Kinematic analysis is a useful and widespread tool used in research and clinical biomechanics for the quantification of human movement. Common marker-based optical motion capture systems are time ...intensive and require highly trained operators to obtain kinematic data. Markerless motion capture systems offer an alternative method for the measurement of kinematic data with several practical benefits. This work compared the kinematics of human gait measured using a deep learning algorithm-based markerless motion capture system to those from a standard marker-based motion capture system. Thirty healthy adult participants walked on a treadmill while data were simultaneously recorded using eight video cameras and seven infrared optical motion capture cameras, providing synchronized markerless and marker-based data for comparison. The average root mean square distance (RMSD) between corresponding joint centers was less than 2.5 cm for all joints except the hip, which was 3.6 cm. Lower limb segment angles relative to the global coordinate system indicated the global segment pose estimates from both systems were very similar, with RMSD of less than 5.5° for all segment angles except those that represent rotations about the long axis of the segment. Lower limb joint angles captured similar patterns for flexion/extension at all joints, ab/adduction at the knee and hip, and toe-in/toe-out at the ankle. These findings indicate that the markerless system would be a suitable alternative technology in cases where the practical benefits of markerless data collection are preferred.
Spatiotemporal parameters can characterize the gait patterns of individuals, allowing assessment of their health status and detection of clinically meaningful changes in their gait. Video-based ...markerless motion capture is a user-friendly, inexpensive, and widely applicable technology that could reduce the barriers to measuring spatiotemporal gait parameters in clinical and more diverse settings. Two studies were performed to determine whether gait parameters measured using markerless motion capture demonstrate concurrent validity with those measured using marker-based motion capture and a pressure-sensitive gait mat. For the first study, thirty healthy young adults performed treadmill gait at self-selected speeds while marker-based motion capture and synchronized video data were recorded simultaneously. For the second study, twenty-five healthy young adults performed over-ground gait at self-selected speeds while footfalls were recorded using a gait mat and synchronized video data were recorded simultaneously. Kinematic heel-strike and toe-off gait events were used to identify the same gait cycles between systems. Nine spatiotemporal gait parameters were measured by each system and directly compared between systems. Measurements were compared using Bland-Altman methods, mean differences, Pearson correlation coefficients, and intraclass correlation coefficients. The results indicate that markerless measurements of spatiotemporal gait parameters have good to excellent agreement with marker-based motion capture and gait mat systems, except for stance time and double limb support time relative to both systems and stride width relative to the gait mat. These findings indicate that markerless motion capture can adequately measure spatiotemporal gait parameters of healthy young adults during treadmill and over-ground gait.
The influence of tibial slope on tibial component migration following total knee arthroplasty has not been widely studied, although excessive posterior slope has been implicated in some failures. As ...implant micromotion measured with radiostereometric analysis can indicate successful fixation, the purpose of this study was to determine the associations between tibial slope, tibial component migration, and inducible displacement.
Radiostereometric analyses at 6 visits over 2 years quantified implant migration for 200 cemented total knee arthroplasties. Longitudinal data analysis examined the influence of postoperative tibial slope on implant migration (overall maximum total point motion (MTPM) migration and anterior–posterior tilt migration), accounting for age, sex, and body mass index. The correlations of tibial slope with 1-year migration, continuous migration, and inducible displacements were also examined. Additionally, the amount of change in slope was compared to migration.
The mean posterior tibial slope was 8.0° (standard deviation SD 3.8°) preoperatively and 3.8° (SD 3.1°) postoperatively, with a mean reduction in slope of 4.2° (SD 4.7°). Postoperative tibial slope (range 14.0° posterior slope to 3.4° anterior slope) was not associated with longitudinal overall migration (P = .671) or anterior–posterior tilt migration (P = .704). There was no association between postoperative tibial slope and migration at 1 year postoperatively (P = .441 for MTPM migration, P = .570 for tilt migration), change in migration from 1 to 2 years (P = .951), or inducible displacement (P = .970 MTPM, P = .730 tilt). The amount of change in tibial slope was also not associated with migration or inducible displacement.
Residual and change in postoperative tibial slope were not associated with implant migration into tilt or overall migration, or inducible displacement for a single implant design. These findings support positioning tibial implants in a range of slopes, which may support patient-specific approaches to implant alignment.
