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Movement Analysis Profile (MAP) for the whole cohort in comparison to the control group, with no gait pathology (NGP). The first nine bar clusters indicate the individual Gait Variable Scores (GVS) for nine kinematic parameters and the last shows the Gait Profile Score (GPS). For each group of results the clear bar is the sound side, the shaded bar is the slipped side and the black bars are the normal mean from individuals with no gait pathology (NGP).
Source publication
Slipped capital femoral epiphysis is known to produce characteristic deformities in the proximal femur, which affect hip motion and may cause a limp. This paper assessed the 3D gait kinematics in adolescents after single screw fixation of moderate to severe, stable, unilateral slipped capital femoral epiphysis. Our goals were to characterize the 3D...
Contexts in source publication
Context 1
... between kinematic data were further explored using the Movement Analysis Profile (MAP). Figure 5 shows the MAP for the sound and slipped sides. The mean GPS for no gait pathology individuals (NGP) is 5.6° (SD 1.4°). ...
Context 2
... found significant gait abnormalities affecting both the slipped and sound side. The kinematic parameters, which showed the greatest deviation from normal, were in the transverse plane; hip rotation and foot progression ( Figure 5). The need to externally rotate the hip during walking, to avoid metaphyseal impingement was predicted by Rab from his 3D computer model (Rab, 1999). ...
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Stable slipped capital femoral epiphysis (SCFE) is the most common disease in the adolescent hip, with an estimated frequency of 10.8 in every 100,000 individuals. Recent studies of the biomechanics of femoroacetabular impingement indicate that small anatomical deformities of the hip arising from SCFE can potentially cause permanent acetabular chon...
Aims:
Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to det...
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Introduction
Hip arthroscopy has become a standard procedure in the treatment of hip joint pain not related to osteoarthritis or dysplasia in the young and active patient. There has been increasing focus on the contribution of the hip capsule to function and on stability following hip arthroscopy. It has been suggested that capsular closure after h...
Citations
... The usual symptoms of SCFE include pain in the hip or knee and associated limping. An examination of the hip typically reveals limited internal rotation and flexion [2]. Early diagnosis and treatment are crucial to prevent complications and further damage. ...
... However, the patients had been treated with different methods, which could have decreased impingement and improved their gait. Sangeux et al. [2] reported data in adolescents with moderate-to-severe SCFE, managed by a single method, and included measurements of the extent of gait deviations. They found considerable gait abnormalities affecting both the affected and unaffected sides. ...
Background: Slipped capital femoral epiphysis (SCFE) is the most common hip disease during infancy and adolescence. Our study aimed to analyze static plantar pressure in children with surgically treated unilateral SCFE. Methods: Twenty-two children with right SCFE with in situ fixation with one percutaneous screw were assessed by PoData plantar pressure analysis under three different conditions (open eyes, eyes closed, and head retroflexed). Results: The total foot loading was significantly higher on the unaffected limb compared with the affected one for all the three testing conditions (p < 0.05). When assessing the differences between testing conditions, there were no significant differences for the right and left foot loadings, or for the three sites of weight distribution, except for the right fifth metatarsal head (lower loading in eyes-closed condition in comparison to eyes open, p = 0.0068), left fifth metatarsal head (increased loading in head-retroflexed condition in comparison to eyes open, p = 0.0209), and left heel (lower loading in head-retroflexed condition in comparison to eyes open, p = 0.0293). Conclusion: Even after a successful surgical procedure, differences in foot loading can impact the postural static activities in different conditions (natural eyes-open, eyes-closed, or head-retroflexed posture).
... 23 Another study found an abnormal gait profile for moderate to severe SCFE patients after in situ pinning. 24 More recently, gait analysis of mild and moderate SCFE patients treated with in situ pinning showed an increase in hip extension moment. 25 Comparing the mean FPA of the SCFE side to contralateral side and to control group, no significant difference (Fig. 2) was found. ...
