the Telemg telemetric electromyograph (BTS). Kinematic data were recorded for the principal lower limb joints (hip, knee and ankle). The examined muscles include vastus lateralis, rectus femoris, biceps femoris and semitendinosus. The results obtained from the operated subjects were compared with those of 10 untreated subjects and 5 subjects without ACL damage. In the operated subjects the knee joint angular values regained a normal flexion pattern for the injured limb during the stance phase. The analysis of joint moments shows: (a) sagittal plane: recovery of the knee flexion moment at loading response and during preswing; (b) frontal plane: recovery of the normal patterns for both hip and knee adduction-abduction moments during the entire stance phase. The examination of ground reaction forces reveals the recovery of frontal component features. The EMG traces show the normal biphasic pattern for the operated subjects as compared to the untreated subjects. The results suggest that the gait parameters shift towards normal value patterns.     

Comparison of inverse dynamics calculated by two- and three-dimensional models during walking

The purpose of the study was to compare joint moments calculated by a two- (2D) and a three-dimensional (3D) inverse dynamics model to examine how the different approaches influenced the joint moment profiles. Fifteen healthy male subjects participated in the study. A five-camera video system recorded the subjects as they walked across two force plates. The subjects were invited to approach a walking speed of 4.5 km/h. The ankle, knee and hip joint moments in the sagittal plane were calculated by 2D and 3D inverse dynamics analysis and compared. Despite the uniform walking speed (4.53 km/h) and similar footwear, relatively large inter-individual variations were found in the joint moment patterns during the stance phase. The differences between individuals were present in both the 2D and 3D analysis. For the entire sample of subjects the overall time course pattern of the ankle, knee and hip joint moments was almost identical in 2D and 3D. However, statistically significant differences were observed in the magnitude of the moments, which could be explained by differences in the joint centre location and joint axes used in the two approaches. In conclusion, there were differences between the magnitude of the joint moments calculated by 2D and 3D inverse dynamics but the inter-individual variation was not affected by the different models. The simpler 2D model seems therefore appropriate for human gait analysis. However, comparisons of gait data from different studies are problematic if the calculations are based on different approaches. A future perspective for solving this problem could be to introduce a standard proposal for human gait analysis.     

Heel height affects lower extremity frontal plane joint moments during walking

Wearing high heels alters walking kinematics and kinetics and can create potentially adverse effects on the body. Our purpose was to determine how heel height affects frontal plane joint moments at the hip, knee, and ankle, with a specific focus on the knee moment due to its importance in joint loading and knee osteoarthritis. 15 women completed overground walking using three different heel heights (1, 5, and 9 cm) for fixed speed (1.3 ms(-1)) and preferred speed conditions while kinematic and force platform data were collected concurrently. For both fixed and preferred speeds, peak internal knee abduction moment increased systematically as heel height increased (fixed: 0.46, 0.48, 0.55 N m kg(-1); preferred: 0.47, 0.49, 0.53 N m kg(-1)). Heel height effects on net frontal plane moments of the hip and ankle were similar to those for the knee; peak joint moments increased as heel height increased. The higher peak internal knee abduction moment with increasing heel height suggests greater medial loading at the knee. Kinetic changes at the ankle with increasing heel height may also contribute to larger medial loads at the knee. Overall, wearing high heels, particularly those with higher heel heights, may put individuals at greater risk for joint degeneration and developing medial compartment knee osteoarthritis.     

Normative Achilles and patellar tendon shear wave speeds and loading patterns during walking in typically developing children

BackgroundMotion analysis is commonly used to evaluate joint kinetics in children with cerebral palsy who exhibit gait disorders. However, one cannot readily infer muscle-tendon forces from joint kinetics. This study investigates the use of shear wave tensiometry to characterize Achilles and patellar tendon forces during gait.Research QuestionHow do Achilles and patellar tendon wave speed and loading modulate with walking speed in typically developing children?MethodsTwelve typically developing children (9–16 years old) walked on an instrumented treadmill with shear wave tensiometers over their Achilles (n = 11) and patellar (n = 9) tendons. Wave speeds were recorded at five leg length-normalized walking speeds (very slow to very fast). Achilles and patellar tendon moment arms were measured with synchronized ultrasound and motion capture. The tendon wave speed-load relationship was calibrated at the typical walking speed and used to estimate tendon loading at other walking speeds.ResultsCharacteristic Achilles and patellar tendon wave speed trajectories exhibited two peaks over a gait cycle. Peak Achilles tendon force closely aligned with peak ankle plantarflexor moment during pushoff, though force exhibited less modulation with walking speed. A second peak in late swing Achilles loading, which was not evident from the ankle moment, increased significantly with walking speed (p < 0.001). The two peaks in patellar tendon loading occurred at 12 ± 1% and 68 ± 6% of the gait cycle, matching the timing of peak knee extension moment in early stance and early swing. Both patellar tendon load peaks increased significantly with walking speed (p < 0.05).SignificanceThis is the first study to use shear wave tensiometry to characterize Achilles and patellar tendon loading during gait in children. These data could serve as a normative comparison when using tensiometry to identify abnormal tendon loading patterns in individuals who exhibit equinus and/or crouch gait.     

