Comparison between passive knee kinematics during surgery and active knee kinematics during walking: A preliminary study

PLOS ONE RESEARCH ARTICLE Comparison between passive knee kinematics during surgery and active knee kinematics during walking: A preliminary study Xavier Gasparutto ID1*, Alice Bonnefoy-Mazure1, Michael Attias2, Raphaël Dumas ID3, Stéphane Armand1, Hermès Miozzari4 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland, 2 School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland, 3 Claude Bernard University Lyon 1 and Gustave Eiffel University, LBMC UMR_T9406, University of Lyon and Laboratory of Biomechanics and Impact Mechanics, Lyon, France, 4 Department of Orthopaedic Surgery and Trauma Care, Geneva University Hospitals, Geneva, Switzerland * Abstract OPEN ACCESS Citation: Gasparutto X, Bonnefoy-Mazure A, Attias M, Dumas R, Armand S, Miozzari H (2023) Comparison between passive knee kinematics during surgery and active knee kinematics during walking: A preliminary study. PLoS ONE 18(3): e0282517. https://doi.org/10.1371/journal. pone.0282517 Editor: Emiliano Cè, Universita degli Studi di Milano, ITALY Received: December 8, 2021 Accepted: February 17, 2023 Published: March 6, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0282517 Copyright: © 2023 Gasparutto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Recovery of function is among a patient’s main expectations when undergoing total knee arthroplasty (TKA). However, normal gait knee function is not always completely restored, which can affect patient satisfaction and quality of life. Computer-assisted surgery (CAS) allows surgeons to evaluate passive knee kinematics intra-operatively. Understanding associations between knee kinematics measured during surgery and during daily activities, such as walking, could help define criteria for success based on knee function and not only on the correct alignment of the implant or the leg. This preliminary study compared passive knee kinematics measured during surgery with active kinematics measured during walking. Eight patients underwent a treadmill gait analysis using the KneeKG™ system both before surgery and three months afterwards. Knee kinematics were measured during CAS both before and after TKA implantation. The anatomical axes of the KneeKG™ and CAS systems were homogenised using a two-level, multi-body kinematics optimisation with a kinematic chain based on the calibration measured during CAS. A Bland–Altman analysis was performed before and after TKA for adduction–abduction angle, internal–external rotation, and anterior–posterior displacement over the whole gait cycle, at the single stance phase and at the swing phase. Homogenising the anatomical axes between CAS and treadmill gait led to limited median bias and limits of agreement (post-surgery -0.6 ± 3.6 deg, -2.7 ± 3.6 deg, and -0.2 ± 2.4 mm for adduction–abduction, internal–external rotation and anterior–posterior displacement, respectively). At the individual level, correlations between the two systems were mostly weak (R2 < 0.3) over the whole gait cycle, indicating low kinematic consistency between the two measurements. However, correlations were better at the phase level, especially the swing phase. The multiple sources of differences did not enable us to conclude whether they came from anatomical and biomechanical differences or from measurement system errors. Data Availability Statement: All data are shared on the online repository Yareta (https://doi.org/10. 26037/yareta:33ylesvms5heboezppb7nkcpau). PLOS ONE | https://doi.org/10.1371/journal.pone.0282517 March 6, 2023 1 / 13 PLOS ONE Code are shared on GitLab (https://gitlab.unige.ch/ KLab). Funding: This work was supported by Geneva University Hospitals’ Department of Orthopaedic Surgery and Trauma Care. The funding source played no role in the study’s design. Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Hermes Miozzari is an associate editor for EFORT Open Reviews and a board member of Swiss Orthopaedics. Stéphane Armand is a member of the editorial board of EFORT Open Reviews. There are no competing interests associated with this research. Comparison between knee kinematics during surgery and walking: A preliminary study Introduction The primary expectation for patients undergoing total knee arthroplasty (TKA) is pain relief. The four next most frequently expressed expectations are all linked to the recovery of function: mobility, walking, physical activities and daily activities [1]. However, TKA does not always fully restore knee function [2], which patients may experience as a failure, with direct effects on their satisfaction and quality of life [3]. In this context, several tools and technologies have been developed to support surgeons in their practice and to assess the knee joint’s functional behaviour during surgery (passive movements) and functional tasks such as walking (active movements). Computer-assisted surgery (CAS) was developed to help plan and execute surgical interventions [4]; its goal is to improve the accuracy and precision of component positioning and leg alignment [4]. More recent CAS systems can also evaluate passive knee kinematics and stability and provide real-time feedback on multiple parameters, such as implant positioning and overall alignment, passive knee range of motion (RoM), ligament balancing and knee laxity during surgery. Fluoroscopy and optoelectronic motion-capture systems are the current standards for assessing active knee movements before and after TKA. Contrary to optoelectronic methods, however, fluoroscopy is not affected by soft-tissue artefacts (STAs) and is thus the gold standard for evaluating active knee function. However, fluoroscopy is highly invasive due to the large dose of radiation received during measurement and the need to perform a CT scan of the lower limb. This method is mainly used for research purposes and, in clinical settings, optoelectronic systems such as the KneeKG™ [5] are the standard means of measuring knee function. The KneeKG™ system was developed to provide patients with a knee kinesiography examination during walking [6], i.e. a measurement of knee kinematics in mobility-impaired patients. This system could be considered the silver standard for knee assessment as it provides surgeons with a rapid understanding of a patient’s knee kinematics and gait (...truncated)