Background:
Slipped capital femoral epiphyses (SCFE) is associated with out-toeing of the foot and external rotation gait. But it is unknown if SCFE patients treated with the modified Dunn procedure have out-toeing at follow up.Therefore, we used instrumented gait analysis and questioned (1) do severe SCFE patients treated with a modified Dunn procedure have symmetrical foot progression angle (FPA) compared with contralateral side and compared with asymptomatic volunteers (2) what is the prevalence of out-toeing gait and what are the outcome socres at follow up.
Methods:
Gait analysis of 22 patients (22 hips) treated with an unilateral modified Dunn procedure for severe SCFE (slip angle >60 degrees, 2002 to 2011) was retrospectively evaluated. Of 38 patients with minimal 5-year follow up, 2 hips (4%) had avascular necrosis of the femoral head and were excluded for gait analysis. Twenty-two patients were available for gait analysis at follow up (mean follow up of 9±2 y). Mean age at follow up was 22±3 years. Mean preoperative slip angle was 64±8 degrees (33% unstable slips) and decreased postoperatively (slip angle of 8±4 degrees). Gait analysis was performed with computer-based instrumented walkway system (GAITRite) to measure FPA with embedded pressure sensors. Patients were compared with control group of 18 healthy asymptomatic volunteers (36 feet, mean age 29±6 y).
Results:
(1) Mean FPA of SCFE patients (3.6±6.4 degrees) at follow up was not significantly different compared with their contralateral side (5.6±5.5 degrees) and compared with FPA of controls (4.0±4.5 degrees). (2) Of the 22 SCFE patients, most of them (19 hips, 86%) had normal FPA (-5 to 15 degrees), 2 patients had in-toeing (FPA<-5 degrees) and 1 had out-toeing (FPA >15 degrees) and was not significantly different compared with control group. (3) Mean modified Harris hip score (mHHS) was 93±11 points, mean Hip Disability and Osteoarthritis Outcome Score (HOOS) score was 91±10 points. Three patients (14%) had mHHS <80 points and walked with normal FPA. The 2 patients with in-toeing and one patient with out-toeing had mHHS >95 points.
Conclusions:
Patients with severe SCFE treated with modified Dunn procedure had mostly symmetrical FPA and good hip scores at long term follow up. This is in contrast to previous studies. Although 1 patient had out-toeing and 2 patients had in-toeing at follow up, they had good hip scores.
Level of evidence:
Level III-retrospective comparative study.
... Correlation of the clinical and radiological results of deformity after slippage with gait analysis (GA), which provides a better understanding of the functional results, may lead to a better evaluation of indications of future joint preservation surgeries. There are a limited number of studies on the evaluation of patients with SCFE by objective methods such as GA [8,[10][11][12]. ...
... Westhoff et al. noted that the strength of the correlation between step size, sagittal pelvis ROM, and FPA increased with the poor radiological index [8]. In a similar study in which patients with a slip-angle less than 30° were excluded, Sangeux et al. reported that kinematic values were not correlated with radiometric measurements (i.e., alpha angle, slip-angle) [12]. This might be, as they expressed, because of the exclusion of patients with a mild slip from the study, which may have led to the accumulation of high levels of radiological deformity measurements. ...