The effect of walking speed on gait kinematics and kinetics after endoprosthetic knee replacement following bone tumor resection

Gait function is one of the most important components of functional outcome evaluation in patients with a tumor around the knee. In addition to walking at a preferred speed, the patients might be sometimes required to walk fast in daily life (e.g., schooling and working) because the major types of bone tumors often occur in adolescence and young adults. Therefore, recovering the ability to walk fast would increase the quality of life of these patients. To clarify which parts of the lower limb are exerted while walking fast, we investigated the kinematic and kinetic changes during fast walking in patients who underwent endoprosthetic knee replacement after bone tumor resection. Laboratory-based gait analysis was performed on eight patients who had undergone endoprosthetic knee replacement following resection of a tumor around the knee. Patients walked at a preferred and faster speed, and the gait parameters were compared between the two walking speeds for each leg. To increase walking speed, patients tended to rely on the bilateral hip, ankle, and contralateral knee to generate additional power. Kinetic analysis showed that involved-side vertical body support was not significantly increased during late stance to increase walking speed, which was associated with a small increase in ankle plantarflexion moment and concentric power. These results suggest to patients after knee reconstruction how to effectively increase their walking speed or redistribute the mechanical load on the muscles and joints to prevent excessive stress on the lower limbs.     

3D joint dynamics of walking in toddlers A cross-sectional study spanning the first rapid development phase of walking

This study aims at giving an insight into the causative forces of walking in toddlers. Therefore, joint angle, moment and power profiles of 10 toddlers with less than 6 months of walking experience are compared to the stereotype adult patterns. In general, joint moments are small, which can be explained both by the small size of toddlers and differences in walking strategy. Also mass specific powers are reduced due to the low average walking speed. Balance problems in toddlers lead to a dominance of hip and knee extending moments throughout stance. The joint moment profiles are characterized by a reduced complexity, which might suggest an immature control of movement. Another feature of toddler gait is that virtually no power is generated at the ankle joint prior to foot-off (no active push-off). We also examined the effect of walking experience on the toddler gait pattern. In general, an evolution towards a more mature gait becomes evident after 4 months of independent walking. Changes are observed in step-time parameters, ankle dorsiflexing moment and power absorption at the hip joint.     

The effect of walking speed on gait kinematics and kinetics after endoprosthetic knee replacement following bone tumor resection

Gait function is one of the most important components of functional outcome evaluation in patients with a tumor around the knee. In addition to walking at a preferred speed, the patients might be sometimes required to walk fast in daily life (e.g., schooling and working) because the major types of bone tumors often occur in adolescence and young adults. Therefore, recovering the ability to walk fast would increase the quality of life of these patients. To clarify which parts of the lower limb are exerted while walking fast, we investigated the kinematic and kinetic changes during fast walking in patients who underwent endoprosthetic knee replacement after bone tumor resection. Laboratory-based gait analysis was performed on eight patients who had undergone endoprosthetic knee replacement following resection of a tumor around the knee. Patients walked at a preferred and faster speed, and the gait parameters were compared between the two walking speeds for each leg. To increase walking speed, patients tended to rely on the bilateral hip, ankle, and contralateral knee to generate additional power. Kinetic analysis showed that involved-side vertical body support was not significantly increased during late stance to increase walking speed, which was associated with a small increase in ankle plantarflexion moment and concentric power. These results suggest to patients after knee reconstruction how to effectively increase their walking speed or redistribute the mechanical load on the muscles and joints to prevent excessive stress on the lower limbs.     

Dynamic loading of the knee and hip joint and compensatory strategies in children and adolescents with varus malalignment

Three-dimensional gait analysis is a diagnostic tool that can be used to gain a better understanding of the relationship between joint loading and the onset or progression of articular cartilage degeneration in subjects with varus malalignment. The purpose of the present study was to investigate knee and hip joint angles and moments in children and adolescents with pathological varus alignment of the knee without signs of knee osteoarthritis (OA). Moreover, we wanted to know if compensatory mechanisms are present in this young patient group. Fourteen, otherwise healthy patients with varus malalignment of the knee and 15 healthy control subjects were analysed. Patients showed a reduced knee extension and a significantly lower maximum knee extension moment in terminal stance compared to controls. The maximum knee adduction moment in mid and terminal stance and the maximum hip abduction moment in loading response were significantly higher in the patient group. In the transverse plane, abnormally increased knee internal rotation and hip external rotation moments were present in patients with varus malalignment. These findings imply that varus malalignment is not an isolated problem in the frontal plane. In contrast to adult patients with established medial knee OA, the young patients assessed in the present study did not show typical compensatory mechanisms such as increased foot progression angle or reduced walking speed. This suggests that children and adolescents with varus malalignment of the knee probably do not need to alter their spatio-temporal gait parameters in order to decrease knee joint loading.     

Effects of infant transportation on lower extremity joint moments: Baby carrier versus carrying in-arms

BackgroundThe act of babywearing is recognizably a task of load carriage and has gained popularity among millennial caregivers.Research QuestionThe implications of babywearing on lower extremity joint moments of the caregiver are still unknown during prolonged transport and a direct comparison of babywearing to carrying an infant in-arms has not been previously conducted.MethodsEighteen females participated in this study by performing 3 conditions: a) 3 min walking unloaded (UL), b) 15 min walking while carrying a mannequin infant in-arms (IA), and c) 15 min walking while wearing a mannequin infant in an anteriorly positioned baby carrier (BC). Two separate data analyses were conducted using a repeated measures ANOVA. First, UL compared to the initial minute of walking for IA and BC. Second, UL compared to the final minute of walking for IA and BC.ResultsDuring initial minute comparisons, both IA and BC conditions increased joint moments in the frontal and sagittal plane at the knee with no change at the ankle and hip. During final minute comparisons, IA maintained the increases in the knee frontal plane joint moments observed during initial minute comparisons but also increased at the hip; however, BC generally showed no statistical difference from UL. Carrying an infant in a baby carrier more closely resembles unloaded walking, while carrying an infant in-arms appears to increase the mechanical load placed on the knee and hip joints in the frontal plane through an increase in joint moments.SignificanceDuring prolonged transportation, caregivers might choose to employ a baby carrier as opposed to carrying an infant in-arms, as in-arm carriage increases the loading knee abduction moment by 8.7% and the loading knee extension moment by 16.7%.