How human gait responds to muscle impairment in total knee arthroplasty patients: Muscular compensations and articular perturbations

Ardestani, Marzieh M.; Moazen, Mehran

doi:10.1016/j.jbiomech.2016.03.047

Cited by 14 publications

(10 citation statements)

References 46 publications

(7 reference statements)

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“…Considering that our body has a redundant number of muscles to execute a movement [Aoi et al, 2016;Valero-Cuevas et al, 2015], and muscles are apt to compensate for each other, thus masking abnormal activities in other muscles [Ardestani et al, 2016;Thompson et al, 2013;Goldberg et al, 2007], we believe that impaired neuro-motor synergies, caused by either surgery or osteoarthritis disease, may not immediately manifest themselves as abnormal EMG patterns.…”

Section: Discussionmentioning

confidence: 99%

“…The remaining 13 TKA subjects with KFS < 5.5 were classified as the low-functional TKA group (8F/5M; age: 61.1±8.4 (year); BMI: 29.8±5.4 (kg/m 2 ), weight: 88.8±16.5 (kg)). KFS equal to 5.5 was chosen as the midpoint of KFS scale (0 to 10) and also based on our previous study demonstrating that 90% of patients with KFS >5.5 have stable knees which is an important factor in knee joint functionality [Ardestani et al, 2017]. To form a control group, we selected gait and EMG data from a database of unimpaired subjects who had no habitual pain and no history of fracture or surgery in the Downloaded for Anonymous User (n/a) at Indiana University -Ruth Lilly Medical Library from ClinicalKey.com by Elsevier on September 29, 2017.…”

Section: Subjectsmentioning

confidence: 99%

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TKA patients with unsatisfying knee function show changes in neuromotor synergy pattern but not joint biomechanics

Ardestani

Malloy

Nam

et al. 2017

Journal of Electromyography and Kinesiology

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Nearly 20% of patients who have undergone total knee arthroplasty (TKA) report persistent poor knee function. This study explores the idea that, despite similar knee joint biomechanics, the neuro-motor synergies may be different between high-functional and low-functional TKA patients. We hypothesized that (1) high-functional TKA recruit a more complex neuro-motor synergy pattern compared to low-functional TKA and (2) high-functional TKA patients demonstrate more stride-to-stride variability (flexibility) in their synergies. Gait and electromyography (EMG) data were collected during level walking for three groups of participants: (i) high-functional TKA patients (n=13); (ii) low-functional TKA patients (n=13) and (iii) non-operative controls (n=18). Synergies were extracted from EMG data using non-negative matrix factorization. Analysis of variance and Spearman correlation analyses were used to investigate between-group differences in gait and neuro-motor synergies. Results showed that synergy patterns were different among the three groups. Control subjects used 5-6 independent neural commands to execute a gait cycle. High functional TKA patients used 4-5 independent neural commands while low-functional TKA patients relied on only 2-3 independent neural commands to execute a gait cycle. Furthermore, stride-to-stride variability of muscles' response to the neural commands was reduced up to 15% in low-functional TKAs compared to the other two groups.

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Section: Discussionmentioning

confidence: 99%

Section: Subjectsmentioning

confidence: 99%

TKA patients with unsatisfying knee function show changes in neuromotor synergy pattern but not joint biomechanics

Ardestani

Malloy

Nam

et al. 2017

Journal of Electromyography and Kinesiology

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“…Our study observed that inadequate extension of operated knee at midstance phase was about 14°, which caused shorter stance phase of operated limb than nonoperated limb ( Table 2 ) and inadequate forward propulsion of body weight and further resulted in lower walking efficiency. Recent studies demonstrated that flexion of operated knee at stance phase was a core indicator that impacted the quality of gait [ 1 , 11 , 12 ], and knee flexion range in stance was the most important variable in discriminating between patients with TKA and controls [ 11 ].The study of Li et al [ 13 ] noted that this was mostly due to inadequate muscle strength of quadriceps femoris and motor control disorder as well as lower moment of force during knee extension.…”

Section: Discussionmentioning

confidence: 99%

Early Spatiotemporal Patterns and Knee Kinematics during Level Walking in Individuals following Total Knee Arthroplasty