Aim: The aim of this study was to evaluate the correlation between gait analysis and clinical and radiographic results in patients operated for slipped capital femoral epiphysis (SCFE).Materials and Methods: This study included 31 patients with unilateral SCFE. The mean follow-up time was 3.3 ± 1.4 years. Harris hip score (HHS) and the Pediatric Outcomes Data Collection Instruments (PODCI) scores were collected. Slip-angle, alpha-angle, lateral femoral head ratio (LFHR), articulotrochanteric distance (ATD), anteroposterior plane femoral head ratio (AP-FHR), anterior head-neck offset ratio (HNOR), and neck-shaft angle (NSA) were measured. An age-matched control group consisting of 20 healthy individuals was used for comparison. Results: Transfer and basic mobility subscale of PODCI was correlated with pelvis tilt ROM (r = −0.7, p < 0.001), foot progression angle (FPA) ROM (r =−0.4, p=0.02), and mean spine tilt (r=−0.6, p<0.001). FPA was also correlated with the HHS (r=−0.5, p<0.001) and pain/comfort subscale of PODCI (r=−0.5, p=0.015). Significant correlations were detected between LFHR and mean hip flexion (r=−0.5, p<0.001), pelvic tilt (r=−0.4, p=0.04), and mean spine tilt (r=0.6, p<0.001). Correlations between ATD and mean internal rotation of the hip (r=0.5, p=0.03) and mean dorsal ankle extension (r=−0.4, p=0.03) were also significant. No significant correlation was found between the alpha angle, AP-FHR, and HNOR with the kinematic values.Conclusion: Clinical scores of patients treated for SCFE were mostly correlated with pelvic tilt ROM, FPA, and spine tilt. LFHR and ATD were observed as the most critical radiological measurements related to a patient’s gait function.
... The strong correlation between the residual growth and the correction of the alpha-angle supports growthsparing slip stabilization techniques, especially in younger patients with significant remaining growth [10,44,45]. Nevertheless, the growth and remodeling-associated improvement of femoral neck deformity after in situ stabilization of SCFE are significantly lower, compared to the enormous correction obtained using the modified Dunn procedure (decrease of alpha-angle: 53⁰, a decrease of slip-angle: 43⁰) [46]. ...
... The surgical technique (promoting physeal arrest or growth-sparing) may also contribute to the final true LLD [1]. A mean true LLD of 14-15 mm is expected at growth plate fusion in treated moderate-to-severe SCFE [46,47]. ...
... On the other hand, apparent LLD after SCFE is also seen after moderate-to-severe slips and is the result of the limited abduction of the SCFE hip in order to avoid FAI. The patient overcomes limited hip abduction during walking by ipsilateral elevation of the pelvis on the coronal plane and simultaneous forward rotation of the pelvis on the transverse plane (movement of the pelvis precedes the movement of the thigh) [1,46]. A study reports an apparent shortening of 17 mm after a single screw fixation of SCFE [46]. ...
Slipped capital femoral epiphysis (SCFE) is a frequent cause of nontraumatic painful hip of the adolescence. It is the result of the separation of the proximal femoral growth cartilage at the level of the hypertrophic cell zone. The femoral neck metaphysis rotates externally and migrates proximally relative to the femoral head epiphysis, which is stably seated in the acetabulum; early diagnosis and in situ stabilization grants the best long term results. Numerous factors affect treatment outcomes. Not all implants have the same effect on the slipped physis. Application of the traditionally used implants, such as non-threaded pins and cannulated screws, is questioned. Modern implants are available, which stabilize the slip without accelerating physis fusion. This allows femoral head and neck growth and remodeling to limit the post-slip sequellae on hip anatomy and function. Femoroacetabular impingement (FAI) complicates almost all slips. It causes progressive labral and articular cartilage damage and leads to early hip osteoarthritis and total hip replacement, approximately ten years earlier compared to the general population. Avascular necrosis of the femoral head is a dramatic complication, seen almost exclusively in unstable slips. It develops within months after the slip and leads to immediate articular joint degeneration and the need for total hip replacement. Another serious complication of SCFE is chondrolysis, which is a rapid progressive articular cartilage degeneration leading to a narrow joint space and restriction of hip motion. Implant-related complications, such as migration and loosening, may lead to the progression of the slip. Though bilateral disease is quite frequent, there is no consensus about the need for preventive surgery on the healthy contralateral hip. Diagnosis of SCFE is frequently missed or delayed, leading to slips of higher severity. Silent slippage of the capital femoral epiphysis is highly suspected as an underlying cause of cam-type FAI and early-onset hip osteoarthritis. There is controversy, whether asymptomatic implants should be removed. Novel surgical techniques, such as the modified Dunn procedure and hip arthroscopy, seem to be effective modalities for the prevention of FAI in SCFE.
