Disregard for patient-specific joint-level variability may be related to decreased functional ability, poor implant longevity and dissatisfaction post-TKA. The purpose of this study was to, 1) compare pre and post-implant intraoperative passive knee adduction angle kinematic patterns and characterize the effect of surgical intervention on each pattern, 2) examine the association between passive pre and post-implant knee kinematics measured intraoperatively and dynamic knee kinematics and kinetics pre and post-TKA measured during gait, and 3) compare dynamic post-TKA kinematic and kinetic patterns between patient-specific knee recipients and traditional TKA recipient. Patients received a TKA using the Stryker Precision Knee navigation system capturing pre/post-implant kinematics through a passive range of flexion. One-week prior and 1-year post-TKA patients underwent three-dimensional gait analysis. Knee joint waveforms were calculated according to the joint coordinate system. Principal component analysis (PCA) was applied to frontal plane gait angles, moments and navigation angles. Paired two- tailed t-tests were used to compare principal component (PC) scores between pre and post-implant patterns, and a one-way ANOVA was used to test if post-implant patterns were significantly different from zero. Two-tailed Pearson correlation coefficients tested for associations between navigation and gait PCscores, and an un-paired two-tailed t-test was used to compare PCscores between patient-specific and traditional TKA groups. Six different passive kinematic phenotypes were captured pre-implant. Although some waveform patterns persisted at small magnitudes post-implant (PC1 and PC3: p<0.001), curves remained within the clinically acceptable alignment range through passive motion. A positive correlation was found between navigation adduction angle PC1 and gait adduction moment PC1 pre and post-TKA (p<0.001, r=0.79; p<0.01 r=0.67), and a negative correlation between navigation adduction angle PC1 and gait adduction angle PC1 post-TKA (p=0.03, r=-0.53). The patient-specific group showed significantly lower PC2 scores than the traditional TKA group (p=0.03), describing a lower flexion moment magnitude during early stance phase, possibly representing a functional limitation or non- confidence during gait. These results were an important first step to assess patient- specific approaches to TKA, suggesting possible applications for patient-specific intraoperative kinematics to aid in surgical decision-making and influence functional outcomes.

[ES] El hombro es una articulación compleja en la que interaccionan múltiples estructuras, lo que permite la realización de movimientos de gran amplitud. Debido a esta característica, puede ser fácilmente alterada si alguno de los componentes falla. Las patologías del hombro son variadas, así como diversa es la sintomatología y el nivel de alteración funcional. El grado de afectación funcional puede ser valorado ya sea mediante escalas clínicas, o con pruebas biomecánicas basadas en el análisis cinemático, que añaden objetividad a los resultados. No obstante, los modelos cinemáticos disponibles en la actualidad no ofrecen una representación realista del movimiento articular, lo que supone una importante limitación a la hora de desarrollar sistemas de valoración funcional. El objetivo principal de esta tesis fue describir el movimiento del hombro mediante técnicas cinemáticas avanzadas que incluyeran el uso de variables funcionales asociadas a la posición, velocidad y aceleración, así como la descripción de la trayectoria del eje instantáneo de rotación, con la finalidad de desarrollar un nuevo enfoque en las técnicas de valoración funcional del hombro. La muestra de estudio estuvo compuesta por 41 sujetos sanos y 15 sujetos con patología de hombro. Se analizaron los movimientos de abducción en el plano frontal y escapular, sin peso y con una maza de 1kg. Se utilizó la escala EVA (Escala Visual Analógica), para determinar el nivel de dolor percibido y la escala DASH (Disabilities of the arm, shoulder and hand), para definir el grado funcional. Se realizó un análisis de variables numéricas, variables funcionales, reproducibilidad y armonía del movimiento y descripción de la