Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?

Rowe, Philip; Myles, C.M.; Walker, C.; Nutton, R.W.

doi:10.1016/s0966-6362(00)00060-6

Cited by 336 publications

(214 citation statements)

References 5 publications

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“…Mobility following total knee arthroplasty (TKA) or total hip arthroplasty (THA) is often considered adequate if it allows patients to walk, climb stairs, or sit on a chair. [1][2][3][4] Furthermore, according to Tew and colleagues,4 at the time of their study, kneeling or squatting would be unattainable following TKA. This is because the maximum flexion provided by most available knee prostheses is between 1108 5 and 1208.…”

Section: Introductionmentioning

confidence: 99%

Hip, knee, and ankle kinematics of high range of motion activities of daily living

et al. 2006

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Treatment of joint disease that results in limited flexion is often rejected by patients in non-Western cultures whose activities of daily living require a higher range of motion at the hip, knee, or ankle. However, limited information is available about the joint kinematics required for high range of motion activities, such as squatting, kneeling, and sitting cross-legged, making it difficult to design prosthetic implants that will meet the needs of these populations. Therefore, the objective of this work was to generate three-dimensional kinematics at the hip, knee, and ankle joints of Indian subjects while performing activities of daily living. Thirty healthy Indian subjects (average age: 48.2 AE 7.6 years) were asked to perform six trials of the following activities: squatting, kneeling, and sitting cross-legged. Floating axis angles were calculated at the joints using the kinematic data collected by an electromagnetic motion tracking device with receivers located on the subject's foot, shank, thigh, and sacrum. A mean maximum flexion of 1578 AE 68 at the knee joint was required for squatting with heels up. Mean maximum hip flexion angles reached up to 958 AE 278 for squatting with heels flat. The high standard deviation associated with this activity underscored the large range in maximum hip flexion angles required by different subjects. Mean ankle range of flexion reached 588 AE 148 for the sitting cross-legged activity. The ranges of motion required to perform the activities studied are greater than that provided by most currently available joint prostheses, demonstrating the need for high range of motion implant design. ß

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Section: Introductionmentioning

confidence: 99%

Hip, knee, and ankle kinematics of high range of motion activities of daily living

et al. 2006

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“…Stairs are often encountered in daily living and require greater lower-extremity ROM and strength to negotiate, compared to level ground walking [1,6,11,15]. Stair ascent may be challenging for individuals with above-theknee (transfemoral) amputation because of the importance of knee ROM and extensor muscles in stair ascent [10].…”

Section: Introductionmentioning

confidence: 99%

Does a Microprocessor-controlled Prosthetic Knee Affect Stair Ascent Strategies in Persons With Transfemoral Amputation?