... An additional article was found in the archives of the related journals. In the end, 13 articles [3,[8][9][10][11][12][13][14][15][16][17][18][19] were included in the review (see Fig. 1). ...
... One article each was published in 2009 [17] and 2010 [16], the other articles were published between 2014 and 2019 [3,[8][9][10][11][12][13][14][15]18,19]. Three research groups each published two papers on the application of functional data analysis in motion analysis [3,9,13,14,18,19]. ...
... One article each was published in 2009 [17] and 2010 [16], the other articles were published between 2014 and 2019 [3,[8][9][10][11][12][13][14][15]18,19]. Three research groups each published two papers on the application of functional data analysis in motion analysis [3,9,13,14,18,19]. Three studies come from Australia and five from Europe (Sweden, Germany and Norway) and the USA. ...
Background Signals are continuously captured during the recording of motion data. Statistical analysis, however, usually uses only a few aspects of the recorded data. Functional data analysis offers the possibility to analyze the entire signal over time. Research question The review is based on the question of how functional data analysis is used in the study of lower limb movements. Methods The literature search was based on the databases EMBASE, PUBMED and OVID MEDLINE. All articles on the application of functional data analysis to motion-associated variables trajectories, ground reaction force,electromyography were included. The references were assessed independently by two reviewers. Results In total 1448 articles were found in the search. Finally, 13 articles were included in the review. All were of moderate methodological quality. The publication year of the studies ranges from 2009 to 2019. Healthy volunteers and persons with cruciate ligament injuries, knee osteoarthritis, gluteal tendinopathy, idiopathic torsional deformities, slipped capital femoral epiphysis and chronic ankle instability were examined in the studies. Movements were analyzed on basis of kinematics (3D motion analysis), ground reaction forces and electromyography. Functional Data Analysis was used in terms of landmark registration, functional principal component analysis, functional t-test and functional ANOVA. Significance Functional data analysis provides the possibility to gain detailed and in-depth insights into the analysis of motion patterns. As a result of the increase in references over the past year, the FDA is becoming more important in the analysis of continuous signals and the explorative analysis of movement data.
... Gait analysis has been shown to be an accurate tool for measuring the effect of hip joint pathologies on hip movement during gait. Reports utilizing gait analysis for paediatric patients with slipped capital femoral epiphysis (SCFE) (Sangeux, Passmore et al. 2014), torsional deformities (Schwartz, Rozumalski et al. 2014), and cerebral palsy (Perry 1992), for example, have detailed the pathokinematics of the hip for these conditions. Figure 11, red curves). ...
Pathologies of the hip affect its biomechanics and vice versa. There is a strong relationship between the shape and orientation of the proximal femur and acetabulum, and the capacity of the hip muscles to generate the moment required to achieve a movement. Conversely, the biomechanics of the musculoskeletal system during gait affects the kinematics, kinetics and joint contact forces at the hip. When abnormal, these forces may lead to the development of hip pathologies. In this chapter, the functional anatomy of the hip and the relationship between bone shape and the capacity of the muscles to develop moments in each anatomical plane, is described. Clinical gait analysis is introduced as a means to study the biomechanics of the hip in detail, and describe the kinematics, kinetics and joint contact forces of typically developing children and adolescents.
... However, moderate and severe slips lead to the development of compensatory movements during gait cycle in order to avoid the impingement of the deformed femoral neck on the acetabulum: Reduced hip abduction leads to pelvic obliquity at the coronal level due to ipsilateral hip elevation. As a result, apparent limb length discrepancy with a shorter limb on the SCAFE side may be observed, that is added to the true ipsilateral shortening due to the actual proximal migration of the femoral neck 35 . Compensatory ipsilateral knee extension and ankle flexion along with opposite changes in the contralateral healthy extremity follow. ...
