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Stasi S, Papagiannis G, Triantafyllou A, Papagelopoulos P, Koulouvaris P. Post-Arthroplasty Spatiotemporal Gait Parameters in Patients with Hip Osteoarthritis or Developmental Dysplasia of the Hip: An Observational Study. J Funct Morphol Kinesiol 2024; 9:110. [PMID: 39051271 PMCID: PMC11270259 DOI: 10.3390/jfmk9030110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Total hip arthroplasty (THA) is a preferred treatment for primary osteoarthritis (OA) or secondary degenerative arthropathy due to developmental hip dysplasia (DDH). Gait analysis is considered a gold standard for evaluating post-arthroplasty walking patterns. This study compared post-THA spatiotemporal gait parameters (SGPs) between OA and DDH patients and explored correlations with demographic and clinical variables. Thirty patients (15 per group) were recorded during gait and their SGPs were analyzed. Functionality was evaluated with the Oxford Hip Score (OHS). The OA patients were significantly older than DDH patients (p < 0.005). Significant and moderate to strong were the correlations between SGPs, age, and four items of the OHS concerning hip pain and activities of daily life (0.31 < Pearson's r < 0.51 all p < 0.05). Following THA, both groups exhibited similar levels of the examined gait parameters. Post-arthroplasty SGPs and OHS correlations indicate limitations in certain activities. Given the absence of pre-operative data and the correlation between age and SGPs and OHS, ANCOVA testing revealed that age adjusts OHS and SGP values, while pre-operative diagnosis has no main effect. These findings indicate that hip OA or DDH do not affect postoperative SGPs and patients' functionality. Future studies should examine both kinematic and kinetic data to better evaluate the post-THA gait patterns of OA and DDH patients.
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Affiliation(s)
- Sophia Stasi
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
| | - Georgios Papagiannis
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
| | - Athanasios Triantafyllou
- 1st Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
| | - Panayiotis Papagelopoulos
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
| | - Panagiotis Koulouvaris
- Biomechanics Laboratory, Department of Physiotherapy, University of the Peloponnese, 23100 Sparta, Greece; (G.P.); (P.P.); (P.K.)
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Ryan NS, Kowalski E, Beaulé PE, Lamontagne M. The Effect of Surgical Approach and Hip Offset Reconstruction on Gait Biomechanics Following Total Hip Arthroplasty. J Arthroplasty 2024; 39:402-408.e1. [PMID: 37597822 DOI: 10.1016/j.arth.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND This study aimed to examine how hip offset (HO) and surgical approach affect gait biomechanics following total hip arthroplasty (THA). METHODS There were 55 THA patients assigned to 3 groups based on surgical approach (ANT: anterior, LAT: lateral, or POS: posterior) and HO difference (large HO: >5 millimeters (mm), small HO; <5 mm, or normal; between +3 mm and -3 mm). Kinematics and kinetics were recorded using motion capture and force plate data. Group differences were assessed using statistical parametric mapping. RESULTS The ANT group demonstrated more normal sagittal plane kinematics and kinetics. No frontal plane kinematic differences were found, but the LAT group displayed more normal frontal plane kinetics. The LAT group displayed a slower walking speed than the ANT group, and the LAT and POS groups used a shorter stride/step length than the control group. The large HO group showed fewer differences in sagittal plane kinematics and kinetics than the small HO and normal groups. No frontal plane kinematic differences were observed, but the normal group demonstrated more significant differences than the large HO and small HO groups. No significant differences were found between any of the HO patient groups. CONCLUSION Anterior and lateral approaches led to more normal gait biomechanics in sagittal kinematics and frontal kinetics, respectively, but only the ANT group exhibited spatiotemporal gait parameters within normal ranges. Hip offset differences greater or less than 5 mm do not significantly change gait patterns. Surgical approach plays a greater role than HO reconstruction in producing more normal gait biomechanics following THA.
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Affiliation(s)
- Nicholas S Ryan
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada
| | - Erik Kowalski
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada; Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mario Lamontagne
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada
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3
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Sara LK, Lewis CL. Rehabilitation Phases, Precautions, and Mobility Goals Following Total Hip Arthroplasty. HSS J 2023; 19:494-500. [PMID: 37937096 PMCID: PMC10626929 DOI: 10.1177/15563316231192980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 11/09/2023]
Abstract
The prevalence of total hip arthroplasty (THA) for advanced hip osteoarthritis (OA) is both increasing and shifting toward a younger average age. However, THA alone does not typically normalize function in these patients. Postoperative rehabilitation is often recommended to optimize joint motion, strength, and function. To date, there are no peer-reviewed clinical practice guidelines for postoperative rehabilitation following THA. Thus, optimal postoperative rehabilitation requires consideration of the existing literature and clinical expertise. This review article summarizes current recommendations for postoperative management of THA, including phases of rehabilitation, postoperative hip precautions, the effect of rehabilitation setting and mode of delivery on postoperative outcomes, and gait mechanics.
