Correcting lower limb segment axis misalignment in gait analysis: A simple geometrical method

Abstract

Background: Obtaining precise and repeatable measurements is essential to clinical gait analysis. However, defining the thigh medial-lateral axis segment remains a challenge, with particular implications for the hip rotation profile. Thigh medial-lateral axis misalignment modifies the hip rotation profile and can result in a phenomenon called crosstalk, which increases knee adduction-abduction amplitude artificially.

Research question: This study proposes an a posteriori geometrical method based solely on segment anatomy that aims to correct the thigh medial-lateral axis definition and crosstalk-related error.

Methods: The proposed method considers the thigh medial-lateral axis as the normal to the mean sagittal plane of the lower limb defined by hip, knee and ankle joint centres during one gait cycle. Its performance was compared to that of an optimisation method which repositions the axis to reduce knee abduction-adduction variance. An existing dataset was used: 75 patients with a knee prosthesis undergoing gait analysis three months and one-year post-surgery. Three-dimensional hip and knee angles were computed for two gait analysis sessions. Crosstalk was quantified using both the coefficient of determination (r²) between knee flexion-extension and adduction-abduction and the amplitude of knee adduction-abduction. The reproducibility of hip internal-external rotation was also quantified using the inter-trial, inter-session and inter-subject standard deviations and the intraclass coefficient (ICC).

Results: Crosstalk was significantly reduced from r² = 0.67 to r² = 0.51 by the geometrical method but remained significantly higher than with the optimisation method with a r² < 0.01.

Significances: Both methods allowed to improve the hip internal-external reproducibility from poor to moderate (original data: ICC = 0.34, geometrical method: ICC = 0.65, optimisation method ICC = 0.73). One advantage of the geometrical method is that, unlike the optimisation method, it does not require much movement, making it suitable for a wider range of patients.

Keywords: Clinical gait analysis; Gait; Hip internal-external rotation reproducibility; Knee crosstalk.