Gait & Posture 36 (2012) 68–72

Contents lists available at SciVerse ScienceDirect

Gait & Posture

journal homepage: www.elsevier.com/locate/gaitpost

Sit-to-stand alterations in advanced knee osteoarthritis

Katia Turcot a,b,*, Stéphane Armand a,b, Daniel Fritschy b, Pierre Hoffmeyer b, Domizio Suvà b
a
Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland
b
Orthopaedic Surgery Service, Geneva University Hospitals, Geneva, Switzerland

A R T I C L E I N F O A B S T R A C T

Article history: This study investigated the full-body strategies utilized during a sit-to-stand (STS) task in patients with
Received 26 March 2011 knee osteoarthritis (OA) and the association between STS alterations and clinical measurements.
Received in revised form 17 October 2011 Twenty-five patients with advanced knee OA and twenty healthy elderly adults were recruited to
Accepted 8 January 2012
participate in this study. Patients were asked to stand up from a chair four times without using their
arms. A 3D motion analysis system was used to capture the full-body kinematics during the task. Two
Keywords: force plates were used to capture the forces under each leg. The following parameters were investigated
Sit-to-stand (STS)
in the knee OA group and compared with the control group: the time to realize STS, the force ratio
Knee osteoarthritis (OA)
between both limbs, the knee and hip kinetics and the trunk kinematics. The pain and functional capacity
Motion analysis
Biomechanics were obtained from the WOMAC. The results showed that patients with knee OA put 10% additional
weight on the contralateral side when compared with the symmetrical strategy of the control group.
Patients with knee OA showed a significantly lower knee flexion moment (0.51 N m/kg vs. 0.72 N m/kg),
a higher maximal trunk flexion (46.48 vs. 37.58), and a higher lateral trunk lean on the contralateral side
(2.48 vs. 0.98) when compared with the control group. The main correlations were found between pain
and the averaged time to complete the STS task (r = 0.55).
With the quantification of the full-body mechanisms utilized during the STS task, which includes both
distal and proximal compensations, our study brings new insights, leading to a better understanding of
the functional alterations in patients with advanced knee OA.
ß 2012 Elsevier B.V. All rights reserved.

1. Introduction
Functional alterations in patients with knee OA are well
recognized. Studies have already demonstrated modifications in
gait [1,2], stair-climbing [3,4], unipodal stance [5], and the sit-to-
stand (STS) task [6–8]. When compared with gait and stair-
climbing, STS requires greater joint forces and moments [9].
Furthermore, the achievement of STS is considered to be one of the
most important activities of daily life [10] and is essential for
independent living in the elderly [11].
In a recent study, the authors evaluated the association of STS
parameters with clinical measures and found that STS was a
selective and functionally valid measure of knee function [12].
They proposed that STS may be used to objectively evaluate the
biomechanical knee function following a total knee arthroplasty
(TKA) [12]. To our knowledge, only a few studies have used the STS
task to investigate the functional disability of patients with
advanced knee OA [6,7] or patients following a TKA [8,9,12–14]. In
* Corresponding author at: Willy Taillard Laboratory of Kinesiology, University
Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14,
Switzerland. Tel.: +41 022 37 27 868; fax: +41 022 37 27 799.
E-mail address: kturcot@gmail.com (K. Turcot).
those studies, the main parameters investigated were the weight-
bearing asymmetry [6,7,12,14], knee motion [9,13,14], knee
angular velocity [6,12], and knee and hip joint moments
[9,13,14]. These studies found that patients with advanced knee
OA or following a TKA had a greater weight-bearing asymmetry
[6,7,12,14], a decrease of hip and knee joint moments [12,16,17]
and a decrease in knee angular velocity [6,12] on the affected side
compared with the healthy elderly.
Although both trunk positioning and movement are recognized
to play key roles in STS strategies [15] and might reflect significant
compensation mechanisms in patients with advanced knee OA,
there is currently only one study reporting on trunk compensation
during STS [12]. The trunk is the heaviest segment of the body and
has the largest contribution to forward movement [16]. In addition,
altered lower-limb kinetics during STS has previously been
associated with modification of upper-body position [17]. There-
fore, to better understand pathologic movement, the trunk should
be fully considered [18,19].
To our knowledge, the study by Boonstra et al. is the only one
that has assessed the sagittal trunk movement during STS in people
with TKA [12]. In their study, they investigated knee and trunk
angular velocities and maximal upper body flexion using inertial
sensors [12]. The authors hypothesized that people with TKA
would accentuate upper body compensation during STS compared