Chu

Xiao

et al. 2017

Journal of Healthcare Engineering

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Purpose With the aim of investigating the spatiotemporal features of early gait pattern and knee kinematics after total knee arthroplasty and analyzing the association between outcomes of gait analyses and knee kinematic parameters, the relationship between walking and dynamic knee deformity at the early period after total knee arthroplasty was assessed in this study. Methods Eighteen patients including 14 women and 4 men who underwent total knee arthroplasty were analyzed using three-dimensional gait analysis system to observe gait parameters and values of maximum knee flexion angle (MKFA) during swing phase and knee flexion angle (KFA) and knee valgus angle (KVA) at midstance phase. Results 3D gait analysis showed that operated side exhibited significantly less total support time and single support time as well as significantly longer swing phase compared with the other side. During walking, the operated side had significantly smaller MKFA and greater KFA and KVA than the nonoperated side. There was moderate to significant correlation between gait pattern and the dynamic knee kinematics. Conclusion The gait abnormality of patients after TKA was associated with inadequate flexion of knees at swing phase and insufficient extension at stance phase as well as increased range of valgus.

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“…The model showed acceptable accuracy in predicting muscle activations and the knee joint contact forces when compared versus in-vivo measurements (Chen et al, 2014;Peng et al, 2018). This model was also used for a series of parametric and probabilistic studies (Ardestani and Moazen, 2016;Chen et al, 2015). Here, this model was used to simulate muscle weakness (strength decline) and ligament laxity (decline in ligament force parameter) and calculate the resultant knee joint kinematics and kinetics.…”

Section: Musculoskeletal Modelmentioning

confidence: 99%

“…From each patient-specific model, 400 versions were generated including (i) 100 BSL models, for which muscle strength and ligament force parameter were chosen from a normal distribution of the nominal values for that subject ±5% (Amiri and Wilson, 2012) , (ii) 100 WEAK models where F0 was chosen from a normal distribution of nominal strength reduced by 30% (Silva et al, 2003). Note our previous study showed reduction beyond 40% can alter the normal gait pattern (Ardestani and Moazen, 2016); (iii) 100 WEAK models with lax ligaments where S0 was chosen from normal distribution of nominal values reduced by 30%. This is consistent with previous literature reporting up to 30% of variation in ligament stiffness amongst TKA subjects with unstable knees (Reinders et al, 2014) which may in turn lead to 2 standard deviation in secondary knee joint kinematics from the average (Kang et al, 2017).…”

Section: Musculoskeletal Modelmentioning

confidence: 99%

Computational analysis of knee joint stability following total knee arthroplasty

Ardestani

Chen

Noori-Dokht

et al. 2019

Journal of Biomechanics

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The overall objective of this study was to introduce knee joint power as a potential measure to investigate knee joint stability following total knee arthroplasty (TKA). Specific aims were to investigate whether weakened knee joint stabilizers cause abnormal kinematics and how it influences the knee joint kinetic (i.e., power) in response to perturbation. Patient-specific musculoskeletal models were simulated with experimental gait data from six TKA patients (baseline models). Muscle strength and ligament force parameter were reduced by up to 30% to simulate weak knee joint stabilizers (weak models). Two different muscle recruitment criteria were tested to examine whether altered muscle recruitment pattern can mask the influence of weakened stabilizers on the knee joint kinematics and kinetics. Level-walking knee joint kinematics and kinetics were calculated though force-dependent kinematic and inverse dynamic analyses. Bode analysis was then recruited to estimate the knee joint power in response to a simulated perturbation. Weak models resulted in larger anterior-posterior (A-P) displacement and internal-external (I-E) rotation compared to baseline (I-E: 18.4±8.5 vs. 11.6±5.7 (deg), A-P: 9.7±5.6 vs. 5.5±4.1 (mm)). Changes in muscle recruitment criterion however altered the results such that A-P and I-E were not notably different from baseline models. In response to the simulated perturbation, weak models versus baseline models generated a delayed power response with unbounded magnitudes. Perturbed power behavior of the knee remained unaltered regardless of the muscle recruitment criteria. In conclusion, impairment at the knee joint stabilizers may or may not lead to excessive joint motions but it notably affects the knee joint power in response to a perturbation. Whether perturbed knee joint power is associated with the patient-reported outcome requires further investigation.

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How human gait responds to muscle impairment in total knee arthroplasty patients: Muscular compensations and articular perturbations

Cited by 14 publications

References 46 publications

TKA patients with unsatisfying knee function show changes in neuromotor synergy pattern but not joint biomechanics

TKA patients with unsatisfying knee function show changes in neuromotor synergy pattern but not joint biomechanics

Early Spatiotemporal Patterns and Knee Kinematics during Level Walking in Individuals following Total Knee Arthroplasty

Computational analysis of knee joint stability following total knee arthroplasty

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