... The true LLD is due to the posterior and medial epiphyseal slip and the subsequent proximal migration of the femoral neck. It is evident in moderate to severe slips and is on average 14-15 mm at the time of physeal closure 35,170 . The apparent shortening is slightly greater than the true shortening (~17mm). ...
... It is also observed in moderate to severe slips and is the result of the restricted abduction of the affected hip in an attempt to avoid impingement of the deformed femoral neck on the acetabulum (cam type FAI). The patient compensates the restricted abduction by ipsilateral pelvis elevation during walking 35 . Older children may present a greater LLD, probably secondary to a delayed diagnosis and hence a slip of higher severity and less remaining growth 170 . ...
Slipped Capital Femoral Epiphysis is the leading cause of limp in the adolescent population. Obesity and endocrine disorders are major predisposing factors that very often lead to bilateral hip involvement. Not infrequently, a delayed or a missed diagnosis results in progression of the slip towards stages of higher severity, implying less favorable long term results after treatment. In situ stabilization of the slipped physis is the globally preferred treatment, yet it does not prevent the affected hip to develop early onset hip osteoarthritis compared to the general population. Femoroacetabular impingement due to a deformed femoral neck seems to be the intermediate pathologic process that causes labral and acetabular cartilage damage and inevitably leads to early hip arthrosis. In fact the vast majority of the slips, especially the moderate and severe slips, will present signs of femoroacetabular impingement. The severity of the slip correlates with the magnitude of the labral and acetabular lesions. Residual growth and remodelling of the hip after in situ stabilization are not sufficient to compensate for the remaining neck deformity in moderate and severe slips. For these slips, arthroscopic osteochondroplasty or a modified Dunn procedure might be more effective in order to reduce the risk of early onset hip osteoarthritis.
... However, moderate and severe slips lead to the development of compensatory movements during gait cycle in order to avoid the impingement of the deformed femoral neck on the acetabulum: Reduced hip abduction leads to pelvic obliquity at the coronal level due to ipsilateral hip elevation. As a result, apparent limb length discrepancy with a shorter limb on the SCFE side may be observed, that is added to the true ipsilateral shortening due to the actual proximal migration of the femoral neck [35]. Compensatory ipsilateral knee extension and ankle flexion along with opposite changes in the contralateral healthy extremity follow. ...
... In order to maintain normal foot progression angle and to restrict out-toeing, the patient advances the pelvis on the SCFE side (a forward turn of the pelvis on the transverse plane). However, besides slip severity, other factors may also affect the gait cycle in SCFE patients, such as the inclination of the femoral neck and/or the acetabulum [35]. ...
Slipped Capital Femoral Epiphysis is the leading cause of limp in the adolescent population. Obesity and endocrine disorders are major predisposing factors that very often lead to bilateral hip involvement. Not infrequently, a delayed or a missed diagnosis results in progression of the slip towards stages of higher severity, implying less favorable long term results after treatment. In situ stabilization of the slipped physis is the globally preferred treatment, yet it does not prevent the affected hip to develop early onset hip osteoarthritis compared to the general population. Femoroacetabular impingement due to a deformed femoral neck seems to be the intermediate pathologic process that causes labral and acetabular cartilage damage and inevitably leads to early hip arthrosis. In fact the vast majority of the slips, especially the moderate and severe slips, will present signs of femoroacetabular impingement. The severity of the slip correlates with the magnitude of the labral and acetabular lesions. Residual growth and remodelling of the hip after in situ stabilization are not sufficient to compensate for the remaining neck deformity in moderate and severe slips. For these slips, arthroscopic osteochondroplasty or a modified Dunn procedure might be more effective in order to reduce the risk of early onset hip osteoarthritis.
... Correlation of the clinical and radiological results of deformity after slippage with gait analysis (GA), which provides a better understanding of the functional results, may lead to a better evaluation of indications of future joint preservation surgeries. There are a limited number of studies on the evaluation of patients with SCFE by objective methods such as GA [8,[10][11][12]. ...