0966-6362/$ – see front matter ß 2012 Elsevier B.V. All rights reserved.
doi:10.1016/j.gaitpost.2012.01.005
 K. Turcot et al. / Gait & Posture 36 (2012) 68–72
with the healthy elderly [12]. However, they found no difference in
upper body flexion between patients with TKA and control subjects
[12]. In a study conducted by Su et al. [9], the authors evaluated the
biomechanics of rising from a chair in patients with knee OA,
patients with a TKA, and the healthy elderly. They reported a
significant increase in the amount of time to realize the STS task in
patients with knee OA compared with the healthy elderly [9]. The
authors explained this difference by an increase of forward body
bending [9]. However, this conclusion was not based on trunk
kinematics data but on the measurement of the center of mass
(COM) [9].
Based on current literature, the full-body compensatory
movements during STS in patients with advanced knee OA and
TKA are still not well understood. Therefore, the first objective of
this study was to investigate the strategy used by patients with
advanced knee OA to rise from a chair, with special emphasis on
compensatory trunk movements. The second objective was to
determine if knee pain and functional level are associated with STS
strategies. We have hypothesized that patient with advanced knee
OA will demonstrate a weight-bearing asymmetry and will show a
higher trunk flexion and a higher lateral trunk lean than the
healthy elderly. Second, we have hypothesized that an association
between STS parameters and clinical measurements should be
observed.
2. Methods
2.1. Subjects
Twenty-five patients (14 men and 11 women) with symptomatic knee OA and
scheduled for a TKA were recruited at the orthopedic service of the University
Hospitals of Geneva to participate in this study. The patients were included if they
have end-stage knee OA (i.e., grade 4 on the Kellgren–Lawrence grading scale [20])
and complained of knee pain. The exclusion criteria were joint prosthesis, a history
of lower limb or back surgery, and neurological or orthopedic disorders other than
the presence of knee OA that could affect their gait or balance. The patients were
also excluded if they could not walk for a short distance without the use of technical
aids. The mean and standard deviation (SD) of age, weight, height, and body mass
index (BMI) was 69 (5) years, 83.3 (15.4) kg, 1.69 (0.08) m, and 29.1 (4.8) kg/m2,
respectively.
Twenty healthy elderly (10 men and 10 women) were recruited as the control
group. All the subjects were included if they were free from knee pain, had no recent
history of lower limb or back surgery, and had no neurological or orthopedic
disorders that could affect their gait or balance. The mean and SD of age, weight,
[(Fig._1)TD$IG]
Fig. 1. Illustration of the determination of the STS phases. The dash line corresponds to the trunk angular velocity, the gray line to the summation of vertical ground reaction
forces and the black line to the summation of anterior pelvic markers position. All phases (T0–T3) are identified. T0 corresponds to the beginning of the STS, T1 to seat-off, T2
to maximal forces and, T3 to end of the STS.
69
height, and BMI was 67 (7) years, 67.4 (10.6) kg, 1.70 (0.10) m, and 23.2 (2.4) kg/m2,
respectively. Written informed consents were obtained from all subjects.
2.2. Instrumentation and data
A 3D 12-camera motion analysis system (VICON Peak, Oxford, UK) was used to
capture the full body motion during the STS task. Reflective markers were placed on
the pelvis and on both lower limbs according to the Davis protocol [21] and on the
trunk according to Gutierrez-Farewik et al. [22]. Two force plates (AMTI,
Watertown, USA) embedded in the floor were used to capture the ground reaction
forces under each leg. The motion and force plate data were synchronized and
sampled at 100 and 1000 Hz, respectively. Marker trajectories were filtered using a
generalized cross-validation (GCV) spline. Force plate data were normalized to body
mass. The joint kinematics and kinetics were generated using the dynamic model
(Vicon Plug-in-Gait). The joint moments were normalized for body weight (N m/
kg).
2.3. STS assessment
The influence of arm use and chair height according to different thigh lengths on
the biomechanical parameters has been addressed previously [15,23]. For the same
movement with a different seat height, the forces generated are different. Therefore,
all the subjects were evaluated in the following standardized position to reduce bias
and allow for comparison between the groups and at follow-up. The subjects sat on
a backless and armless chair, with the chair height set to place both knees at 908,
with both tibias vertical to the floor. No restriction was imposed for feet position.
The subjects were asked to rise from the chair at their self-selected pace and were
instructed not to use their arms to help them rise from the chair. Each subject
completed the STS task four times. The first three well-executed STS trials were
used for data analyses.
2.4. Pain and functional level assessment
Pain level and functional capacity were obtained from the WOMAC question-
naire [24]. A visual analog scale (0–100) was also used to quantify the pain of the
affected knee for the group of patients with knee OA. A zero indicated no pain,
whereas a 100 signified an intolerable pain.
2.5. Data analysis
All of the data were normalized to 100% of the STS task, as defined from the
beginning to the end of the STS task (Fig. 1). The beginning of the STS task (T0) was
determined using the angular velocity of the thorax segment. When the angular
velocity of the thorax moved above zero, the beginning of the STS task was
identified. When the angular velocity of the thorax returns to zero, the end of the
STS task (T3) was noted [14]. Furthermore, two other instants were identified: the
seat-off (T1) and the peak value of the floor reaction forces (T2). The seat-off
corresponded to the instant at which the buttocks left the chair. This instant was
70 K. Turcot et al. / Gait & Posture 36 (2012) 68–72