trayectoria del eje instantáneo de rotación (EIR). Como resultado, se ha demostrado la alta fiabilidad del procedimiento. Las diferencias encontradas entre los sujetos sanos y patológicos, solo eran evidentes a nivel de grupos, además la dispersión de la muestra era considerable. Los valores de reproducibilidad y armonía fueron similares para los dos grupos. En promedio, los sujetos patológicos tenían menor ángulo, velocidad y aceleración, pérdida que se producía de forma continua a lo largo del ciclo, como se observa en el análisis de las funciones del movimiento. Se encontró que la escala DASH guardaba una relación con las variables cinemáticas funcionales, si bien, era moderada. Por otra parte, al aumentar el nivel de afectación, se observaba una clara disminución de la velocidad angular, y un cambio en el patrón de movimiento. Con respecto al efecto de la carga, no se encontraron diferencias claras en la población de estudio. Finalmente, la trayectoria del EIR describía una ruta de inicio por debajo del acromion, seguido de un desplazamiento vertical y medio-lateral, con un patrón que aunque era similar entre los grupos, se veía afectado de forma diferente por el dolor o el nivel de afectación funcional en la muestra de patológicos. En conclusión, los resultados indican que las variables funcionales son más sensibles a los cambios que las variables numéricas clásicas basadas en rangos o valores máximos. Por otra parte, las diferencias encontradas entre los sujetos patológicos y los sanos, solo son claras a nivel de conjunto, pero no separan de forma nítida a los individuos de cada grupo, pudiendo ser solo evidentes en caso de afectaciones muy severas, pero no con niveles moderados o bajos. El estudio del EIR es novedoso y proporciona información acerca de la coordinación del movimiento, aspecto de especial relevancia dada la composición del complejo articular del hombro. Finalmente, de los resultados se extrae el interés del uso de medidas repetidas usando el sujeto como factor y utilizando las escalas de valoración funcional, ya que el uso solo de datos biomecánicos no parece ser suficiente. / [CAT] El muscle és una articulació complexa en la qual interaccionen múltiples estructures, la qual cosa permet la realització de moviments de gran amplitud. A causa d'aquesta característica, pot ser facilment alterada si algun dels components falla. Les patologies del muscle són variades, així com diversa és la simptomatologia i el nivell d'alteració funcional. El grau d'afectació funcional pot ser valorat ja siga mitjanvant escales clíniques, o amb proves biomecaniques basades en l'analisi cinematica, que afigen objectivitat als resultats. No obstant aixo, els models cinematics disponibles en l'actualitat no ofereixen una representació realista del moviment articular, la qual cosa suposa una important limitació a l'hora de desenvolupar sistemes de valoració funcional. L'objectiu principal d'aquesta tesi va ser descriure el moviment del muscle mitjanvant tecniques cinematiques avanvades que inclogueren l'ús de variables funcionals associades a la posició, velocitat i acceleració, així com la descripció de la trajectoria de l'eix instantani de rotació, amb la finalitat de desenvolupar un nou enfocament en les tecniques de valoració funcional del muscle. La mostra d'estudi va estar composta per 41 subjectes sans i 15 subjectes amb patología de muscle. Es van analitzar els moviments d'abducció en el pla frontal i en el pla escapular, amb pes d'1 quilogram i sense pes. Es va utilitzar l'escala EVA (escala visual analogica), per a determinar el nivell de dolor percebut i l'escala DASH (Disabilities of the arm, shoulder and hand), per a definir el grau funcional. Es va realitzar una analisi de variables numeriques, variables funcionals, reproducibilitat i harmonia del moviment i descripció de la trajectoria de l'eix instantani de rotació. Com a resultat, s'ha demostrat l'alta fiabilitat del procediment. Les diferencies oposades entre els subjectes sans i patologics, només eren evidents a nivell de grups, a més la dispersió de la mostra era considerable. Els valors de reproducibilitat i harmonia van ser similars per als dos grups. En mitjana, els subjectes patologics tenien menor angle, velocitat i acceleració, perdua