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Clinical gait analysis of hip disarticulation amputees
Abstracts
normally necessitate the use of foot-switches. The basis for the technique is to use a videorecorder in slow motion. To test the feasibility of this idea a subject was filmed walking at five different self-selected speeds from very slow to very fast over a resistive grid walkway. A program was written that allowed a computer to act as an event timer. The videotape was played back in slow motion and the mouse button clicked for each make and break of contact starting and finishing with a right heelstrike. The durations of the temporal phases were calculated as percentages of stride time. The calculation does not require one to know the factor by which the tape is slowed since the absolute time for a stride is not needed, simply the relative time. The results for total support, swing, and double support were compared to those obtained from the walkway and a regression coefficient of 0.988 obtained) indicating that the technique is valid. Clinical application of gait in ortbopaedics E Y S Chuo
Johns Hopkins Orthopaedic Surgery, Baltimore, Maryland, USA Objective of gait analysis has always been regarded as a non-essential test in orthopaedics with unknown clinical value. Due to its expensive equipment/space requirement plus the demands on specialized personnel, such service has frequently been faced with compensation problems from the hospital management and the health care payment providers. However, recent development in clinical gait analysis and its applications began to change such contention and several recontructive procedures have relied on gait data to justify their indications and proceed to offer the essential information for preoperative planning. Certain requirements must be maintained in order to facilitate greater acceptance for its clinical value: (1) physicians and surgeons should be involved in developing gait parameters for specific application; (2) gait analysis instrument and data reduction processes must be easy to use and able to produce fast, reliable, and consistent data; (3) gait analysis results must be able to differentiate normal and abnormal subjects with varying degrees of pathological involvement. It is of crucial importance to recognize that gait analysis can be used to assess disease progress and treatment outcome. Nevertheless, gait analysis and its laboratory operation cannot survive relying upon clinical service alone. Such facility must be justified through its value in education and research, which hopefully will also open up new avenues for future clinical applications. Functional evaluation of patients with knee arthrosis treated by high tibi~l osteotomy and total knee arthroplasty u&g objective gait analysis F Cutuni
Istituto Ortopedici Rizzoli, Istituto di Recerca CodivillaPutti, Bologna, Italy Degenerative joint disease at the knee is becoming more and more frequent due to the increase of trauma but
1i’5
overall to the increase in the average age. of life. The efficacy of the treatment in recovery, motion, and reducing pain depends upon many factors. Patient selection, implant position in the case of total knee replacement (TKR), mechanical and anatomical tibiofemoral angle in case of TKR or of tibia1 osteotomy, and general surgical techniques are the major determinants of successful surgery. The knee joint is responsible for the most demanding biomechanical functions of the musculoskeletal system because of the complexity of the trunk-lower limb joint co-ordination. The choice of treatment and the patient selection (osteotomy or total joint arthroplasty) in some cases is still cantroversial. High tibia1 osteotomy demonstrated a survivorship time of about 7 years and total joint anthroplasty performed in young patients may lead to several prosthesis revisions. The surgeon’s need is to have more quantitative data that can lead to a better treatment indication and to demonstrate the efficacy and the survivorship of the treatment. The early failure of both treatment procedures is not dependent only upon the uncorrected mechanical alignment but it also seems really important to know how the patient loads the knee during walking or during the daily living activities. It has been proven by gait analysis that the joint loading depends upon may factors, including trunk kinematics and particularly muscular pattern.
Clinical gait analysis of hip dim D R W Hmay, D Hynd, D J Ewing S C Hughes
Biomedical Engineering Group, Department of Mechanical Engineering, University of Surrey, Guildford, Surrey, UK Preliminary investigations in gait analysis have been conducted on the unique dual force platform system in the Biomedical Engineering Laboratories at the University of Surrey. To date 43 patients have been assessed; these include 23 lower-limb amputees, 20 male and three female. Included in these are three very-highlevel amputees with hip disarticulations. Patient BG is a right TH amputee age 54 amputated in 1977 for malignant fibrosarcoma. Patient AA is a left TH amputee age 27, amputated in 1977, again for fibrosarcoma. Patient PM is very rare in that he is a left TH amputee for osteosarcoma but also has a massive endoprosthetic distal femoral and total knee for chondrosarcoma. Aged 36, he was amputated in 1969. Each patient was asked to walk comfortably and safely along the platform at his or her own interpretation of walking speed. Measurements of vertical floor reaction forces with corresponding instantaneous centres of pressures and associated timings are recorded in real time. Concurrently with the force measurements, two-dimensional video is also recorded with split-screen techniques. The results will be analysed in relation to their individual prosthetic problems, i.e. hardware reliability, and the subsequent prescription charges recommended.