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Affiliation(s)
- Lauren K Sara
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Cara L Lewis
- Department of Physical Therapy, Boston University, Boston, MA, USA
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Langley B, Whelton C, Page R, Chalmers O, Cramp M, Morrison SC, Dey P, Board T. Exploring pelvis and thigh movement and coordination patterns during walking in patients after total hip arthroplasty. Gait Posture 2023; 103:196-202. [PMID: 37245333 DOI: 10.1016/j.gaitpost.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Patients after total hip arthroplasty (THA) have altered hip kinematics compared to healthy controls, specifically hip extension and range of motion are lower. Exploring pelvis-thigh coordination patterns and coordination variability may help to elucidate why differences in hip kinematics are evident in patients following THA. RESEARCH QUESTION Do sagittal plane hip, pelvis and thigh kinematics, and pelvis-thigh movement coordination and coordination variability differ between patients following THA and healthy controls during walking? METHODS Sagittal plane hip, pelvis and thigh kinematics were collected using a three-dimensional motion capture system while 10 patients who had undergone THA and 10 controls walked at a self-selected pace. A modified vector coding technique was used to quantify pelvis-thigh coordination and coordination variability patterns. Peak hip, pelvis and thigh kinematics and ranges of motion, and movement coordination and coordination variability patterns were quantified and compared between groups. RESULTS Patients after THA have significantly (p ≤ .036; g ≥ 0.995) smaller peak hip extension and range of motion, and peak thigh anterior tilt and range of motion compared to controls. Additionally, patients following THA have significantly (p ≤ .037; g ≥ 0.646) more in-phase distally and less anti-phase distally dominated pelvis-thigh movement coordination patterns compared to controls. SIGNIFICANCE The smaller peak hip extension and range of motion displayed by patients following THA is due to smaller peak anterior tilt of the thigh, which in turn limits thigh range of motion. The lower sagittal plane thigh, and in turn hip, motion used by patients after THA may be due to increases in the in-phase coordination of pelvis-thigh motion patterns, which cause the pelvis and thigh to work as a singular functional unit.
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Affiliation(s)
- Ben Langley
- Musculoskeletal Population Health Research Group, Edge Hill University, Lancashire, UK.
| | - Chris Whelton
- The Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | - Richard Page
- Musculoskeletal Population Health Research Group, Edge Hill University, Lancashire, UK
| | - Oliver Chalmers
- Musculoskeletal Population Health Research Group, Edge Hill University, Lancashire, UK
| | - Mary Cramp
- Allied Health Professions, Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Stewart C Morrison
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Paola Dey
- Musculoskeletal Population Health Research Group, Edge Hill University, Lancashire, UK
| | - Tim Board
- The Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
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5
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Anwar SFZ, Wang Y, Raza W, Arnold G, Wang W. Mechanical energy fluctuation in lower limbs during walking in participants with and without total hip replacement. ROYAL SOCIETY OPEN SCIENCE 2023; 10:230041. [PMID: 36866080 PMCID: PMC9974294 DOI: 10.1098/rsos.230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/15/2023] [Indexed: 05/13/2023]
Abstract
Mechanical energy fluctuation of the segments of lower limbs during walking has not been fully investigated. It was hypothesized that the segments may work as a pendulum, i.e. the kinetic and potential energies exchanged out of phase. This study aimed to investigate energy changes and recovery during gait in hip replacement patients. The gait data for 12 participants with total hip replacement and 12 age-matched control was compared. The kinetic, potential and rotative energies for whole lower limb and thigh, calf and foot, were calculated. The effectiveness of a pendulum effect was analysed. Gait parameters (speeds and cadence) were calculated. The results showed that the thigh had significant effectiveness as a pendulum during gait with energy recovery coefficient of approximately 40% while the calf and foot were less like a pendulum during gait. In comparison, energy recoveries of lower limbs in the two groups were not significantly different. If the pelvis was considered as an approximate to the centre of mass, however, the control group had a higher energy recovery than total-hip-replacement group by roughly 10%. This study concluded that, unlike centre of mass energy recovery, the mechanical energy recovery mechanism in the lower limbs during walking is not affected after total hip replacement.
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Affiliation(s)
- St. Fatimah Zahrah Anwar
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Ying Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Wasim Raza
- Department of Biomedical Engineering, NED University of Engineering and Technology, LEJ Campus, Karachi, Pakistan
| | - Graham Arnold
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Weijie Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
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6
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Langley B, Page RM, Whelton C, Chalmers O, Morrison SC, Cramp M, Dey P, Board TN. Do patients with well-functioning total hip arthroplasty achieve typical sagittal plane hip kinematics? A proof of concept study. Hip Int 2023; 33:247-253. [PMID: 34496218 PMCID: PMC9978862 DOI: 10.1177/11207000211044471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) patients have been shown to not achieve normal sagittal plane hip kinematics. However, previous studies have only conducted group level analysis and as such lack the sensitivity to highlight whether individual patients do achieve normal hip kinematics. As such this study looked to determine whether some patients with well-functioning THA achieve typical sagittal plane hip kinematics. METHODS Sagittal plane hip kinematics were collected on 11 well-functioning THA patients (Oxford Hip Score = 46 ± 3) and 10 asymptomatic controls using a 3-dimensional motion analysis system during self-paced walking. High-functioning THA patients were identified as those who displayed sagittal plane hip kinematics that were within the variance of the control group on average, and low-functioning patients as those who did not. RESULTS 5 THA patients were identified as high-functioning, displaying hip kinematics within the variance of the control group. High-functioning THA patients displayed peak hip flexion and extension values more closely aligned to asymptomatic control group than low-functioning patients. However, hip range of motion was comparable between high- and low-functioning total hip arthroplasty patients and reduced compared to controls. CONCLUSION The presence of high-functioning THA patients who display comparable sagittal plane hip kinematics to controls suggests these patients do achieve normative function and challenges the conclusions of previous group level analysis. Understanding why some patients achieve better function post-operatively will aid pre- and post-operative practices to maximise functional recovery.