Balance tests have clinical utility in identifying balance deficits and supporting recommendations for appropriate treatments. Motion capture technology can be used to measure whole-body kinematics ...during balance tasks, but to date the high technical and financial costs have limited uptake of traditional marker-based motion capture systems for clinical applications. Markerless motion capture technology using standard video cameras has the potential to provide whole-body kinematic assessments with clinically accessible technology. Our aim was to quantify poses and movement strategies during static balance tasks (tandem stance, single limb stance, standing hip abduction, and quiet standing on foam with eyes closed) using video-based markerless motion capture software (Theia3D) and principal component analysis to examine the associations with age, body mass index (BMI) and sex. In 30 healthy adults, the mean poses for all balance tasks had at least one principal component (PC) that differed significantly by sex. Age was significantly associated with the PC describing leg height for the hip abduction task and erect posture for the quiet standing task. BMI was significantly associated with the PC capturing knee flexion in the single leg stance task. The movement strategies used to maintain balance showed significant differences by sex for the tandem stance pose. BMI was correlated with PCs for movement strategies for hip abduction and quiet standing tasks. Results from this study demonstrate how markerless motion capture technology could be used to augment analyses of balance both in the clinic and in the field.
Markerless motion capture allows whole-body movements to be captured without the need for physical markers to be placed on the body. This enables motion capture analyses to be conducted in more ...ecologically valid environments. However, the influences of varied clothing on video-based markerless motion capture assessments remain largely unexplored. This study investigated two types of clothing conditions, “Sport” (gym shirt and shorts) and “Street” (unrestricted casual clothing), on gait parameters during overground walking by 29 participants at self-selected speeds using markerless motion capture. Segment lengths, gait spatiotemporal parameters, and lower-limb kinematics were compared between the two clothing conditions. Mean differences in segment length for the forearm, upper arm, thigh, and shank between clothing conditions ranged from 0.2 cm for the forearm to 0.9 cm for the thigh (p < 0.05 for thigh and shank) but below typical marker placement errors (1 – 2 cm). Seven out of 9 gait spatiotemporal parameters demonstrated statistically significant differences between clothing conditions (p < 0.05), however, these differences were approximately ten times smaller than minimal detectable changes in movement-related pathologies including multiple sclerosis and cerebral palsy. Hip, knee, and ankle joint angle root-mean-square deviation values averaged 2.6° and were comparable to previously reported average inter-session variability for this markerless system (2.8°). The results indicate that clothing, a potential limiting factor in markerless motion capture performance, would negligibly alter meaningful clinical interpretations under the conditions investigated.
The low radiation biplanar X-ray imager (EOS imaging, Paris, France) scans patients in a weight-bearing position, provides calibrated images, and limits radiation, an asset for serial ...radiostereometric analysis (RSA) studies. RSA in vivo precision values have not been published for this type of imaging system, thus the goal of this study was to assess the precision of RSA in vivo utilizing a low radiation biplanar imager.
At a mean of 5 years post-surgery (range 1.4-7.5 years), 15 total knee arthroplasty (TKA) participants (mean age 67 years at the time of imaging, 12 female, 3 male) with RSA markers implanted during index surgery were scanned twice at the same visit in the EOS imager. Precision of marker-based analysis was calculated by comparing the position of the implant relative to the underlying bone between the 2 examinations.
The 95% limit of precision was 0.11, 0.04, and 0.15 mm along the x, y, and z axes, respectively and 0.15°, 0.20°, and 0.14° around the same axes.
This precision study has shown an in vivo RSA precision of ≤ 0.15 mm and ≤ 0.20°, well within published uniplanar values for conventional arthroplasty RSA, with the added benefit of weight-bearing imaging, a lower radiation dose, and without the need for a reference object during the scan.
This updated meta-analysis evaluates the migration pattern of the tibial component of primary total knee replacements measured with radiostereometric analysis (RSA). We aimed to evaluate whether ...6-month maximum total point motion (MTPM) values could be used instead of 1-year MTPM for RSA threshold testing and to present the pooled migration patterns for different implant designs that can be used as a benchmark.
The search included all published RSA studies on migration patterns of tibial components until 2023. Study groups were classified according to their prosthesis brand, fixation, and insert (PFI). Sub-analyses were performed to compare the mean tibial component migration patterns of different implant variables, stratified according to fixation.