identified at the lowest position of both the anterior pelvic markers. The peak value 3.1. Difference in movement time
of the floor reaction forces was identified using the maximal value of the
summation of both the vertical ground reaction forces.
The variables tested during STS were the movement time, the force ratio, the The mean time to perform the STS (T0–T3) was significantly
maximal knee and hip joint moments in the sagittal plane and the maximal trunk higher for patients with knee OA (3.2  1.7 s vs. 2.6  0.6 s;
movement in the sagittal and frontal planes. The completed description of each p = 0.032). The time from the beginning of the STS task to the seat-
variable is presented below. off (T0–T1) was not different between the patient and control groups
The mean time of the STS task and the time from the beginning of the STS task to
the seat-off (i.e., T0–T1) and from the seat-off to the peak value of the floor reaction
(0.8  0.5 s vs. 0.8  0.3 s; p = 0.758), whereas a significant higher time
forces (i.e., T1–T2) were calculated and compared between the groups. from the seat-off to the peak value of the floor reaction forces (T1–T2)
The mean ratio and the ratio between the maximal vertical ground reaction was found for patients with knee OA (0.6  0.7 s vs. 0.2  0.1 s;
forces (GRFvmax) at T1–T2 were calculated. For patients with knee OA, the ratio p = 0.001).
corresponded to the GRFvmax of the affected side divided by the GRFvmax of the
contralateral side. For the group of control subjects, the ratio corresponded to the
GRFvmax of the left side divided by the GRFvmax of the right side. 3.2. Difference in ratio
Knee and hip internal flexion moments were obtained from inverse dynamics
computed using the Plug-In-Gait model (Vicon Nexus, Oxford, UK). The peak value The mean ratio calculated during the second phase of STS (T1–T2)
of knee and hip moments for the affected side during the interval T1–T2 was showed that patients with knee OA put an average of 10% additional
calculated.
Finally, the maximal flexion of the thorax and its maximal lateral lean during the
weight in the nonaffected side compared with the symmetrical
realization of the STS were also calculated. strategy of the control group (0.91  0.14 vs. 0.99  0.11; p = 0.046)
The mean values for the above-listed variables were obtained by averaging the (Table 2).
discrete values across the three trials. All the computations were performed with
MATLAB R2008b (Mathworks, USA) and the open-source Biomechanical ToolKit
3.3. Difference in lower joint kinetics and trunk kinematics
package for MATLAB (http://code.google.com/p/b-tk).