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Affiliation(s)
- Ben Langley
- Sport and Physical Activity, Faculty of
Arts and Sciences, Edge Hill University, Ormskirk, UK,Ben Langley, Edge Hill University, St
Helens Road, Ormskirk, Lancashire, L39 4QP, UK.
| | - Richard M Page
- Sport and Physical Activity, Faculty of
Arts and Sciences, Edge Hill University, Ormskirk, UK
| | - Chris Whelton
- Centre for Hip Surgery, Wrightington
Hospital, Wigan Wrightington and Leigh NHS Trust, Wigan, UK
| | - Oliver Chalmers
- Centre for Doctoral Training in
Prosthetics and Orthotics, School of Health and Society, University of Salford,
Salford, UK
| | | | - Mary Cramp
- Allied Health Professions, Health and
Applied Sciences, University of the West of England; Bristol, UK
| | - Paola Dey
- Faculty of Health and Social Care, Edge
Hill University, Ormskirk, UK
| | - Tim N Board
- Centre for Hip Surgery, Wrightington
Hospital, Wigan Wrightington and Leigh NHS Trust, Wigan, UK
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7
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Anwar SFZ, Wang Y, Raza W, Arnold G, Wang W. Mechanical energy fluctuation in lower limbs during walking in participants with and without total hip replacement. ROYAL SOCIETY OPEN SCIENCE 2023. [PMID: 36866080 DOI: 10.5061/dryad.r4xgxd2fr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Mechanical energy fluctuation of the segments of lower limbs during walking has not been fully investigated. It was hypothesized that the segments may work as a pendulum, i.e. the kinetic and potential energies exchanged out of phase. This study aimed to investigate energy changes and recovery during gait in hip replacement patients. The gait data for 12 participants with total hip replacement and 12 age-matched control was compared. The kinetic, potential and rotative energies for whole lower limb and thigh, calf and foot, were calculated. The effectiveness of a pendulum effect was analysed. Gait parameters (speeds and cadence) were calculated. The results showed that the thigh had significant effectiveness as a pendulum during gait with energy recovery coefficient of approximately 40% while the calf and foot were less like a pendulum during gait. In comparison, energy recoveries of lower limbs in the two groups were not significantly different. If the pelvis was considered as an approximate to the centre of mass, however, the control group had a higher energy recovery than total-hip-replacement group by roughly 10%. This study concluded that, unlike centre of mass energy recovery, the mechanical energy recovery mechanism in the lower limbs during walking is not affected after total hip replacement.
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Affiliation(s)
- St Fatimah Zahrah Anwar
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Ying Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Wasim Raza
- Department of Biomedical Engineering, NED University of Engineering and Technology, LEJ Campus, Karachi, Pakistan
| | - Graham Arnold
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Weijie Wang
- University Department of Orthopaedic and Trauma Surgery, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
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8
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D’Isidoro F, Brockmann C, Friesenbichler B, Zumbrunn T, Leunig M, Ferguson SJ. Moving fluoroscopy-based analysis of THA kinematics during unrestricted activities of daily living. Front Bioeng Biotechnol 2023; 11:1095845. [PMID: 37168610 PMCID: PMC10164959 DOI: 10.3389/fbioe.2023.1095845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/10/2023] [Indexed: 05/13/2023] Open
Abstract
Introduction: Knowledge of the accurate in-vivo kinematics of total hip arthroplasty (THA) during activities of daily living can potentially improve the in-vitro or computational wear and impingement prediction of hip implants. Fluoroscopy- based techniques provide more accurate kinematics compared to skin marker-based motion capture, which is affected by the soft tissue artefact. To date, stationary fluoroscopic machines allowed the measurement of only restricted movements, or only a portion of the whole motion cycle. Methods: In this study, a moving fluoroscopic robot was used to measure the hip joint motion of 15 THA subjects during whole cycles of unrestricted activities of daily living, i.e., overground gait, stair descent, chair rise and putting on socks. Results: The retrieved hip joint motions differed from the standard patterns applied for wear testing, demonstrating that current pre-clinical wear testing procedures do not reflect the experienced in-vivo daily motions of THA. Discussion: The measured patient-specific kinematics may be used as input to in vitro and computational simulations, in order to investigate how individual motion patterns affect the predicted wear or impingement.