que es produia de forma contínua al llarg del cicle, com s'observa en l'analisi de les funcions del moviment. Es va trobar que l'escala DASH guardava una relació con les variables cinematiques funcionals, si bé, era moderada. D'altra banda, en augmentar el nivell d'afectació, s'observava una clara disminució de la velocitat angular, i un canvi en el patró de moviment. Respecte a l'efecte de la carrega, no es van trobar diferencies clares en la població d'estudi. Finalment, la trajectoria del EIR descrivia una ruta d'inici per davall de l'acromi, seguit d'un desplavament vertical i mig-lateral, amb un patró que encara que era similar entre els grups, es veia afectat de forma diferent pel dolor o el nivell d'afectació funcional en la mostra de patologics. En conclusió, els resultats indiquen que les variables funcionals són més sensibles als canvis que les variables numeriques classiques basades en rangs o valors maxims. D'altra banda, les diferencies oposades entre els subjectes patologics i els sans, només són clares a nivell de conjunt, pero no separen de forma nítida als individus de cada grup, podent ser només evidents en cas d'afectacions molt severes, pero no amb nivells moderats o baixos. L'estudi del EIR és nou i proporciona informació sobre la coordinació del moviment, aspecte d'especial rellevancia donada la composició del complex articular del muscle. Finalment, dels resultats s'extrau l'interés de l'ús de mesures repetides usant el subjecte com a factor i utilitzant les escales de valoració funcional, ja que l'ús sol de dades biomecanics no sembla ser suficient. / [EN] The shoulder complex is a structure of joints with the largest range of motion. Consequently, it is susceptible to injury. Shoulder pathologies involve different levels of functional impairment that can be assessed either by clinical scales or by objective methods such as kinematic analysis. However, currently available kinematic models do not offer a realistic representation of joint movement, which is an important limitation when developing functional assessment systems. The main goal of current dissertation is to describe the movement of the shoulder, using advanced kinematic techniques that include the use of position, velocity and acceleration variables, as well as the use of the instantaneous helical axis, in order to develop new techniques of functional assessment. This study included 41 healthy subjects and 15 subjects with shoulder pathology. Subjects performed humeral elevation in 2 planes (frontal and scapular) and 2 conditions (loaded and unloaded). The VAS (visual analog scale) was used to determine the level of perceived pain and the DASH scale (Disabilities of the arm, shoulder and hand) to define the functional impairment. An analysis of numerical variables, functional variables, reproducibility and harmony of the movement and description of the trajectory of the instantaneous helical axis (IHA) was carried out. As a result, the high reliability of the procedure has been demostrated. Significative differences were found between healthy and pathological subjects. However, it was only evident about groups, in addition the dispersion was considerable. Reproducibility and harmony values were similar for both. The functional analysis showed that the pathological group had lower angle, velocity and acceleration throughout the entire cycle. It was found that the DASH scale had a moderate relation with the functional kinematic variables. On the other hand, when increasing the level of affectation, an obvious decrease of the angular velocity, and a change in the movement pattern was observed. Regarding the effect of loading, no clear differences were found in the study population. Finally, the IHA described a vertical and mid-lateral displacement, with an initial point below the acromion. The pattern was similar in both groups, however it was affected by the level of pain and functional impairment. In conclusion, these findings suggest that functional variables are more sensitive to changes than classical numerical variables. On the other hand, differences between healthy and pathological subjects are only evident at group level. It seems that it is only evident in highly affected patients, not in those with a mild or intermediate impairment. Moreover, the study of the IHA is novel and provides relevant information about the shoulder joint coordination. Finally, we concluded that the use of repeated measurements using the subject as a factor along with the use of scales of functional assessment provides a better description of the movement since the exclusive use of biomechanical data, does not seem to be sufficient. / Cáceres Cáceres, ML. (2019). Aplicación de la cinemática articular a la valoración funcional del hombro [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/133994 / TESIS

