Trunk Lean in Control and Osteoarthritic Gait

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URL: http://hdl.handle.net/1974/2599

Abstract

Trunk lean over the stance limb during gait has been linked to a reduction in the knee adduction moment, which is associated with joint loading. Differences were examined in knee adduction moments and frontal plane trunk lean during gait between subjects with knee osteoarthritis and a control group of healthy adults. Additionally, subject variability in human motion data presents a challenge to researchers when trying to detect differences between subject groups. The individual differences in neutral posture between subjects is a source of variation in joint angles. A method was developed using principal component analysis (PCA) to objectively reduce this inter subject variability.

Gait analysis was performed on 80 subjects (40 osteoarthritis). Models were developed to define lateral thoracic tilt, as well as pelvic tilt. The trunk and pelvis frontal plane angles were used to describe trunk lean and pelvic tilt. Angles were calculated across the stance phase of gait. We analyzed the data, (i) by extracting discrete parameters (mean and peak) waveform values, and (ii) using principal component analysis (PCA) to extract shape and magnitude differences between the waveforms.

Osteoarthritis (OA) subjects had a higher knee adduction moment than the control group (α=0.05). Although the discrete parameters for trunk lean did not show differences between groups, PCA did detect characteristic waveform differences between the control and osteoarthritis groups. The data show that subjects display similar waveform shapes, however waveforms vary in magnitude, suggesting a variation in posture between subjects. The results from the PCA reveal that the first PC, which captures the most variation in the data, represents this variation in magnitude. The second PC describes a significant difference in range of motion between the subject groups.

Subjects with knee OA were found to have a different range of motion of their pelvis and trunk than control subjects. These changes are consistent with a strategy to lower the knee adduction moment. As an alternative to conventional subjective methods, PCA should be employed to reduce inter subject variability in order to ensure objective analysis in human motion waveform data.

Cited Works (13)

Year	Entry
1991	Davis RB III, Õunpuu S, Tyburski D, Gage JR. A gait analysis data collection and reduction technique. Hum Mov Sci. October 1991;10(5):575-587.
2007	Landry SC, McKean KA, Hubley-Kozey CL, Stanish WD, Deluzio KJ. Knee biomechanics of moderate OA patients measured during gait at a self-selected and fast walking speed. J Biomech. 2007;40(8):1754-1761.
2002	Miyazaki T, Wada M, Kawahara H, Sato M, Baba H, Shimada S. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis. July 2002;61(6):617-622.
1998	Hurwitz DE, Sumner DR, Andriacchi TP, Sugar DA. Dynamic knee loads during gait predict proximal tibial bone distribution. J Biomech. May 1998;31(5):423-430.
2002	Baliunas AJ, Hurwitz DE, Ryals AB, Karrar A, Case JP, Block JA, Andriacchi TP. Increased knee joint loads during walking are present in subjects with knee osteoarthritis. Osteoarthritis Cartilage. July 2002;10(7):573-579.
2008	Astephen JL, Deluzio KJ, Caldwell GE, Dunbar MJ. Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity. J Orthop Res. March 2008;26(3):332-341.
1998	Sharma L, Hurwitz DE, Thonar EJ-MA, Sum JA, Lenz ME, Dunlop DD, Schnitzer TJ, Kirwan-Mellis G, Andriacchi TP. Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Arthritis Rheum. July 1998;41(7):1233-1240.
1993	MacKinnon CD, Winter DA. Control of whole body balance in the frontal plane during human walking. J Biomech. June 1993;26(6):633-644.
2007	Deluzio KJ, Astephen JL. Biomechanical features of gait waveform data associated with knee osteoarthritis: an application of principal component analysis. Gait Post. January 2007;25(1):86-93.
1990	Kadaba MP, Ramakrishnan HK, Wootten ME. Measurement of lower extremity kinematics during level walking. J Orthop Res. May 1990;8(3):383-392.
2000	Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, Kington RS, Lane NE, Nevitt MC, Zhang Y, Sowers M, McAlindon T, Spector TD, Poole AR, Yanovski SZ, Ateshian G, Sharma L, Buckwalter JA, Brandt KD, Fries JF. Osteoarthritis: new insights, I: the disease and its risk factors. Ann Intern Med. October 17, 2000;133(8):635-646.
2002	Hurwitz DE, Ryals AB, Case JP, Block JA, Andriacchi TP. The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. J Orthop Res. January 2002;20(1):101-107.
1984	Winter DA. Kinematic and kinetic patterns in human gait: variability and compensating effects. Hum Mov Sci. March–June 1984;3(1-2):51-76.