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Affiliation(s)
| | | | | | | | | | - Stephen J. Ferguson
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- *Correspondence: Stephen J. Ferguson,
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FitzPatrick A, Rodgers G, Fernandez J, Hooper G. Synchronized acoustic emission and gait analysis of total hip replacement patients. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Kaynak G, Karaismailoglu B, Ozsahin MK, Gorgun B, Inan M, Erdogan F. High hip center arthroplasty in the treatment of severe hip dysplasia: Are knee and ankle compromised? Clin Biomech (Bristol, Avon) 2022; 91:105542. [PMID: 34861496 DOI: 10.1016/j.clinbiomech.2021.105542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited information about the effect of hip center location on gait parameters of knee and ankle. This study aimed to compare anatomical vs. high hip center arthroplasty according to gait parameters of knee and ankle and investigate whether the high hip center has any adverse effect on these joints or not. METHODS 20 patients who underwent unilateral total hip arthroplasty (Group 1; 10 patients with anatomical reconstruction, Group 2; 10 patients with high hip center) due to Crowe type III-IV developmental dysplasia of the hip and completed 2 years of follow-up were included. The patients were examined by 3-D gait analysis. FINDINGS The maximum extension of the knee on the operated side was lower in Group 2 (p = 0.044). Longitudinal knee joint force was higher in Group 2 on both operated (p = 0.041) and non-operated sides (p = 0.031). Lateral knee joint force was also higher in Group 2 (p = 0.023). No significant difference was detected in ankle parameters. INTERPRETATION Unilateral high hip center has been shown to restrict the dynamic knee range of motion on the operated side and increase the knee load on both sides, thus putting the knees at risk for osteoarthritis. LEVEL OF EVIDENCE Level III, Retrospective comparative study.
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Affiliation(s)
- Gokhan Kaynak
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Bedri Karaismailoglu
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey.
| | - Mahmut Kursat Ozsahin
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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11
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Lewis CL, Halverstadt AL, Graber KA, Perkins Z, Keiser E, Belcher H, Khuu A, Loverro KL. Individuals With Pre-arthritic Hip Pain Walk With Hip Motion Alterations Common in Individuals With Hip OA. Front Sports Act Living 2021; 3:719097. [PMID: 34505057 PMCID: PMC8421535 DOI: 10.3389/fspor.2021.719097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals with hip osteoarthritis (OA) commonly walk with less hip extension compared to individuals without hip OA. This alteration is often attributed to walking speed, structural limitation, and/or hip pain. It is unclear if individuals who are at increased risk for future OA (i.e., individuals with pre-arthritic hip disease [PAHD]) also walk with decreased hip extension. Objectives: (1) Determine if individuals with PAHD exhibit less hip extension compared to individuals without hip pain during walking, and (2) investigate potential reasons for these motion alterations. Methods: Adolescent and adult individuals with PAHD and healthy controls without hip pain were recruited for the study. Kinematic data were collected while walking on a treadmill at three walking speeds: preferred, fast (25% faster than preferred), and prescribed (1.25 m/s). Peak hip extension, peak hip flexion, and hip excursion were calculated for each speed. Linear regression analyses were used to examine the effects of group, sex, side, and their interactions. Results: Individuals with PAHD had 2.9° less peak hip extension compared to individuals in the Control group (p = 0.014) when walking at their preferred speed. At the prescribed speed, the PAHD group walked with 2.7° less hip extension than the Control group (p = 0.022). Given the persistence of the finding despite walking at the same speed, differences in preferred speed are unlikely the reason for the reduced hip extension. At the fast speed, both groups increased their hip extension, hip flexion, and hip excursion by similar amounts. Hip extension was less in the PAHD group compared to the Control group (p = 0.008) with no significant group-by-task interaction (p = 0.206). Within the PAHD group, hip angles and excursions were similar between individuals reporting pain and individuals reporting no pain. Conclusions: The results of this study indicate that kinematic alterations common in individuals with hip OA exist early in the continuum of hip disease and are present in individuals with PAHD. The reduced hip extension during walking is not explained by speed, structural limitation, or current pain.
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Affiliation(s)
- Cara L Lewis
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Anne L Halverstadt
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Kerri A Graber
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Zoe Perkins
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Emily Keiser
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Hadwin Belcher
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Anne Khuu
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States
| | - Kari L Loverro
- Human Adaptation Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States.,U.S. Army Combat Capabilities Development Command Soldier Center, Natick, MA, United States
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12
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Queen RM, Schmitt D. Sex-Specific Difference in Dynamic Balance Following Total Hip Replacement. Innov Aging 2021; 5:igab019. [PMID: 34316518 PMCID: PMC8304153 DOI: 10.1093/geroni/igab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives Total hip arthroplasty (THA) is a common surgical procedure in older adults (65 years or older). THA has high patient satisfaction, but little is known about balance and mobility limitations after surgery and if outcomes are sex-specific. This study was aimed to evaluate post-THA asymmetry during unilateral standing and a dynamic balance and reach test and test the hypotheses that balance performance would be decreased on the surgical limb and that balance deficits would be greater in women than in men. Research Design and Methods Primary, unilateral THA (70 male, 57 female) patients completed a bilateral 10-s single-leg stance test. Sixty male but only 34 female participants could maintain unilateral balance for 10 s or greater. The cohort who successfully completed the 10-s single-limb stance test then completed a Lower Quarter Y-Balance Test in which the maximum anterior (ANT), posteromedial (PM), and posterolateral reach distances were obtained bilaterally and used to calculate the asymmetry score. All variables were compared using a mixed-model repeated-measures analysis of variance (sex by limb), while independent samples t tests were used to assess sex-specific asymmetry. Results Women failed single-leg stance at a higher rate than men (85.7% vs 59.6%; p = .001). Reach distance was different between limbs for all reach directions (p < .004) with greater reach distance on the nonoperative limb for all patients. Men had a greater reach distance in the ANT (p = .004) and PM (p = .006) directions. Discussion and Implications These results indicate that post-THA, the operative limb and female patients have greater balance limitations. These results are novel and reveal sex-specific patterns that emphasize the need for sex-specific postoperative rehabilitation programs to improve long-term outcomes, especially in older adults with muscle weakness and balance deficits.