2.6. Statistical analysis

The unpaired Student’s t-tests were used to analyze the difference between
groups’ characteristics. The parameters extracted from the kinematics and kinetics
data and averaged from the three trials were compared between groups. For
nonparametric data, Kruskal–Wallis and multiple Dunn comparison tests were
performed. For parametric data, one-way ANOVA was used. When significant
differences existed, Tukey’s post hoc tests were conducted. A significant difference
was defined as p < 0.05. For patients with knee OA, Spearman’s correlations were
conducted to evaluate the associations between clinical (i.e., pain, function) and
biomechanical parameters.
Patients with knee OA showed a significant lower knee internal
flexion moment during T1–T2 (0.51  0.16 N m/kg vs.
0.72  0.15 N m/kg; p = 0.0002), a higher maximal trunk flexion
(46  128 vs. 37  188; p = 0.007), and a higher lateral trunk lean on
the contralateral side flexion (2.4  1.88 vs. 0.9  1.78; p = 0.008)
during the STS task when compared with the control group. However,
no difference between the groups was obtained for the knee adduction
moment (0.10  0.07 N m/kg vs. 0.11  0.08 N m/kg; p = 0.597) and
for the hip flexion moment (0.60  0.18 N m/kg vs. 0.68  0.23 N m/
kg; p = 0.189) (Table 2).

3. Results 3.4. Correlations between clinical and biomechanical parameters

No difference between the groups was found for age and height,
whereas weight and BMI were significantly higher for patients
with knee OA (Table 1). The average and SD of the parameters
extracted from the STS are presented for both groups in Table 2.
Table 1
Demographic data for patients with knee OA and control subjects.
Age (year) Weight (kg)* Height (m)
The correlations between all of the significant parameters found
between the groups for the STS and clinical measures were
calculated for the group of patients with knee OA, and they are
presented in Table 3. The main correlations were found between
the pain score obtained from the WOMAC questionnaire and the
averaged time to complete the STS task (r = 0.55) and between the
total score of the WOMAC questionnaire and the average time to
complete the STS task (r = 0.46).
BMI (kg/m2)*

Knee OA patients 69  5 83.3  15.4 1.69  0.08 29.1  4.8 4. Discussion

Control subjects 67  7 67.4  10.6 1.70  0.10 23.2  2.4
*
Significant difference between groups with p < 0.05. Knee OA is a disabling disease associated with pain and loss of
function. The assessment of STS in patients with advanced knee OA
Table 2
Mean and standard deviation (SD) of parameters calculated from the sit-to-stand (STS) for patients with advanced knee OA and control subjects.

STS parameters Patients with knee OA (n = 25) Control subjects (n = 20) P value

Mean SD Mean SD

Force ratio (%)

Mean ratio (T1–T2) 0.91 0.14 0.99 0.11 0.046*

Time (s)
Mean time (STS) 3.2 1.2 2.6 0.4 0.032*
Mean time (T0–T1) 0.8 0.4 0.8 0.2 0.758
Mean time (T1–T2) 0.6 0.5 0.2 0.1 0.001*

Joint moment (N m/kg)

Maximal knee add/abd (T1–T2) 0.10 0.07 0.11 0.08 0.597
Maximal knee flex/ext (T1–T2) 0.51 0.16 0.72 0.15 0.0002*
Maximal hip flex/ext (T1–T2) 0.60 0.18 0.68 0.23 0.189

Trunk angle (8)