normally necessitate the use of foot-switches. The basis for the technique is to use a videorecorder in slow motion. To test the feasibility of this idea a subject was filmed walking at five different self-selected speeds from very slow to very fast over a resistive grid walkway. A program was written that allowed a computer to act as an event timer. The videotape was played back in slow motion and the mouse button clicked for each make and break of contact starting and finishing with a right heelstrike. The durations of the temporal phases were calculated as percentages of stride time. The calculation does not require one to know the factor by which the tape is slowed since the absolute time for a stride is not needed, simply the relative time. The results for total support, swing, and double support were compared to those obtained from the walkway and a regression coefficient of 0.988 obtained) indicating that the technique is valid. Clinical application of gait in ortbopaedics E Y S Chuo
Johns Hopkins Orthopaedic Surgery, Baltimore, Maryland, USA Objective of gait analysis has always been regarded as a non-essential test in orthopaedics with unknown clinical value. Due to its expensive equipment/space requirement plus the demands on specialized personnel, such service has frequently been faced with compensation problems from the hospital management and the health care payment providers. However, recent development in clinical gait analysis and its applications began to change such contention and several recontructive procedures have relied on gait data to justify their indications and proceed to offer the essential information for preoperative planning. Certain requirements must be maintained in order to facilitate greater acceptance for its clinical value: (1) physicians and surgeons should be involved in developing gait parameters for specific application; (2) gait analysis instrument and data reduction processes must be easy to use and able to produce fast, reliable, and consistent data; (3) gait analysis results must be able to differentiate normal and abnormal subjects with varying degrees of pathological involvement. It is of crucial importance to recognize that gait analysis can be used to assess disease progress and treatment outcome. Nevertheless, gait analysis and its laboratory operation cannot survive relying upon clinical service alone. Such facility must be justified through its value in education and research, which hopefully will also open up new avenues for future clinical applications. Functional evaluation of patients with knee arthrosis treated by high tibi~l osteotomy and total knee arthroplasty u&g objective gait analysis F Cutuni
Istituto Ortopedici Rizzoli, Istituto di Recerca CodivillaPutti, Bologna, Italy Degenerative joint disease at the knee is becoming more and more frequent due to the increase of trauma but
1i’5
overall to the increase in the average age. of life. The efficacy of the treatment in recovery, motion, and reducing pain depends upon many factors. Patient selection, implant position in the case of total knee replacement (TKR), mechanical and anatomical tibiofemoral angle in case of TKR or of tibia1 osteotomy, and general surgical techniques are the major determinants of successful surgery. The knee joint is responsible for the most demanding biomechanical functions of the musculoskeletal system because of the complexity of the trunk-lower limb joint co-ordination. The choice of treatment and the patient selection (osteotomy or total joint arthroplasty) in some cases is still cantroversial. High tibia1 osteotomy demonstrated a survivorship time of about 7 years and total joint anthroplasty performed in young patients may lead to several prosthesis revisions. The surgeon’s need is to have more quantitative data that can lead to a better treatment indication and to demonstrate the efficacy and the survivorship of the treatment. The early failure of both treatment procedures is not dependent only upon the uncorrected mechanical alignment but it also seems really important to know how the patient loads the knee during walking or during the daily living activities. It has been proven by gait analysis that the joint loading depends upon may factors, including trunk kinematics and particularly muscular pattern.
Clinical gait analysis of hip dim D R W Hmay, D Hynd, D J Ewing S C Hughes
Biomedical Engineering Group, Department of Mechanical Engineering, University of Surrey, Guildford, Surrey, UK Preliminary investigations in gait analysis have been conducted on the unique dual force platform system in the Biomedical Engineering Laboratories at the University of Surrey. To date 43 patients have been assessed; these include 23 lower-limb amputees, 20 male and three female. Included in these are three very-highlevel amputees with hip disarticulations. Patient BG is a right TH amputee age 54 amputated in 1977 for malignant fibrosarcoma. Patient AA is a left TH amputee age 27, amputated in 1977, again for fibrosarcoma. Patient PM is very rare in that he is a left TH amputee for osteosarcoma but also has a massive endoprosthetic distal femoral and total knee for chondrosarcoma. Aged 36, he was amputated in 1969. Each patient was asked to walk comfortably and safely along the platform at his or her own interpretation of walking speed. Measurements of vertical floor reaction forces with corresponding instantaneous centres of pressures and associated timings are recorded in real time. Concurrently with the force measurements, two-dimensional video is also recorded with split-screen techniques. The results will be analysed in relation to their individual prosthetic problems, i.e. hardware reliability, and the subsequent prescription charges recommended.