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Affiliation(s)
- Robin M Queen
- Kevin P. Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, USA.,Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Daniel Schmitt
- Department of Evolutionary Anthropology, Duke University, Durham, North Carolina, USA
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13
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Harandi VJ, Ackland DC, Haddara R, Cofré Lizama LE, Graf M, Galea MP, Lee PVS. Individual muscle contributions to hip joint-contact forces during walking in unilateral transfemoral amputees with osseointegrated prostheses. Comput Methods Biomech Biomed Engin 2020; 23:1071-1081. [PMID: 32691622 DOI: 10.1080/10255842.2020.1786686] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Direct skeletal attachment of prostheses in transfemoral amputees circumvents skin-interface complications associated with conventional sockets; however, joint pain and musculoskeletal disease is known to occur postoperatively. This study quantified hip contact forces and the roles of individual muscles in producing hip contact forces during walking in transfemoral amputees with osseointegrated prostheses. Musculoskeletal models were developed for four transfemoral amputees. Gluteus maximus and gluteus medius were the major contributors to the hip contact forces, and the intact limb hip muscles demonstrated greater contributions to hip contact forces than those of the residual limb. The findings may be useful for mitigating walking asymmetry.
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Affiliation(s)
| | | | - Raneem Haddara
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - L Eduardo Cofré Lizama
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Mark Graf
- Department of Allied Health, Royal Melbourne Hospital, Melbourne, Australia
| | - Mary Pauline Galea
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Peter Vee Sin Lee
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
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14
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Hip Abductor Strength and Lower Limb Load on Nonoperating Predict Functional Mobility in Women Patients With Total Hip Arthroplasty. Am J Phys Med Rehabil 2020; 100:72-76. [DOI: 10.1097/phm.0000000000001523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Mendiolagoitia L, Rodríguez MÁ, Crespo I, del Valle M, Olmedillas H. Kinematic Gait Analysis After Primary Total Hip Replacement: A Systematic Review: Gait After Total Hip Replacement: A Systematic Review. Indian J Orthop 2020; 54:767-775. [PMID: 33133399 PMCID: PMC7573021 DOI: 10.1007/s43465-020-00101-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/28/2020] [Indexed: 02/04/2023]
Abstract
Total hip replacement (THR) is a surgical procedure indicated for patients affected by severe hip osteoarthritis. Although this technique has proved to be effective in relieving pain and restoring function, gait limitations may persist following this procedure. The objective of this systematic review was to evaluate gait kinematics after THR and compare the results with those of the pre-operative state and with healthy control individuals. PubMed/MEDLINE, Embase, Web of Science, CENTRAL and Scopus databases were searched until December 2019. Methodological quality and internal validity score of each study were assessed using the PEDro and the Newcastle-Ottawa scales. In all, ten studies met our inclusion criteria. Following THR, statistically significant improvements were seen in dynamic hip and knee range of motion of both the affected and the contralateral limb, single-limb support time symmetry, step length, stride length, walking speed and gait pattern. However, deficits were observed in all the previous parameters, as well as in hip adduction angle in comparison with healthy subjects. In conclusion, gait patterns improve after THR in comparison with the pre-operative state, although there are deficits relative to healthy individuals.
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Affiliation(s)
- Luis Mendiolagoitia
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | | | - Irene Crespo
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain ,Institute of Biomedicine, Universidad de León, León, Spain
| | - Miguel del Valle
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | - Hugo Olmedillas
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain ,Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
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16
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Bravi M, Gallotta E, Morrone M, Maselli M, Santacaterina F, Toglia R, Foti C, Sterzi S, Bressi F, Miccinilli S. Concurrent validity and inter trial reliability of a single inertial measurement unit for spatial-temporal gait parameter analysis in patients with recent total hip or total knee arthroplasty. Gait Posture 2020; 76:175-181. [PMID: 31862666 DOI: 10.1016/j.gaitpost.2019.12.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/07/2019] [Accepted: 12/10/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoarthritis (OA) is one of the main causes of disability and its frequent hip and knee joint localization requires surgical joint replacement treatment. Patients after total hip (THA) or knee (TKA) arthroplasty often show gait abnormalities, whose comprehension is crucial in order to plan an appropriate rehabilitative treatment. Wearable sensor devices can be a valid tool for gait assessment in clinical practice, being relatively inexpensive and easy to use. RESEARCH QUESTION Does the use of crutches influence the ability of a single inertial measurement unit (IMU), placed on the lower trunk, to correctly record the spatial-temporal gait parameters in patients after recent THA or TKA? METHODS 20 patients walking with crutches after recent THA or TKA and 10 healthy subjects were recruited. Each participant was recorded simultaneously with an IMU and with an optoelectronic motion capture system during 5 consecutive walking tests. RESULTS Intraclass correlation index of spatial-temporal parameters recorded with the IMU showed moderate to excellent reliability results both for healthy subjects (ICC range 0.626-0.897) and for patients (ICC range 0.596-0.951). In terms of concurrent validity, Pearson's r coefficient of healthy subjects, showed strong to very strong levels of correlations for some spatial-temporal parameters (speed, mean cadence, left and right stride length and stride duration) (r range 0.646-0.977) and very week to moderately week levels of correlation for gait cycle phases (swing, stance, single support and double support) (r range 0.390-0.633). Patients' data analysis showed similar results for general spatial-temporal parameters (r range 0.704-0.986) and slightly lower values for gait cycle phases (r range 0.077-0.464). SIGNIFICANCE We can consider the single IMU as a reliable tool for the detection of some spatial-temporal gait parameters. Crutches seem to interfere with the detection of the gait cycle phases.