... Westhoff et al. noted that the strength of the correlation between step size, sagittal pelvis ROM, and FPA increased with the poor radiological index [8]. In a similar study in which patients with a slip-angle less than 30° were excluded, Sangeux et al. reported that kinematic values were not correlated with radiometric measurements (i.e., alpha angle, slip-angle) [12]. This might be, as they expressed, because of the exclusion of patients with a mild slip from the study, which may have led to the accumulation of high levels of radiological deformity measurements. ...
Introduction: Slipped capital femoral epiphysis (SCFE) is known to produce characteristic deformities in proximal femur, which affect hip motion and may cause a limp [1]. The aim of this study was to evaluate correlation between kinematic-kinetic changes related to postoperative residual deformity after in situ
pinning of SCFE and clinical and also radiographic results.Research question: Can three-dimensional gait analysis be used as an evaluation tool for functional and radiologic outcomes of patients with SCFE?
Methods: Three-dimensional gait analysis of SCFE patients who were treated with in situ pinning were evaluated. To measure patient’s quality of life and physical function, Harris hip score and Pediatric Outcomes Data Collection Instruments (PODCI) scores were used. Preoperative and sixth months postoperative Southwick angles (SA) in the anterior–posterior (AP) and lateral views and Articulo-Trochanteric Distance (ATD) were measured. A control group consisted of age-matched healthy people with no history of
any medical problems that resulted in problems during gait. Results: Thirty-one patients with mean age of 16 years were included. The average age of patients at surgery was 12.9 years and mean follow-up time was 3.3 years. The mean preoperative Southwick angles of the patients in AP view was 19.68 and lateral
view was 32.78. Postoperative measurements of the SA in AP and lateral views were 14.48 and 23.38 respectively. The Southwick angles in postoperative AP view showed significant correlation
with the mean knee flexion, thorax tilt and gait velocity (p < 0.05). There was a significant correlation between the SA in postoperative lateral view and minimum knee flexion during swing (p < 0.05) and gait velocity (p < 0.01). There was a significant correlation between ATD with maximum internal rotation of hip,
maximum knee abduction angle and knee abduction (p < 0.05). The Harris hip scores correlated significantly with maximum ankle dorsiflexion and foot progression angle (FPA) (p < 0.05). The Adolescent Global Functions Scales significantly correlated with pelvic tilt, the FPA, mean spine tilt and minimum spine tilt
(towards to standing limb side, maximum spine tilt (towards swinging limb). The Adolescent Happiness Scales correlated with mean pelvis internal rotation and FPA (p < 0.01). The Adolescent Pain and Comfort Scales correlated with FPA (p < 0.05). The Adolescent Sports and Physical Function Scales correlated with the
pelvic tilt, FPA and spine tilt. The Adolescent Transfer and Basic Mobility Scale significantly correlated with pelvic tilt, spine tilt and FPA (p < 0.05). Discussion: There were significant correlations between both
functional and radiological results with the gait analysis data of patients with unilateral SCFE. Three-dimensional gait analysis can be used as an evaluation tool for functional and radiographic
outcomes of patients with SCFE.
... Funkční výsledky flekčně-rotační osteotomie u téže choroby prokázaly značné zlepšení po operaci, vyjádřené jako gait deviation index (5). Funkční výsledky po fixaci in situ (pinning) vyjádřené mean gait profile score ukázaly značné rozdíly mezi léčenou a zdravou stranou (28). ...
Recent studies have shown that the evaluation of both conservative and surgical therapy cannot do without gait analysis. Orthopaedic textbooks, with some exceptions, deal in great detail with a thorough clinical examination of the patient but gait assessment is mentioned only marginally. More attention is paid to gait analysis in rehabilitation medicine. Motion and gait analysis laboratories equipped with optoelectronic cameras and force platforms were first developed for cerebral palsy children. Recently, several studies have been published on the use of these methods in disorders of hip and knee joints or spine diseases. © 2016, Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. All rights reserved.
