A Framework for Analytical Validation of Inertial-Sensor-Based Knee Kinematics Using a Six-Degrees-of-Freedom Joint Simulator.

The success of kinematic analysis that relies on inertial measurement units (IMUs) heavily depends on the performance of the underlying algorithms. Quantifying the level of uncertainty associated with the models and approximations implemented within these algorithms, without the complication of soft-tissue artefact, is therefore critical. To this end, this study aimed to assess the rotational errors associated with controlled movements. Here, data of six total knee arthroplasty patients from a previously published fluoroscopy study were used to simulate realistic kinematics of daily activities using IMUs mounted to a six-degrees-of-freedom joint simulator. A model-based method involving extended Kalman filtering to derive rotational kinematics from inertial measurements was tested and compared against the ground truth simulator values. The algorithm demonstrated excellent accuracy (root-mean-square error ≤0.9°, maximum absolute error ≤3.2°) in estimating three-dimensional rotational knee kinematics during level walking. Although maximum absolute errors linked to stair descent and sit-to-stand-to-sit rose to 5.2° and 10.8°, respectively, root-mean-square errors peaked at 1.9° and 7.5°. This study hereby describes an accurate framework for evaluating the suitability of the underlying kinematic models and assumptions of an IMU-based motion analysis system, facilitating the future validation of analogous tools.