Maximal flexion (STS) 46.4 8.7 37.5 12.3 0.007*
Maximal lateral lean (STS) 2.4 1.8 0.9 1.7 0.008*
*
Significant difference between groups with p < 0.05.
 K. Turcot et al. / Gait & Posture 36 (2012) 68–72
Table 3
Correlations (r) between sit-to-stand parameters and clinical measurements.
Knee WOMAC WOMAC
pain pain function
r r r r
Force ratio (T1–T2) 0.07 0.05 0.08
Mean time (STS) 0.28 0.55* 0.34
Time (T1–T2) 0.25 0.21 0.26
Max knee flex/ext moment 0.02 0.09 0.26
Maximal lateral trunk lean 0.10 0.13 0.11
Maximal trunk flexion 0.34 0.27 0.22
*
Significant correlations with p < 0.05.
could help in the determination of their functional level and could
be used as an objective outcome of improvement following a TKA.
However, there is currently a lack of literature regarding STS full-
body movement alterations in patients with advanced knee OA,
especially on the implications of trunk movement. Moreover, no
study has yet quantified the 3D kinematics of the trunk during STS
for this population.
The objective of our study was to investigate the altered
movement patterns during a standardized STS motion in patients
with advanced knee OA. Full-body 3D kinematics and lower body
kinetics were assessed to highlight movement compensations and
identify their relationships with pain and functional status.
The patients with advanced knee OA demonstrated an overload
of the contralateral limb of 10% compared with a symmetric force
ratio of 0.99 for the control subjects. This outcome is in agreement
with previous studies [6,7]. The study by Christiansen and Stevens-
Lapsley [7] compared the weight-bearing asymmetry during the
STS task in patients having severe unilateral knee OA with a group
of healthy elderly. The authors found an increase in asymmetry in
the patients with knee OA with an average loading of the affected
limb at 87% of the nonaffected one [7]. In the present study, we
found a mean loading of the affected limb at 91% of the nonaffected
one. Compared with the study by Christiansen and Stevens-Lapsley
[7], the patients evaluated in the present study could not use their
arms to rise from their chair.
In the present study, no correlation between the force ratio and
clinical scores was found. We had presumed that patients with a
more symptomatic knee joint would overload the contralateral
limb more. However, this was not confirmed by our results.
Conversely, we found that the increase in the knee pain was
positively correlated, but not significant, with the forward trunk
lean (r = 0.36) and the average time to perform the STS task
(r = 0.28). These results suggest that to reduce the forces and
moments required to rise from the chair, the patients horizontally
displace their center of mass by leaning their trunk forward. This
strategy increases the time to stand up and decreases the
solicitation of the quadriceps muscles. This is in agreement with
the significant reduction of 41% of the knee flexor moment in the
group of advanced knee OA patients compared with the control
subjects.
As shown in Su et al. [9], patients with knee OA performed the
STS more slowly than the healthy elderly [9]. As demonstrated in
the present study, Su et al. explained the increase in the time to
perform the STS task with the forward lean of the trunk [9]. In fact,
we found a significant increase of 98 for trunk flexion in patients
with knee OA compared with the control subjects.
Our results showed that patients with knee OA had a superior
lateral trunk lean, when compared with the control subjects. In a
recent study conducted by Hunt et al. [25], the authors
demonstrated that patients with an advanced knee OA lean their
trunk significantly more laterally during gait compared with
healthy subjects. The increase in the lateral lean on the affected
side was proposed as a mechanical strategy to reduce pain as well
71
as the knee adductor moment by moving the COM laterally [25]. In
the present study, patients shifted their weight on the contralateral
WOMAC side to unload the affected side. This strategy leads to a significant