Studiedesign: Deskriptiv laborativ studie Introduktion: En främre korsbandsskada är en vanlig men allvarlig skada inom idrotten. Trots en läkt skada kan individen uppvisa förändringar i form av fysiska faktorer såsom förändrat rörelsemönster, eller psykologiska faktorer såsom ökad rädsla för återskada. Personer som drabbats av en främre korsbandskada har setts uppvisa en asymmetri mellan det skadade och det friska benet genom en ökad avlastning i det skadade benet. Den traditionella rehabilitering avser en individ som återställd när denne klarar en uppsättning standardiserade fysiska tester för knät. Studier har dock visat på att även psykologiska faktorer har en betydande roll vid förändrat rörelsemönster och återgång till sport. Syfte: Undersöka psykologiska faktorers relation till avlastning i knäleden under idrottslika hopptest med och utan sekundära kognitiva uppgifter för personer med en främre korsbandsskada. Ett sekundärt syfte var att undersöka skillnader i avlastning mellan de två hopptesterna. Metod: Tio kvinnliga idrottsaktiva idrottare som tidigare opererats för en främre korsbandsskada utförde drop-jump test med och utan sekundära kognitiva uppgifter. Avlastning i knäleden mättes genom asymmetri i maximalt knäflexionsmoment under de första 100 ms av landningen mellan respektive ben. Testerna utfördes i ett rörelseanalyslaboratorium där åtta rörelsekameror och två kraftplattor användes. Enkäten Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) användes för att kartlägga psykologiska faktorer såsom känslor, förtroende och riskbedömning. Pearson’s korrelationskoeficcient användes för att analysera samband mellan ACL-RSI och asymmetri i knäflexionsmoment och presenterades i spridningsdiagram. Parat T-test tillämpades vid jämförelse av avlastning i knäleden mellan de båda hopptesterna. Resultat: Inga signifikanta samband påvisades mellan asymmetri i knäflexionsmoment och ACL-RSI varken i hopptest utan eller i hopptest med tillägg av kognitiv uppgift (Pearson’s R=-0.210-0.502, p=0.168-0.652). Inga tydliga skillnader observerades i knäflexionsmoment mellan benen vid hopptest utan kognitiv uppgift (p=0.103). Däremot visades ett lägre knäflexionsmoment i skadat ben relativt oskadat ben vid hopptest med tillägg av kognitiv uppgift (p=0.024). Inga tydliga skillnader observerades i asymmetri i knäflexionsmoment mellan hopp utan o ch hopp med tillägg av kognitiv uppgift (p=0.176). Konklusion: Studiens resultat indikerar på ett minskat knäflexionsmoment i det skadade benet jämfört med det oskadade. Detta gäller främst i hopptestet med sekundära kognitiva uppgifter. Ingen slutsats om psykologiska faktorers påverkan på avlastning i knäleden kan dras på grund av låg signifikans. Den låga deltagarantalet gör att detta arbete kan ses som en pilotstudie, varpå den kan bidra till hypotesgenerering vid framtida forskning. Framtida studier bör även inkludera ett större antal deltagare samt även de individer som ej återgått till sport.

KISS (Kinematic Support System) is a locally developed gait analysis system at Middle East Technical University (METU), and the performance of the system was evaluated before as a whole. However, such evaluations do not differentiate between the efficacy of the data acquisition system and the model-based gait analysis methodology. In this thesis, kinematic results of the KISS system will be compared with those of the Ankara University based commercial VICON (Oxford Metrics Ltd., Oxford, UK) system, in view of evaluating the performance of data acquisition system and the gait analysis methodology separately. This study is expected to provide guidelines for future developments on the KISS system.

