Linking Joint Impairment and Gait Biomechanics in Patients with Juvenile Idiopathic Arthritis
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Annals of Biomedical Engineering ( 2019) https://doi.org/10.1007/s10439-019-02287-0
Linking Joint Impairment and Gait Biomechanics in Patients with Juvenile Idiopathic Arthritis ERICA MONTEFIORI ,1,2 LUCA MODENESE ,2,3 ROBERTO DI MARCO,2,4 SILVIA MAGNI-MANZONI,5 CLARA MALATTIA,6 MAURIZIO PETRARCA,7 ANNA RONCHETTI,8 LAURA TANTURRI DE HORATIO,9 PIETER VAN DIJKHUIZEN,10 ANQI WANG,11 STEFAN WESARG,11 MARCO VICECONTI,12,13 CLAUDIA MAZZA`,1,2 and FOR THE MD-PAEDIGREE CONSORTIUM 1
Department of Mechanical Engineering, University of Sheffield, Sheffield, UK; 2INSIGNEO Institute for In Silico Medicine, University of Sheffield, Sheffield, UK; 3Department of Civil and Environmental Engineering, Imperial College London, London, UK; 4Department of Mechanical and Aerospace Engineering, ‘‘Sapienza’’ University of Rome, Rome, Italy; 5Pediatric Rheumatology Unit, IRCCS ‘‘Bambino Gesu`’’ Children’s Hospital, Passoscuro, Rome, Italy; 6Pediatria II - Reumatologia, Istituto Giannina Gaslini, Genoa, Italy; 7Movement Analysis and Robotics Laboratory (MARLab), Neurorehabilitation Units, IRCCS ‘‘Bambino Gesu`’’ Children’s Hospital, Passoscuro, Rome, Italy; 8UOC Medicina Fisica e Riabilitazione, IRCCS Istituto Giannina Gaslini, Genoa, Italy; 9Department of Imaging, IRCCS ‘‘Bambino Gesu`’’ Children’s Hospital, Passoscuro, Rome, Italy; 10Paediatric Immunology, University Medical Centre Utrecht Wilhelmina Children’s Hospital, Utrecht, The Netherlands; 11 Visual Healthcare Technologies, Fraunhofer IGD, Darmstadt, Germany; 12Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy; and 13Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy (Received 22 February 2019; accepted 8 May 2019) Associate Editor Jane Grande-Allen oversaw the review of this article.
Abstract—Juvenile Idiopathic Arthritis (JIA) is a paediatric musculoskeletal disease of unknown aetiology, leading to walking alterations when the lower-limb joints are involved. Diagnosis of JIA is mostly clinical. Imaging can quantify impairments associated to inflammation and joint damage. However, treatment planning could be better supported using dynamic information, such as joint contact forces (JCFs). To this purpose, we used a musculoskeletal model to predict JCFs and investigate how JCFs varied as a result of joint impairment in eighteen children with JIA. Gait analysis data and magnetic resonance images (MRI) were used to develop patient-specific lower-limb musculoskeletal models, which were evaluated for operator-dependent variability (< 3.6, 0.05 N kg21 and 0.5 BW for joint angles, moments, and JCFs, respectively). Gait alterations and JCF patterns showed high between-subjects variability reflecting the pathology heterogeneity in the cohort. Higher joint impairment, assessed with MRI-based evaluation, was weakly associated to overall joint overloading. A stronger correlation was observed between impairment of one limb and overload of the contralateral limb, suggesting risky compensatory strategies being adopted
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