total increase in the lateral trunk lean on the contralateral side, which
results in a significant decrease of the sagittal knee joint moments
0.09 on the affected side. This is also proposed as a mechanical strategy
0.46* to reduce pain as well as to decrease the solicitation of weaker
0.24 muscles.
0.19
The functional status was also found to be associated with the
0.06
0.27 STS biomechanical parameters (Table 3). The main result
demonstrated a positive correlation but was not significant
between the WOMAC function score and the time to perform
the STS task (r = 0.34). Furthermore, the results showed that a
reduction in the functional capacity is associated with a decrease in
the knee flexor moment. We can speculate that this is closely
linked with the quadriceps weakness recognized in knee OA [26].
However, the quantification of muscle strength was not considered
in the present study.
A limitation of this study is that we had recruited advanced
knee OA patients scheduled for a TKA, but we did not consider
bilateral affectation. In fact, among all of the patients evaluated, 16
out of 25 reported symptoms in the contralateral knee. This aspect
may have underestimated the loading asymmetry in the STS task
for this population.
This study is the first to have investigated the 3D trunk
compensations in patients with advanced knee OA during the
performance of the STS task. With the quantification of full-body
mechanisms during the STS task, which includes both distal and
proximal compensations, our study brings new insights, leading to
a better understanding of the functional alterations in patients
with advanced knee OA. Moreover, our data show the association
between compensatory movements and clinical measurements.
It has been recognized that abnormal movement patterns
developed with knee OA can persist for a long time after TKA,
although pain and function are usually improved [27]. Therefore,
identification of altered movement patterns prior to TKA is
essential for patient follow-up. Maintaining altered movements
following TKA might increase the risk of developing knee OA on the
contralateral side and may have a negative influence on rehabili-
tation.
Further studies are therefore needed to identify the modifica-
tion of patients’ strategy in the realization of the STS task after TKA.
The identification of relevant parameters reflecting patients’
function prior to TKA might be helpful in the rehabilitation
process of patients with knee OA after a TKA, thus improving
patient satisfaction.
Acknowledgments
This work was supported by the Orthopaedic Surgery Service of
the Geneva University Hospitals, the Clinical Research Center of the
University Hospital and Faculty of Medicine of Geneva University
and the Louis-Jeantet Foundation and by the ‘‘Fonds de la
Recherche en Santé du Québec’’. The authors would like to thank
Dr. Anne Lübbeke for her contributions to the development of the
protocol.
Conflict of interest statement
None.
References
[1] Baliunas AJ, Hurwitz DE, Ryals AB, Karrar A, Case JP, Block JA, et al. Increased
knee joint loads during walking are present in subjects with knee osteoarthri-
tis. Osteoarthritis Cartilage 2002;10(7):573–9.
[2] Turcot K, Aissaoui R, Boivin K, Pelletier M, Hagemeister N, de Guise JA. The
responsiveness of three-dimensional knee accelerations used as an estimation
72 K. Turcot et al. / Gait & Posture 36 (2012) 68–72
of knee instability and loading transmission during gait in osteoarthritis
patient’s follow-up. Osteoarthritis Cartilage 2009;17(2):213–9.
[3] Hicks-Little CA, Peindl RD, Hubbard TJ, Scannell BP, Springer BD, Odum SM,
et al. Lower extremity joint kinematics during stair climbing in knee osteoar-
thritis. Med Sci Sports Exerc 2011;43(3):516–24.
[4] Asay JL, Mundermann A, Andriacchi TP. Adaptive patterns of movement during
stair climbing in patients with knee osteoarthritis. J Orthop Res
2009;27(3):325–9.
[5] Turcot K, Hagemeister N, de Guise JA, Aissaoui R. Evaluation of unipodal stance
in knee osteoarthritis patients using knee accelerations and center of pressure.