Einleitung: Die Ellbogengelenkdysplasie (ED) stellt eine der häufigsten Lahmheitsursachen bei jungen Hunden mittelgroßer und großer Rassen dar. Dabei wird der radioulnaren Inkongruenz eine maßgebliche Rolle in der Pathogenese zugesprochen. GUILLOU und Mitarbeiter (2011) konnten zeigen, dass eine axiale radioulnare Translation von bis zu 1 mm in gesunden kaninen Ellbogengelenken in vivo auftritt. Auf dieser Basis entstand die Hypothese einer vermehrten radioulnaren Beweglichkeit in dysplastischen Gelenken, die zu einer dynamischen Inkongruenz führen könnte, da ca. 40 % der Patienten keine messbare Stufe aufweisen. Ziele der Untersuchungen: Ziel der Studie war der Vergleich der dynamischen radioulnaren Inkongruenz bei orthopädisch gesunden und dysplastischen Hunden in vivo. Material und Methoden: Sieben dysplastische Ellbogengelenke von sechs Hunden und sechs orthopädisch gesunde Ellbogengelenke von fünf Hunden sind in die Studie eingegangen. Alle Probanden der ED Gruppe zeigten einen fragmentierten Processus coronoideus medialis ulnae. Nach Implantation von jeweils mindestens drei Markern in Humerus, Radius und Ulna erfolgte die biplanare, fluoroskopische Untersuchung der Gelenke, während die Hunde im Schritt auf einem Laufband geführt wurden. Die gewonnenen Röntgenvideoaufnahmen wurden aufgearbeitet und die gemessene Bewegung der Marker auf rekonstruierte dreidimensionale Knochenmodelle jedes Probanden übertragen. Alle Animationen wurden visuell beurteilt und anschließend die relative radioulnare und humeroulnare Bewegung an den animierten Knochenmodellen gemessen und als Translation in Millimeter und Rotation in Grad angegeben. Weiterhin wurden die Kontaktflächenmuster für die ulnare Gelenkfläche in dysplastischen und gesunden Gelenken bestimmt und gegeneinander visuell verglichen. Ergebnisse: Für die relative radioulnare Translation konnten in der Kontrollgruppe 0,7 mm und in der ED Gruppe 0,5 mm gemessen werden. Beide Werte unterschieden sich nicht signifikant voneinander (P= 0,2092; Konfidenzintervall -0,6 – 0,2). Die relative humeroulnare Rotation lag in der Kontrollgruppe bei 2,9 Grad und in der ED Gruppe bei 5,3 Grad. Damit lag ein signifikanter Unterschied zwischen beiden Gruppen vor (P= 0,0229; Konfidenzintervall 0,4 – 4,4). Die Kontaktflächenmuster zeigten in der Kontrollgruppe, während der dargestellten Fußungsphase, eine homogene Verteilung des Kontaktes über das gesamte mediale Koronoid. Hingegen konnte in dysplastischen Gelenken eine Reduktion des Kontaktes im kraniolateralen Anteil des Koronoids beobachtet werden. Schlussfolgerung: Die radioulnare Bewegung zeigt zwischen gesunden und dysplastischen Gelenken keinen signifikanten Unterschied auf. Die Hypothese einer ausgeprägten Translation zwischen Radius und Ulna in Gelenken erkrankter Hunde, die während der Bewegung zu einer dynamischen RUI führt kann damit widerlegt werden. Allerdings zeigt der Humerus in dysplastischen Gelenken eine vermehrte Rotationsbewegung, die zu einer Verlagerung der Trochlea humeri gegen den medialen Kronfortsatz führt. Dieser visuell und quantitativ erfasste Effekt spiegelt sich auch in den Kontaktflächenmustern wieder. Da Pathologien im Sinne des FPC typischerweise im Bereich des dargestellten, konzentrierten Kontaktes auftreten, ist davon auszugehen, dass es durch die humerale Rotation zu einer vermehrten Belastung des Koronoids kommt, welche zur Fragmentation des Kronfortsatzes führen kann. Die Ursache dieser vermehrten Bewegung ist derzeit nicht bekannt. Möglicherweise spielen Weichteilpathologien eine Rolle, ähnlich der Pathogenese der Hüftgelenksdysplasie. Neben der bereits bekannten und beschriebenen statischen RUI scheint die Rotationsinstabilität des Humerus eine entscheidende Rolle in der Pathogenese der ED zu spielen, insbesondere in kongruent erscheinenden Gelenken. / Introduction: Elbow dysplasia (ED) is one of the most frequent reasons for forelimb lameness especially in young large breed dogs. Radio-ulnar incongruence is discussed to be one of the main factors in the pathogenesis of ED. GUILLOU et al. (2011) described an axial translation between the radius and