Elsevier

Journal of Biomechanics

Volume 62, 6 September 2017, Pages 14-20
Journal of Biomechanics

Soft tissue displacement over pelvic anatomical landmarks during 3-D hip movements

https://doi.org/10.1016/j.jbiomech.2017.01.013Get rights and content

Abstract

The position, in a pelvis-embedded anatomical coordinate system, of skin points located over the following anatomical landmarks (AL) was determined while the hip assumed different spatial postures: right and left anterior superior and posterior superior iliac spines, and the sacrum. Postures were selected as occurring during walking and during a flexion–extension and circumduction movement, as used to determine the hip joint centre position (star-arc movement). Five volunteers, characterised by a wide range of body mass indices (22–37), were investigated. Subject-specific MRI pelvis digital bone models were obtained. For each posture, the pose of the pelvis-embedded anatomical coordinate system was determined by registering this bone model with points digitised over bony prominences of the pelvis, using a wand carrying a marker-cluster and stereophotogrammetry. The knowledge of how the position of the skin points varies as a function of the hip posture provided information regarding the soft tissue artefact (STA) that would affect skin markers located over those points during stereophotogrammetric movement analysis. The STA was described in terms of amplitude (relative to the position of the AL during an orthostatic posture), diameter (distance between the positions of the AL which were farthest away from each other), and pelvis orientation. The STA amplitude, exhibited, over all postures, a median [inter-quartile] value of 9[6] and 16[11] mm, for normal and overweight volunteers, respectively. STA diameters were larger for the star-arc than for the walking postures, and the direction was predominantly upwards. Consequent errors in pelvic orientation were in the range 1–9 and 4–11 degrees, for the two groups respectively.

Introduction

The movement between markers attached to the skin surface, as used in stereophotogrammetry for the analysis of human motion, and the underlying bone (soft tissue artefact: STA) has been investigated in various body segments and during different motor tasks. This was made possible by simultaneously monitoring the movement of the skin markers and of the underlying bone using methods such as intracortical pins (Andersen et al., 2012; Andriacchi et al., 1998; Benoit et al., 2006; Camomilla et al., 2013; Cappozzo et al., 1996; Cereatti et al., 2009; Dal Maso et al., 2016; Fuller et al., 1997; Lafortune et al., 1992; Ramsey et al., 2003; Reinschmidt et al., 1997; Westblad et al., 2002), percutaneous bone tracking devices (Houck et al., 2004, Holden et al., 1997, Manal et al., 2000), fluoroscopy (Akbarshahi et al., 2010, Charbonnier et al., 2014, Kuo et al., 2011, Sati et al., 1996, Stagni et al., 2005, Tsai et al., 2009, Tsai et al., 2011), or X-rays (Maslen and Ackland, 1994).

Although a reasonable amount of relevant information concerning the lower and upper limb segments is available in the literature (Leardini et al., 2005, Peters et al., 2010), only two studies provided information on the STA that affects the pelvis. One investigation was performed during gait and sit to stand using markers mounted on pins inserted into the sacrum (Rozumalski et al., 2007). This study showed larger STA for the anterior superior than for the posterior iliac spine areas, and in the craniocaudal direction. A non-invasive assessment of pelvic STA was performed relying on the estimate of the pelvic bone-pose provided by a multiple anatomical calibration (Hara et al., 2014). This technique involves static calibrations performed through manual palpation of relevant anatomical landmarks (ALs) and consequent identification of their position using stereophotogrammetry through the range of motion of the joint of interest (Cappello et al., 1997). In this way, the STA issue is bypassed and a reliable pelvis pose can be assessed in each posture of interest. This method, besides not showing the STA components caused by the wobbling of the soft tissues, suffers from unavoidable intra-operator variability in the multiple identification of the ALs. This variability has been found to have a root mean square (rms) value in the range 11–20 mm causing pelvic orientation rms variability between 2 and 4 deg (Della Croce et al., 1999). Moreover, the hip postures investigated in Hara et al. (2014) simulated movements occurring only in the sagittal plane, which is not the case in locomotion and other functional motor tasks. A special case in which the STA affecting the pelvis is generated during a hip 3-D movement, characterised by large flexion-extensions and adduction-abductions excursions (the so-named star-arc movement; Camomilla et al., 2006), is the estimate of the hip joint centre position using a functional approach. The STA affecting this estimate (Kainz et al., 2015) heavily impacts the accuracy of movement analysis (Stagni et al., 2000). This calls for an accurate characterisation of the artefact (Camomilla et al., 2013) as a premise for its compensation (De Rosario et al., 2013, Rouhandeh et al., 2014a). Another limitation of the study of Hara et al. (2014) is that only information relative to normal-weight subjects is provided.