Whitehead

Wolf

Scoville

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Stair ascent can be difficult for individuals with transfemoral amputation because of the loss of knee function. Most individuals with transfemoral amputation use either a step-to-step (nonreciprocal, advancing one stair at a time) or skip-step strategy (nonreciprocal, advancing two stairs at a time), rather than a step-over-step (reciprocal) strategy, because step-to-step and skip-step allow the leading intact limb to do the majority of work. A new microprocessor-controlled knee (Ottobock X2 1 ) uses flexion/extension resistance to allow step-over-step stair ascent. Questions/Purposes We compared self-selected stair ascent strategies between conventional and X2 1 prosthetic knees, examined between-limb differences, and differentiated stair ascent mechanics between X2 1 users and individuals without amputation. We also determined which factors are associated with differences in knee position during initial contact and swing within X2 1 users. Methods Fourteen individuals with transfemoral amputation participated in stair ascent sessions while using conventional and X2 1 knees. Ten individuals without amputation also completed a stair ascent session. Lowerextremity stair ascent joint angles, moment, and powers and ground reaction forces were calculated using inverse dynamics during self-selected strategy and cadence and controlled cadence using a step-over-step strategy. Results One individual with amputation self-selected a stepover-step strategy while using a conventional knee, while 10 individuals self-selected a step-over-step strategy while using X2 1 knees. Individuals with amputation used greater prosthetic knee flexion during initial contact (32.5°, p = 0.003) and swing (68.2°, p = 0.001) with higher intersubject variability while using X2 1 knees compared to conventional knees (initial contact: 1.6°, swing: 6.2°). The increased prosthetic knee flexion while using X2 1 knees normalized knee kinematics to individuals without amputation during swing (88.4°, p = 0.179) but not during initial contact (65.7°, p = 0.002). Prosthetic knee flexion during initial contact and swing were positively correlated with prosthetic limb hip power during pull-up (r = 0.641, p = 0.046) and push-up/ early swing (r = 0.993, p \ 0.001), respectively. Conclusions Participants with transfemoral amputation were more likely to self-select a step-over-step strategy similar to individuals without amputation while using X2 1 knees than conventional prostheses. Additionally, the increased prosthetic knee flexion used with X2 1 knees placed large power demands on the hip during pull-up and push-up/early swing. A modified strategy that uses less knee flexion can be used to allow step-over-step ascent in individuals with less hip strength. Level of EvidenceLevel II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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“…In general, gait and climbing slopes required greater than 90°knee flexion, using stairs and getting in and out of chairs required 90°to 120°fl exion, and getting in and out of a bath required 135°fl exion [40,50]. Individuals typically need 111°to 165°k nee flexion for kneeling, squatting, and sitting crosslegged [21,39,41].…”

Section: Introductionmentioning

confidence: 99%

“…Individuals typically need 111°to 165°k nee flexion for kneeling, squatting, and sitting crosslegged [21,39,41]. Activities such as golf, catching in a softball game, meditation, yoga, and gardening often require knee flexion greater than 150° [39,50]. Checking Dr. Freiberg has received consulting fees and royalties from Biomet Inc, Warsaw, IN, and Zimmer, Inc, Warsaw, IN.…”

Section: Introductionmentioning

confidence: 99%

“…However, the laboratory requires trained personnel and is time-consuming and costly. A third method, flexible electrogoniometry, was introduced as a promising outcome measure that evaluates functional range of motion of the knee in the clinical setting [40,50]. One study of patients evaluated with flexible electrogoniometry before and after TKA concluded this cohort of patients failed to exploit the range of knee motion available to them while performing activities of daily living [40].…”

Section: Introductionmentioning

confidence: 99%

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2009 Marshall Urist Young Investigator Award: How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion?

Huddleston¹,

Scarborough

Goldvasser

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Although high-flexion TKA designs aim to safely accommodate deep flexion, it is unknown how often patients use deep flexion outside the laboratory. We used a validated smart-activity monitor to document the prevalence of knee flexion greater than 90°in 20 consecutive patients (21 knees) who had high-flexion TKAs, at a minimum of 2 years' followup. Patients wore the device continuously for a mean of 35.7 ± 0.5 hours. The 21 knees flexed more than 90°for an average of 10 ± 3.8 minutes (0.5%). Activities performed with flexion greater than 90°w ere, on average, 70% in single-limb stance, 12% moving from sitting to standing, 8% walking, 7% moving from standing to reclining, 2% stepping, 0.9% moving from lying to standing, and 0.1% running. Eight knees flexed greater than 120°for an average of 2.2 minutes (range, 0.2-15 minutes), or 0.1% of the testing time. Activities performed with flexion greater than 120°were, on average, 90% in single-limb stance, 6% moving from sitting to standing, 3% walking, 0.6% moving from standing to reclining, 0.3% stepping, and 0.1% moving from lying to standing. Peak flexion used at any time during testing was, on average, 84%

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Knee joint kinematics in gait and other functional activities measured using flexible electrogoniometry: how much knee motion is sufficient for normal daily life?

Cited by 336 publications

References 5 publications

Hip, knee, and ankle kinematics of high range of motion activities of daily living

Hip, knee, and ankle kinematics of high range of motion activities of daily living

Does a Microprocessor-controlled Prosthetic Knee Affect Stair Ascent Strategies in Persons With Transfemoral Amputation?

2009 Marshall Urist Young Investigator Award: How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion?

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