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Affiliation(s)
- Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Via Alvaro Del Portillo 5, 00128, Rome, Italy.
| | - Emilio Gallotta
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Via Alvaro Del Portillo 5, 00128, Rome, Italy.
| | - Michelangelo Morrone
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Via Alvaro Del Portillo 5, 00128, Rome, Italy.
| | - Mirella Maselli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Via Alvaro Del Portillo 5, 00128, Rome, Italy.
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Via Alvaro Del Portillo 5, 00128, Rome, Italy.
| | - Rossana Toglia
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Via Alvaro Del Portillo 5, 00128, Rome, Italy.
| | - Calogero Foti
- Physical Medicine and Rehabilitation Unit, University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Via Alvaro Del Portillo 5, 00128, Rome, Italy.
| | - Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Via Alvaro Del Portillo 5, 00128, Rome, Italy.
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University, Via Alvaro Del Portillo 5, 00128, Rome, Italy.
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17
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DeCook CA, LaCour MT, Nachtrab JK, Khasian M, Dessinger GM, Komistek RD. In Vivo Determination and Comparison of Total Hip Arthroplasty Kinematics for Normal, Preoperative Degenerative, and Postoperative Implanted Hips. J Arthroplasty 2020; 35:588-596. [PMID: 31543419 DOI: 10.1016/j.arth.2019.08.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The study objective is to analyze subjects having a normal hip and compare in vivo kinematics to subjects before and after receiving a total hip arthroplasty. METHODS Twenty subjects, 10 with a normal hip and 10 with a preoperative, degenerative hip were analyzed performing normal walking on level ground while under fluoroscopic surveillance. Seven preoperative subjects returned after receiving a total hip arthroplasty using the anterior surgical approach by a single surgeon. Using 3-dimensional to 2-dimensional registration techniques, joint models were overlayed on fluoroscopic images to obtain transformation matrices in the image space. From these images, displacements of the femoral head and acetabulum centers were computed, as well as changes in contact patches between the 2 surfaces throughout the gait cycle. RESULTS Implanted hips experienced the least amount of separation, compression, and overall sliding throughout the entire gait cycle, but they did show signs of edge loading contact patterns. Conversely, the degenerative hips experienced the most compression, sliding, and separation, with the maximum amount of sliding being 6.9 mm. The normal group ranged in the middle, with the maximum amount of sliding being 1.75 mm. CONCLUSION Current analysis revealed trends that degenerative hips experience more abnormal hip kinematics that leads to higher articulating surface forces and stresses within the acetabulum. None of the implanted hips experienced hip separation.
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Affiliation(s)
- Charles A DeCook
- Arthritis and Total Joint Specialists, Northside Hospital Atlanta, Atlanta, GA
| | - Michael T LaCour
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Jarrod K Nachtrab
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Milad Khasian
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Garett M Dessinger
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
| | - Richard D Komistek
- MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN
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18
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Setoguchi D, Kinoshita K, Kamada S, Sakamoto T, Kise N, Kotani N, Goto K, Shiota E, Inoue T, Yamamoto T. Hybrid Assistive Limb improves restricted hip extension after total hip arthroplasty. Assist Technol 2020; 34:112-120. [DOI: 10.1080/10400435.2020.1712498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Daisuke Setoguchi
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Satoshi Kamada
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Tetsuya Sakamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Naoki Kise
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Naoya Kotani
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kyosuke Goto
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Etsuji Shiota
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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19
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Judd DL, Cheuy VA, Forster JE, Christiansen CL, Stevens-Lapsley JE. Incorporating Specific Functional Strength Integration Techniques to Improve Functional Performance for Veterans After Total Hip Arthroplasty: Protocol for a Randomized Clinical Trial. Phys Ther 2019; 99:1453-1460. [PMID: 31392991 PMCID: PMC8284176 DOI: 10.1093/ptj/pzz109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/02/2018] [Accepted: 04/06/2019] [Indexed: 11/13/2022]
Abstract
BACKGROUND Total hip arthroplasty (THA) is a common procedure, yet persistent deficits in functional performance exist after surgery. These deficits may be related to movement compensations observed after THA, which negatively affect quality of life and may increase morbidity and health care utilization, including in the veteran population. However, the best rehabilitative approach to remediating movement compensations and physical function deficits has not been determined. OBJECTIVE The objective is to determine if a functional strength integration intervention (FSI), as part of a post-THA rehabilitation program, improves movement compensation, physical function, muscle strength, and self-reported outcome measures more than a control group (CON) undergoing a standard of care exercise program. DESIGN This is a 2-arm randomized, controlled clinical trial. SETTING The Veteran Affairs outpatient physical therapy clinics and academic research laboratory will be the settings. PARTICIPANTS One hundred veterans undergoing THA for hip osteoarthritis will be included in the study. INTERVENTIONS Participants will be randomized to either the FSI or CON group and participate in visits of physical therapy over 8 weeks. The FSI protocol will include targeted exercise to improve muscular control and stability around the hip and trunk to minimize movement compensation during daily activity combined with progressive resistance exercise. The CON protocol will include patient education, flexibility activity, and low load resistance exercise. MEASUREMENTS Functional performance, muscle strength and endurance, and self-reported outcomes will be measured at baseline (prior to surgery), midway through intervention (6 weeks after surgery), at the end of intervention (10 weeks after surgery), and 26 weeks after THA. LIMITATIONS The inability to blind treating therapists to study arm allocation is a limitation. CONCLUSIONS The proposed study aims to determine if targeted FSI can affect movement compensation to improve functional outcomes after THA more than traditional rehabilitation paradigms.