96 studies (43 new studies), including 197 study groups and 4,706 knees, were included. Most migration occurred within the first 6 postoperative months (126 study groups: mean 0.58 mm, 95% confidence interval CI 0.50-0.65), followed by minimal migration between 6 and 12 months (197 study groups: mean 0.04 mm, CI 0.03-0.06), irrespective of the fixation method used. Distinct migration patterns were observed among the different fixation methods. No differences were found in migration patterns among cemented components in any of the sub-group analyses conducted. For uncemented implants, trabecular metal surfaced components seemed to migrate less than porous-coated or uncoated components Conclusion: Based on the small difference between MTPM values at 6 months and 1 year, MTPM at 6 months could be used instead of MTPM at 1 year for RSA threshold testing. The pooled migration patterns can be used as benchmark for evaluation of new implants by defining fixation-specific RSA thresholds when combined with implant survival.
Background and purpose - Thresholds of implant migration for predicting long-term successful fixation of tibial components in total knee arthroplasty have not separated cemented and uncemented ...fixation. We compared implant migration of cemented and uncemented components at 1 year and as the change in migration from 1 to 2 years.
Patients and methods - Implant migration of 360 tibial components measured using radiostereometric analysis was compared at 1 year and as the change in migration from 1 to 2 years in 222 cemented components (3 implant designs) and 138 uncemented components (5 implant designs).
Results - 1-year maximum total point motion was lower for the cemented tibial components compared with the uncemented components (median = 0.31 mm 0.03-2.98 versus 0.63 mm 0.11-5.19 respectively, p < 0.001, mixed model). The change in migration from 1 to 2 years, however, was equivalent for cemented and uncemented components (mean SD 0.06 mm 0.19 and 0.07 mm 0.27 mm respectively, p = 0.6, mixed model).
Interpretation - These findings suggest that current thresholds of acceptable migration at 1 year may be better optimized by considering cemented and uncemented tibial components separately as higher early migration of uncemented components was not associated with decreased stability from 1 to 2 years.
The anatomic dual mobility (ADM) acetabular component was introduced because of previously described low dislocation rates for this type of construct. The shape of the anatomic cup and the motion of ...polyethylene liner may have implications for acetabular cup fixation and polyethylene liner wear; therefore, the purpose of this study was to assess the migration patterns and wear rates of the ADM component using radiostereometric analysis.
Uncemented ADM acetabular components were implanted in 27 patients. Radiostereometric analysis exams were taken at 6 follow-up visits over 3 years. Proximal translation and sagittal rotation of the cup and polyethylene total wear and wear rates were calculated. Oxford 12 Hip scores and satisfaction were recorded.
Mean proximal translation was below the 0.2 mm threshold at 2 years associated with acceptable long-term survivorship (0.16 mm standard deviation {SD} 0.31 at 3 years). Mean sagittal rotation was 0.29 degrees (SD 1.03) and was greater in female subjects (P < .001). Following bedding-in, the annual wear rate was 0.02 mm/y, below the 0.1 mm/y threshold. There was no association between cup migration and polyethylene wear. Patient satisfaction at 3 years was 96%. Mean Oxford 12 Hip scores improved from 21 (SD 7) preoperatively to 43 (SD 7) 3 years postoperatively.
The ADM cup demonstrated stable migration at 3 years indicating low risk for aseptic loosening. Bedding-in in the first year was followed by low annual wear rates. These finding suggest no increased risk of the dual mobility and anatomic design on fixation or wear.
High-viscosity (HV) bone cements have been formulated to offer potentially advantageous handling characteristics. However, alteration in the handling characteristics could influence implant fixation ...and survival. The primary objective of this study was to use radiostereometric analysis after total knee arthroplasty to assess the migration of the Triathlon tibial component fixed with HV cement (Simplex HV).
Twenty-three patients were followed for two years with radiostereometric analysis examinations at 6 visits. Migration was compared with published thresholds and with a control group from a previously published study from the same center using the same implants fixed with a medium viscosity cement. Inducible displacement was assessed, and Oxford 12 Knee Scores and satisfaction were recorded.
Mean maximum total point motion migration reaching 0.40 mm (SD 0.16) at one year, and 0.41mm (SD 0.17) at two years, demonstrating a pattern of stable fixation, below published thresholds of acceptable migration, and not significantly different from the control group. One implant had continuous migration between 1 and 2 years but was clinically asymptomatic. Mean maximum total point motion inducible displacement measured at least one year postoperatively was 0.3 mm (SD 0.12). Mean Oxford 12 Knee Scores improved from 19 (SD 7) preoperatively to 42 (SD 8) 2 years postoperatively.
The use of HV cement demonstrated an acceptable pattern of migration at 2 years, indicating low risk for aseptic loosening.
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