Therefore, the aim of this study was to assess pelvic STA expanding current available knowledge to 3-D hip poses, including those normally occurring during walking and during the above-mentioned star-arc movement, and to volunteers characterised by a wide range of body mass indices (BMIs). An experimental approach similar to that illustrated in Hara et al. (2014) was used, but with an enhanced anatomical calibration technique, named UP–CAST and illustrated in Donati et al., 2007, Donati et al., 2008, which drastically reduces the intra-operator variability of pelvic orientation estimation.

Section snippets

Materials and methods

Five healthy volunteers with body mass index ranging from 22 to 37 (Table 1) participated in the study after signing a written informed consent.

Results

The characteristics of the static positions assumed by the volunteers are reported in Table 2.

For each volunteer and sAL, the STA amplitudes and the STA diameters are reported for the MS and SA postures (Table 3). For the anterior pelvic ALs, the STA amplitudes ranged from 3.1 to 25.4 mm and from 4.6 to 52.1 mm, for normal and overweight volunteers, respectively; for the posterior ALs, from 1.9 to 22.0 mm and from 7.2 to 29.4 mm, for normal and overweight volunteers, respectively. The sRASIS

Discussion

In this study a multiple anatomical calibration based on a non-invasive and highly repeatable approach was performed and pelvic STA was assessed relative to static postures assumed to resemble the mid–stance phase of gait (MS) and the star-arc movement (SA), entailing hip flexion-extension and adduction–abduction ranges of motion larger than during gait. The STA was characterised in terms of amplitude and direction with respect to different ALs, task performed, and subjects’ BMI. Pelvic tilt,

Conflict of interest

The authors do not have any financial or personal relationships with other people or organisations that could inappropriately influence the manuscript.

References (47)

  • A. Cereatti et al.

    Hip joint centre location: an ex vivo study

    J. Biomech.

    (2009)
  • C. Charbonnier et al.

    A patient-specific measurement technique to model shoulder joint kinematics

    Orthop. Traumatol.: Surg. Res.

    (2014)
  • F. Dal Maso et al.

    Glenohumeral joint kinematics measured by intracortical pins, reflective markers, and computed tomography: a novel technique to assess acromiohumeral distance

    J. Electromyogr. Kinesiol.

    (2016)
  • H. De Rosario et al.

    Propagation of soft tissue artifacts to the center of rotation: a model for the correction of functional calibration techniques

    J. Biomech.

    (2013)
  • M. Donati et al.

    Anatomical frame identification and reconstruction for repeatable lower limb joint kinematics estimates

    J. Biomech.

    (2008)
  • M. Donati et al.

    Enhanced anatomical calibration in human movement analysis

    Gait Posture

    (2007)
  • N.M. Fiorentino et al.

    In-vivo quantification of dynamic hip joint center errors and soft tissue artifact

    Gait Posture

    (2016)
  • J. Fuller et al.

    A comparison of lower-extremity skeletal kinematics measured using skin-and pin-mounted markers

    Hum.Mov. Sci.

    (1997)
  • R. Hara et al.

    Quantification of pelvic soft tissue artifact in multiple static positions

    Gait Posture

    (2014)
  • J.P. Holden et al.

    Surface movement errors in shank kinematics and knee kinetics during gait

    Gait Posture

    (1997)
  • J. Houck et al.

    Validity and comparisons of tibiofemoral orientations and displacement using a femoral tracking device during early to mid stance of walking

    Gait Posture

    (2004)
  • H. Kainz et al.

    Estimation of the hip joint centre in human motion analysis: a systematic review

    Clin. Biomech.

    (2015)
  • M.-Y. Kuo et al.

    Influence of soft tissue artifacts on the calculated kinematics and kinetics of total knee replacements during sit to-stand

    Gait Posture

    (2011)
  • Cited by (0)

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