Osteoarthritis Cartilage 2011;19(3):281–6.
[6] Boonstra MC, Schwering PJ, De Waal Malefijt MC, Verdonschot N. Sit-to-stand
movement as a performance-based measure for patients with total knee
arthroplasty. Phys Ther 2010;90(2):149–56.
[7] Christiansen CL, Stevens-Lapsley JE. Weight-bearing asymmetry in relation to
measures of impairment and functional mobility for people with knee osteo-
arthritis. Arch Phys Med Rehabil 2010;91(10):1524–8.
[8] Mizner RL, Snyder-Mackler L. Altered loading during walking and sit-to-stand
is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res
2005;23(5):1083–90.
[9] Su FC, Lai KA, Hong WH. Rising from chair after total knee arthroplasty. Clin
Biomech (Bristol Avon) 1998;13(3):176–81.
[10] Schenkman M, Berger RA, Riley PO, Mann RW, Hodge WA. Whole-body
movements during rising to standing from sitting. Phys Ther
1990;70(10):638–48 [discussion 648–651].
[11] Dehail P, Bestaven E, Muller F, Mallet A, Robert B, Bourdel-Marchasson I, et al.
Kinematic and electromyographic analysis of rising from a chair during a ‘‘Sit-
to-Walk’’ task in elderly subjects: role of strength. Clin Biomech (Bristol Avon)
2007;22(10):1096–103.
[12] Boonstra MC, De Waal Malefijt MC, Verdonschot N. How to quantify knee
function after total knee arthroplasty? Knee 2008;15(5):390–5.
[13] Farquhar SJ, Kaufman KR, Snyder-Mackler L. Sit-to-stand 3 months after
unilateral total knee arthroplasty: comparison of self-selected and con-
strained conditions. Gait Posture 2009;30(2):187–91.
[14] Farquhar SJ, Reisman DS, Snyder-Mackler L. Persistence of altered movement
patterns during a sit-to-stand task 1 year following unilateral total knee
arthroplasty. Phys Ther 2008;88(5):567–79.
[15] Janssen WG, Bussmann HB, Stam HJ. Determinants of the sit-to-stand move-
ment: a review. Phys Ther 2002;82(9):866–79.
[16] Gillet C, Duboy J, Barbier F, Armand S, Jeddi R, Lepoutre FX, et al. Contribution
of accelerated body masses to able-bodied gait. Am J Phys Med Rehabil
2003;82(2):101–9.
[17] Doorenbosch C, Harlaar J, Roebroeck ME, Lankhorst GJ. Two strategies of
transferring from sit-tostand, the activation of monoarticular and biarticular
muscles. J Biomech 1994;27:1299–307.
[18] Romkes J, Peeters W, Oosterom AM, Molenaar S, Bakels I, Brunner R. Evaluating
upper body movements during gait in healthy children and children with
diplegic cerebral palsy. J Pediatr Orthop B 2007;16(3):175–80.
[19] Goujon-Pillet H, Sapin E, Fode P, Lavaste F. Three-dimensional motions of
trunk and pelvis during transfemoral amputee gait. Arch Phys Med Rehabil
2008;89(1):87–94.
[20] Lequesne MG, Maheu E. Clinical and radiological evaluation of hip, knee and
hand osteoarthritis. Aging Clin Exp Res 2003;15(5):380–90.
[21] Davis III RB, Ounpuu S, Tyburski D, Gage JR. A gait analysis data collection and
reduction technique. Hum Mov Sci 1991;10:575–87.
[22] Gutierrez-Farewik EM, Bartonek A, Saraste H. Comparison and evaluation of
two common methods to measure center of mass displacement in three
dimensions during gait. Hum Mov Sci 2006;25(2):238–56.
[23] Yamada T, Demura S. Influence of the relative difference in chair seat height
according to different lower thigh length on floor reaction force and lower-
limb strength during sit-to-stand movement. J Physiol Anthropol Appl Human
Sci 2004;23(6):197–203.
[24] Whitehouse SL, Lingard EA, Katz JN, Learmonth ID. Development and testing of
a reduced WOMAC function scale. J Bone Joint Surg Br 2003;85(5):706–11.
[25] Hunt MA, Wrigley TV, Hinman RS, Bennell KL. Individuals with severe knee
osteoarthritis (OA) exhibit altered proximal walking mechanics compared
with individuals with less severe OA and those without knee pain. Arthritis
Care Res (Hoboken) 2010;62(10):1426–32.
[26] Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, et al.
Osteoarthritis: new insights, Part 1: the disease and its risk factors. Ann Intern
Med 2000;133(8):635–46.
[27] Milner CE. Is gait normal after total knee arthroplasty? Systematic review of
the literature. J Orthop Sci 2009;14(1):114–20.