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Affiliation(s)
- Dana L. Judd
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Mail Stop C244, 13121 East 17th Avenue, Room 3116, Aurora, CO 80045 (USA)
| | - Victor A. Cheuy
- Department of Physical Therapy and Rehabilitation Science and Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - Jeri E. Forster
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus; and Rocky Mountain Mental Illness, Research, Education and Clinical Center, US Department of Veterans Affairs, Denver, Colorado
| | - Cory L. Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus; and Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Aurora, Colorado
| | - Jennifer E. Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus; and Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System
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20
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Towards an Inertial Sensor-Based Wearable Feedback System for Patients after Total Hip Arthroplasty: Validity and Applicability for Gait Classification with Gait Kinematics-Based Features. SENSORS 2019; 19:s19225006. [PMID: 31744141 PMCID: PMC6891461 DOI: 10.3390/s19225006] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 11/17/2022]
Abstract
Patients after total hip arthroplasty (THA) suffer from lingering musculoskeletal restrictions. Three-dimensional (3D) gait analysis in combination with machine-learning approaches is used to detect these impairments. In this work, features from the 3D gait kinematics, spatio temporal parameters (Set 1) and joint angles (Set 2), of an inertial sensor (IMU) system are proposed as an input for a support vector machine (SVM) model, to differentiate impaired and non-impaired gait. The features were divided into two subsets. The IMU-based features were validated against an optical motion capture (OMC) system by means of 20 patients after THA and a healthy control group of 24 subjects. Then the SVM model was trained on both subsets. The validation of the IMU system-based kinematic features revealed root mean squared errors in the joint kinematics from 0.24° to 1.25°. The validity of the spatio-temporal gait parameters (STP) revealed a similarly high accuracy. The SVM models based on IMU data showed an accuracy of 87.2% (Set 1) and 97.0% (Set 2). The current work presents valid IMU-based features, employed in an SVM model for the classification of the gait of patients after THA and a healthy control. The study reveals that the features of Set 2 are more significant concerning the classification problem. The present IMU system proves its potential to provide accurate features for the incorporation in a mobile gait-feedback system for patients after THA.
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21
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Karaismailoglu B. Letter to the Editor on "Gait Analysis of Leg Length Discrepancy-Differentiated Hip Replacement Patients With Developmental Dysplasia: A Midterm Follow-Up". J Arthroplasty 2019; 34:1853-1854. [PMID: 30890389 DOI: 10.1016/j.arth.2019.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/18/2019] [Indexed: 02/01/2023] Open
Affiliation(s)
- Bedri Karaismailoglu
- Sinop Ayancik State Hospital, Orthopaedics and Traumatology Department, Sinop, Turkey
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22
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Reply to Letter to the Editor on "Gait Analysis of Leg Length Discrepancy-Differentiated Hip Replacement Patients With Developmental Dysplasia: A Midterm Follow-Up". J Arthroplasty 2019; 34:1854-1856. [PMID: 31109756 DOI: 10.1016/j.arth.2019.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 04/10/2019] [Indexed: 02/05/2023] Open
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23
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Gallagher NE, Bruce-Brand R, Bennett D, O'Brien S, Beverland DE. No difference in gait kinematics or kinetics between limbs in bilateral total hip replacement patients at long-term follow-up. Clin Biomech (Bristol, Avon) 2019; 67:166-170. [PMID: 31125910 DOI: 10.1016/j.clinbiomech.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/26/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies report that gait parameters of patients following total hip replacement improve from pre-operative levels, although in most cases do not reach those of normal subjects. However, studies are generally of unilateral total hip replacement patients at short-term follow-up. There have been no reports of 3D gait kinematics and kinetics in patients with bilateral total hip replacements at long-term follow-up. The aim of this study was to compare temporospatial parameters and 3D lower limb gait kinematics and kinetics at long-term follow-up between limbs and against controls for patients who have undergone staged bilateral total hip replacement. METHODS 3D gait analysis was performed on 13 patients who had undergone bilateral total hip replacement, at an average follow-up of 10.1 (first hip) and 9.3 years (second hip), and a normal elderly control group comprising 10 subjects. FINDINGS Knee flexion/extension range of motion was marginally greater in Hip 2 (p = 0.049) compared to Hip 1 by 3.2°. There were no other significant differences in temporospatial parameters or a range of lower limb kinematics or kinetics between the first and second operated hip. Multiple gait parameters were significantly worse for both hips compared to age-matched normal individuals. INTERPRETATION Although symmetrical biomechanical recovery was achieved, significant gait deficiencies remain in both hips compared to normal controls. These deficits may provide targets for enhanced rehabilitation programs.