the ulna up to 1 mm in sound canine elbow joints in vivo. Based on this study we developed the hypothesis that pronounced radio-ulnar movement in dysplastic joints leads to a dynamic radio-ulnar incongruence. This dynamic incongruence might explain why 40 % of dysplastic dogs show no measurable step formation. Objective: The aim of the study was to compare the dynamic radio-ulnar incongruence in sound and dysplastic dogs in vivo. Material and Methods: Seven dysplastic joints in six dogs and six sound joints in five dogs were evaluated. All dysplastic joints showed a fragmented coronoid process and a radio-ulnar incongruence and cartilage lesions on the ulnar and humeral joint surface in a varying degree. A minimum of three Tantalum markers were implanted into the Humerus, Radius and Ulna each. Afterwards biplanar fluoroscopic gait analysis was performed while the dogs were walking on a treadmill. Gained marker movement was transferred onto reconstructed three dimensional CT bone models of each dog. The 3D animations were visually assessed and relative movement between the radius and ulna as well as between the humerus and ulna was measured and expressed as translation (millimeter) and rotation (degree). Further the joint contact patterns of the ulnar joint surface were determined for all dysplastic and sound joints and visually compared to each other. Results: Relative radio-ulnar translation was 0.7 mm in sound joints and 0.5 mm in dysplastic joints. There was no significant difference between these two groups (P= 0.2092; convidence interval -0.6 to 0.2). A significant difference between the dysplastic and the sound group was present in the relative humeral rotation (P= 0.0229; convidence interval 0.4 to 4.4). Humeral rotation relative to the ulna was 2.9 degree in sound and 5.3 degree in dysplastic joints. Humero-ulnar contact at the medial coronoid process was evenly distributed over the medial coronoid process in control elbows, while contact area in dysplastic elbows was reduced and shifted to the lateral aspect of the medial coronoid process Conclusion: Radio-ulnar movement is not significantly different between dysplastic and sound elbow joints. So the hypothesis of a pronounced axial translation between the radius and the ulna in dysplastic joints, leading to dynamic RUI can be neglected. However the humerus shows a significantly pronounced rotational movement in dysplastic joints compared to sound elbows. The trochlea humeri moves towards cranio-lateral and hits the medial coronoid process at its cranio-lateral aspect. The effect of this rotational movement can be shown in the joint contact patterns of the ulnar joint surface. Contact is shifted towards the tip and the lateral aspect of the coronoid process. In that area fragmentation of the medial coronoid process is typically observed. It seems that rotation of the humerus relative to the ulna leads to reduced contact and mechanical overload of the coronoid process. The cause of this increased rotational movement remains unknown. Maybe the documented movement could be interpreted as joint instability similar to the pathogenesis of hip dysplasia in which soft tissue laxity results in joint instability and degenerative joint disease. Besides the already described static radio-ulnar incongruence humeral rotational instability seems to play a role in the pathogenesis of elbow dysplasia, especially in congruent joints.

KISS (Kinematic Support System) is a locally developed gait analysis system at Middle East Technical University (METU), and the performance of the system was evaluated before as a whole. However, such evaluations do not differentiate between the efficacy of the data acquisition system and the model-based gait analysis methodology. In this thesis, kinematic results of the KISS system will be compared with those of the Ankara University based commercial VICON (Oxford Metrics Ltd., Oxford, UK) system, in view of evaluating the performance of data acquisition system and the gait analysis methodology separately. This study is expected to provide guidelines for future developments on the KISS system.

