Advanced multimodal visualisation of clinical gait and fluoroscopy analyses in the assessment of total knee replacement

Traditional gait and fluoroscopy analysis of human movement are largely utilised but are still limited in registration, integration, synchronisation and visualisation capabilities. The present work exploits the features of a recently developed software tool based on multimodal display (Data Manager developed within the EU-funded project 'Multimod') in an exemplary clinical case. Standard lower limb gait analysis, comprising segment position, ground reaction force and EMG data collection, and three-dimensional fluoroscopy analysis at the replaced joint were performed in a total knee replacement patient while ascending stairs. Clinical information such as X-rays and standard scores were also available. Data Manager was able to import all this variety of data and to structure these in an original hierarchical tree. Bone and prosthesis component models were registered to corresponding marker position data for effective three-dimensional animations. These were also synchronised with corresponding standard video sequences. Animations, video, time-histories of collected and also processed data were shown in various combinations, according to specific interests of the bioengineering and medical professionals expected to observe and to interpret this large amount of data. This software tool demonstrated to be a valuable means to enhance representation and interpretation of measurements coming from human motion analysis. In a single software, a thorough and effective clinical and biomechanical analysis of human motion was performed.

[1]  S H Holzreiter,et al.  Assessment of gait patterns using neural networks. , 1993, Journal of biomechanics.

[2]  William K. Pratt,et al.  Digital image processing (2nd ed.) , 1991 .

[3]  J J O'Connor,et al.  Bone position estimation from skin marker co-ordinates using global optimisation with joint constraints. , 1999, Journal of biomechanics.

[4]  G. Ferrigno,et al.  Technique for the evaluation of derivatives from noisy biomechanical displacement data using a model-based bandwidth-selection procedure , 1990, Medical and Biological Engineering and Computing.

[5]  I Söderkvist,et al.  Determining the movements of the skeleton using well-configured markers. , 1993, Journal of biomechanics.

[6]  K N An,et al.  Calibration of measured center of pressure of a new stairway design for kinetic analysis of stair climbing. , 1996, Journal of biomechanics.

[7]  D A Dennis,et al.  Mobile-bearing knee replacement: concepts and results. , 2000, Instructional course lectures.

[8]  T P Andriacchi,et al.  Studies of human locomotion: past, present and future. , 2000, Journal of biomechanics.

[9]  C. Ranawat,et al.  Total condylar knee replacment: preliminary report. , 1976, Clinical orthopaedics and related research.

[10]  A S Arnold,et al.  Graphics-based modeling and analysis of gait abnormalities. , 1998, Bio-medical materials and engineering.

[11]  A. Leardini,et al.  Data management in gait analysis for clinical applications. , 1998, Clinical biomechanics.

[12]  Alberto Leardini,et al.  The MULTIMOD Data Manager: An essential tool for musculo-skeletal modelling , 2004 .

[13]  M G Benedetti,et al.  Analysis of ground reaction forces by means of wavelet transform. , 2000, Clinical biomechanics.

[14]  A. Cappozzo,et al.  Human movement analysis using stereophotogrammetry. Part 3. Soft tissue artifact assessment and compensation. , 2005, Gait & posture.

[15]  J. Gage Gait analysis. An essential tool in the treatment of cerebral palsy. , 1993, Clinical orthopaedics and related research.

[16]  A Cappello,et al.  Skin movement artefact assessment and compensation in the estimation of knee-joint kinematics. , 1998, Journal of biomechanics.

[17]  D A Dennis,et al.  In Vivo Knee Kinematics Derived Using an Inverse Perspective Technique , 1996, Clinical orthopaedics and related research.

[18]  D Hailey,et al.  An assessment of gait analysis in the rehabilitation of children with walking difficulties , 2000, Disability and rehabilitation.

[19]  Steven J Stanhope,et al.  A novel method for displaying gait and clinical movement analysis data. , 2004, Gait & posture.

[20]  D R Pedersen,et al.  A comparison of the accuracy of several hip center location prediction methods. , 1990, Journal of biomechanics.

[21]  James R. Gage,et al.  Gait Analysis: Principles and Applications , 1995 .

[22]  M Pearcy,et al.  Graphical presentation of the range of hip and knee rotations for clinical evaluation of gait. , 2001, Clinical biomechanics.

[23]  G. Ferrigno,et al.  Real-time human motion estimation using biomechanical models and non-linear state-space filters , 2006, Medical and Biological Engineering and Computing.

[24]  E S Grood,et al.  A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. , 1983, Journal of biomechanical engineering.

[25]  A Leardini,et al.  Position and orientation in space of bones during movement: anatomical frame definition and determination. , 1995, Clinical biomechanics.

[26]  H J Sommer,et al.  A three-dimensional musculoskeletal database for the lower extremities. , 1997, Journal of biomechanics.

[27]  Angelo Cappello,et al.  Fluoroscopic and gait analysis of the functional performance in stair ascent of two total knee replacement designs. , 2003, Gait & posture.

[28]  Paul J. Besl,et al.  A Method for Registration of 3-D Shapes , 1992, IEEE Trans. Pattern Anal. Mach. Intell..

[29]  S A Banks,et al.  The mechanics of knee replacements during gait. In vivo fluoroscopic analysis of two designs. , 1997, The American journal of knee surgery.

[30]  S.A. Banks,et al.  Accurate measurement of three-dimensional knee replacement kinematics using single-plane fluoroscopy , 1996, IEEE Transactions on Biomedical Engineering.

[31]  A. Cappozzo,et al.  Human movement analysis using stereophotogrammetry. Part 2: instrumental errors. , 2004, Gait & posture.

[32]  Angelo Cappello,et al.  Multiple anatomical landmark calibration for optimal bone pose estimation , 1997 .

[33]  Loslever,et al.  Multivariate graphical presentation for gait rehabilitation study. , 1998, Gait & posture.

[34]  I. Charlton,et al.  Repeatability of an optimised lower body model. , 2004, Gait & posture.

[35]  Alberto Leardini,et al.  A model-based method for the reconstruction of total knee replacement kinematics , 1999, IEEE Transactions on Medical Imaging.

[36]  Lorenzo Chiari,et al.  Human movement analysis using stereophotogrammetry. Part 4: assessment of anatomical landmark misplacement and its effects on joint kinematics. , 2005, Gait & posture.

[37]  Christoph Bregler,et al.  Non-Rigid Modeling of Body Segments for Improved Skeletal Motion Estimation , 2003 .

[38]  Thomas P. Andriacchi,et al.  Gait biomechanics and the evolution of total joint replacement , 1997 .

[39]  A. Cappozzo,et al.  Human movement analysis using stereophotogrammetry. Part 1: theoretical background. , 2005, Gait & posture.

[40]  W A Hodge,et al.  Making Sense of Knee Arthroplasty Kinematics: News You Can Use , 2003, The Journal of bone and joint surgery. American volume.