The variation of lateral and posterior coverage of the femoral head by the acetabulum during walking influences stability during gait
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1. Introduction Gait balance, assessed by the angle formed between the line joining the center-of-mass (COM) to the center-of-pressure (COP) and the vertical during gait, has been shown to be related to skeletal-postural and anthro- pometric parameters . Although skeletal-postural parameters are mea- sured on standing radiographs, they are known to vary during gait. There are currently no studies evaluating how the variations of skeletal-postural parameters during gait influence subject’s balance during walking. 2. Research question How does the variation of skeletal-postural parameters during gait influence subject’s balance during walking? 3. Methods 72 asymptomatic subjects (age: 28.6 ± 11 years [18–59], 29F) underwent 3D gait analysis  with additional markers on the thighs and shanks. The COM-COP angle with the vertical was calculated in both the frontal and sagittal planes during the gait cycle  (Fig. 1). Subjects then underwent low-dose full-body biplanar X-rays with the markers still in place. 3D reconstructions were obtained for the spine, pelvis and lower limbs. 3D bones were registered at each frame of the gait cycle . A new technique developed for this study, utilizing finite element modelling, was used to reduce soft tissue artefacts. Skeletal- postural parameters were then computed during the gait cycle, using the 3D registered bones, at each time frame (Fig. 2); mean, minimum, maximum and ROM were calculated on the waveforms during the gait cycle. In order to determine which varying skeletal-postural parameter during gait determined the variation of the COM-COP angles, univariate analysis (Pearson’s correlation) followed by a multivariate analysis (stepwise-multiple-linear-regression models) were computed; COM- COP parameters were the dependant variables and varying skeletal- postural parameters during gait were the independent variables. 4. Results Minimum (−14.2 ± 3.4°) and average (3.1 ± 1.6°) of the sagittal COM-COP angle were found to be determined by the minimum of the posterior coverage (post_cov) of the femoral head by the acetabulum during gait (β = 0.40; R2 = 0.16; p = 0.003 and β = 0.32; R2 = 0.1; p = 0.001,respectively).ROM(33.9 ± 5.1°)andmaximum (19.7 ± 2.8°) of the sagittal COM-COP angle were found to be related to the ROM (β = 0.29; R2 = 0.09; p = 0.03) and maximum (β = 0.34; R2 = 0.11; p = 0.006) of the acetabular abduction during gait, re- spectively. ROM of the frontal COM-COP angle (8.8 ± 2.51°) was found to be determined by the average of the post_cov (β = 0.51; R2 = 0.26; p = 0.004) during gait. 5. Discussion This is the first study to evaluate how the variation of skeletal- postural parameters during walking influences the stability during gait (Fig. 3). A less pronounced posterior coverage of the acetabulum during gait predisposes to more instability by decreasing the minimum COM- COP angle; a more pronounced acetabular abduction (decreased lateral coverage) during gait predisposes to more instability by increasing the ROM and the maximum of the COM-COP angle. Therefore, gait in- stability in the sagittal plane seems to be influenced by the variation of the posterior and lateral coverage of the femoral head by the acet- abulum during walking.
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