Breathing is a vital phenomenon that implies synergy of various anatomical structures that constitute the thorax. Joint physiology remains a relatively poorly-known component of the overall thorax physiology. Quantitative literature related to in vivo thorax kinematics during breathing is scarce. The present work focuses specifically on developing and applying a methodology to reach this goal. The developed method combined processing of CT data obtained at different lung volumes and infographic techniques. Detailed ranges of motion (ROMs) and axes of movement (mean helical axes, MHAs) were obtained at costovertebral joints in 12 asymptomatic subjects; rib ROMs gradually decrease with increasing rib number; lung volume and rib level have a significant influence on rib ROM; MHAs did not differ between rib levels. In addition, the method was applied on a sample of 10 patients with cystic fibrosis. The pathological condition significantly influenced CVJ ROMs while the orientation of the MHAs did not differ. Finally, the sternal displacement, sternal angle variations and sternocostal joints (SCJ at rib1 to 7) kinematics during breathing motion were analyzed. Rib ranges of motion relative to sternum decreased with increasing rib number similarly to CVJ. Orientation of the MHAs did not differ between SCJ levels. A significant linear correlation was demonstrated between sternum vertical displacement and rib ranges of motion at both CVJ and SCJ. The present work substantially contributes to 3D modelling of human thorax in breathing at a joint level both qualitatively and quantitatively. / Doctorat en Sciences biomédicales et pharmaceutiques (Médecine) / info:eu-repo/semantics/nonPublished

Human movement is inherently complex, requiring the control and coordination of many neurophysiological and biomechanical degrees-of-freedom, and the extent to which individuals exhibit variation in their movement patterns is captured by the construct of motor variability (MV). MV is being used increasingly to describe movement quality and function among clinical populations and elderly individuals. However, current evidence presents conflicting views on whether increased MV offers benefits or is a hindrance to performance. To better understand the utility of MV for performance prediction, we focused on current research needs in the military domain. Dismounted soldiers, in particular, are expected to perform at a high level in complex environments and under demanding physical conditions. Hence, it is critical to understand what strategies allow soldiers to better adapt to fatigue and diverse environmental factors, and to develop predictive tools for estimating changes in soldier performance. Different aspects of performance such as motor learning, experience, and adaptability to fatigue were investigated when soldiers performed various gait tasks, and gait variability (GV) was quantified using four different types of measures (spatiotemporal, joint kinematics, detrended fluctuation analysis, and Lyapunov exponents). During a novel obstacle course task, we found that frontal plane coordination variability of the hip-knee and knee-ankle joint couples exhibited strong association with rate of learning the novel task, explaining 62% of the variance, and higher joint kinematic variability during the swing phase of baseline gait was associated with faster learning rate. In a load carriage task, GV measures were more sensitive than average gait measures in discriminating between experience and load condition: experienced cadets exhibited reduced GV (in spatiotemporal measures and joint kinematics) and lower long-term local dynamic stability at the ankle, compared to the novice group. In the final study investigating multiple measures of obstacle performance, and variables predictive of changes in performance following intense whole-body fatigue, joint kinematic variability of baseline gait explained 28-59% of the variance in individual performances changes. In summary, these results support the feasibility of anticipating and augmenting task performance based on individual motor variability. This work also provides guidelines for future research and the development of training programs specifically for improving military training, performance prediction, and performance enhancement. / Doctor of Philosophy / All people move with some level of inherent variability, even when doing the same activity, and the extent to which individuals exhibit variation in their movement patterns is captured by the construct of motor variability (MV). MV is being increasingly used to describe movement quality and function among clinical populations and elderly individuals. However, it is still unclear whether increased MV offers benefits or is a hindrance to performance. To better understand the utility of MV for performance prediction, we focused on current research needs in the military domain. Dismounted soldiers, in particular, are expected to perform at a high level in complex environments and under demanding physical conditions. Hence, it is critical to understand what strategies allow soldiers to better adapt to fatigue and diverse environmental factors, and to develop tools that might predict changes in soldier performance. Different aspects of performance were investigated, including learning a new activity, experience, and adaptability to fatigue, and gait variability was quantified through different approaches. When examining how individual learn a novel obstacle course task, we found that certain aspects of gait variability had strong associations with learning rate. In a load carriage task, variability measures were determined to be more sensitive to difference in experience level and load condition compared to typical average measures of gait. Specifically, variability increased with load, and the experienced group was less variable overall and more stable in the long term. Lastly, a subset of gait variability measures were associated with individual differences in fatigue-related changes in performance during an obstacle course. In summary, the results presented here support that it may be possible to both anticipate and enhance task performance based on individual variability. This work also provides guidelines for future research and the development of training programs specifically for improving military training, performance prediction, and performance enhancement.

[Truncated abstract] Measuring the kinematics of joints and implants following orthopaedic surgery is important since joint motion directly influences the functional outcome of the patient and the longevity of the implant. Radiostereometric Analysis (RSA) has been used to assess the motion over time of various joints and implant designs following corrective orthopaedic and joint replacement surgery for more than 20 years in more than 10,000 patients around the world. While the use of RSA reduces the risk of implanting potentially inferior prostheses on a large scale, conventional methodological procedures are based on the acquisition of static, stereographic x-ray images that are not suitable for measuring skeletal kinematics in a dynamic manner. The purpose of this thesis was to design, validate and test a novel technique for dynamically assessing the skeletal motion of human subjects using RSA and single-plane digital x-ray video fluoroscopy. The validation procedure utilised two in-vitro phantom models of human joints capable of simulating normal kinematic motion. These phantom models were supplied with realistic spatial displacement protocols derived from cadaveric specimens. The spatial positions of a series of tantalum markers that were implanted in each skeletal segment were measured using RSA. Skeletal motion was determined in x-ray fluoroscopy images by minimising the difference between the markers measured and projected in the single image plane. Accuracy was determined in terms of bias and precision by analysing the deviation between the applied displacement protocol and measured pose estimates. ... The RSA and low dose single-plane fluoroscopy technique developed, validated and tested in this thesis is capable of dynamically measuring the kinematics of any joint in the human body, following the implantation of small metallic markers in the surrounding bone during corrective orthopaedic surgery. The kinematics of joints with replacement prostheses, such as the total knee replacement (TKR), can be analysed in addition to the kinematics of joints without replacement prostheses, such as the sacroiliac joint. The technique may be used in the future on groups of human subjects enrolled in controlled trials that are designed to analyse the kinematics of the shoulder, spine, hip, knee, patella or ankle joints for the purposes of quantitatively comparing the kinematics of different prosthesis designs and various corrective orthopaedic procedures.

It has been noticed that the need for total knee replacement surgery is increasing for Asian region. A total knee replacement is a permanent surgical solution for a patient having debilitating pain in knee joint suffering from arthritis. In this surgery, knee joint is replaced with components made up of bio-compatible materials after which the patient can resume the normal day to day activities. Western population has bigger build compared to Asian population. Most of the total knee replacement prosthesis are designed for western population. When these total knee prosthesis are used for Asian population, they cause a mismatch leading to various clinical complications such as reduced range of motion and pain. The studies have been limited to clinical complications caused by the mismatch. To address this limitation, current study is aimed to find the mechanical implications such as stress distribution, maximum stresses, maximum displacements etc., caused by mismatch of total knee replacement components with knee. A surgeon selects total knee components for a patient based on some critical dimensions of femur and tibia bone of knee. In addition, a method to accurately calculate these dimensions of the femur and tibia bone of a real knee was developed in the current study. This method calculated the points of curvature greater than a threshold (decided based on the radius of the curvature) found out using the formula of curvature. Further, the highest point was calculated based on maximum height from a line drawn between initial and final point within the captured points, also the extreme points were calculated based on the sign change in slope of points within the captured points, giving multiple points on the boundary of bones extracted in an MRI image of a patient. The distance between two selected farthest points, out of these points, in specific direction was the basis for selection of the TKR components. Total knee replacement components were modeled in Geomatics Studio 12 software, bones were modeled in Rhinoceros 5 software, assembly of bones and total knee replacements components was done in Solid works 2013 software, the finite element model of the assembly was developed in Hyper mesh 11 software and, the stress analysis and post processing was done in ABAQUS 6.13 software. A static, implicit non linear analysis was performed. Simulations were performed for two conditions: at standing (0o of flexion) and at hyper-flexed (120o of flexion). In order to figure out if there were any mechanical implications of mismatch, the full model of assembly consisting of femur, tibia and fibula bones assembled with total knee replacement components, and the reduced model consisting of only total knee replacement components were simulated separately, results of which have been discussed in the current thesis. In this work, the effect of change of length of ligaments at 120o of flexion in detail was also studied. This study brought out various outcomes of contact mechanics and kinematics between the components of total knee replacement prosthesis.