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Affiliation(s)
- Nicola E Gallagher
- Outcomes Unit, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, United Kingdom.
| | - Robert Bruce-Brand
- Outcomes Unit, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, United Kingdom.
| | - Damien Bennett
- Outcomes Unit, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, United Kingdom.
| | - Seamus O'Brien
- Outcomes Unit, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, United Kingdom.
| | - David E Beverland
- Outcomes Unit, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, United Kingdom.
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24
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Huang CH, Foucher KC. Step Length Asymmetry and Its Associations With Mechanical Energy Exchange, Function, and Fatigue After Total Hip Replacement. J Orthop Res 2019; 37:1563-1570. [PMID: 30977546 PMCID: PMC6588448 DOI: 10.1002/jor.24296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Abnormalities in gait remain after total hip replacement (THR). The purpose of this study was to evaluate step length asymmetry and its links to other aspects of gait and physical function after THR and to investigate links with mechanical energy exchange. The rationale is that step length asymmetry may influence gait efficiency, which could adversely influence fatigue and physical function. We evaluated 18 participants (6 males and 12 females) 1-5 years post-THR. Step length symmetry and mechanical energy exchange were assessed by instrumented gait analysis. Fatigue was assessed using a PROMIS Fatigue Short Form. We assessed physical function using a 6-minute walk test (6MWT). We used a one sample T test to determine whether the symmetry index (SI) was significantly different from 0 and Pearson's correlations to explore associations among the variables. The step length SI was statistically significantly different from zero (p=0.01). A more symmetric step length was associated with better 6MWT (R=-0.57, p=0.03). Higher (better) mechanical energy exchange was associated with more fatigue (R=0.50, p=0.04). Mechanical energy exchange was not associated with step length SI or 6MWT. Better 6MWT was associated with less fatigue (R=-0.61, P=0.01). This suggests that the association between step length symmetry and function is not directly governed by its effect on the energy exchange. Additionally, after a relatively long period of postsurgery, participants may have adapted their gait by increasing mechanical energy exchange to minimize fatigue. Statement of Clinical Significance: A gait retraining intervention targeting step length symmetry could improve function without adversely affecting walking energetics in THR patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1563-1570, 2019.
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Affiliation(s)
- Chun-Hao Huang
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
| | - Kharma C. Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago., 1919 W. Taylor St., 647 AHSB, Telephone:312-355-3948,
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25
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De Pieri E, Lunn DE, Chapman GJ, Rasmussen KP, Ferguson SJ, Redmond AC. Patient characteristics affect hip contact forces during gait. Osteoarthritis Cartilage 2019; 27:895-905. [PMID: 30772383 DOI: 10.1016/j.joca.2019.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine hip contact force (HCF), calculated through multibody modelling, in a large total hip replacement (THR) cohort stratified by patient characteristics such as body mass index (BMI), age and function. METHOD 132 THR patients undertook one motion capture session of gait analysis at a self-selected walking speed. HCFs were then calculated using the AnyBody Modelling System. Patients were stratified into three BMI groups, five age groups, and finally three functional groups determined by their self-selected gait speed. By means of statistical parametric mapping (SPM), statistical analyses of the 1-dimensional time series were performed to separately evaluate the influence of age, BMI and functionality on HCF. RESULTS The mean predicted HCFs were comparable to HCFs measured with instrumented prostheses reported in the literature. The SPM analysis revealed a statistically significant positive linear correlation between BMI and HCF, indicating that obese patients are more likely to experience higher HCF during most of the stance phase, while a statistically significant negative correlation with age was found only during the late swing-phase. Patients with higher functional ability exhibited significantly increased peak HCF, while patients with lower functional ability demonstrated lower HCFs overall and a pathological flattening of the typical double hump force profile. CONCLUSION HCFs experienced at the bearing surface are highly dependent on patient characteristics. BMI and functional ability were determined to have the biggest influence on contact forces. Current preclinical testing standards do not reflect this.
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Affiliation(s)
- E De Pieri
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
| | - D E Lunn
- Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - G J Chapman
- Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | | | - S J Ferguson
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
| | - A C Redmond
- Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK.
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26
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Lunn DE, Chapman GJ, Redmond AC. Hip kinematics and kinetics in total hip replacement patients stratified by age and functional capacity. J Biomech 2019; 87:19-27. [DOI: 10.1016/j.jbiomech.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/29/2019] [Accepted: 02/09/2019] [Indexed: 01/14/2023]
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27
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Gait Training Using the Honda Walking Assistive Device ® in a Patient Who Underwent Total Hip Arthroplasty: A Single-Subject Study. ACTA ACUST UNITED AC 2019; 55:medicina55030069. [PMID: 30875846 PMCID: PMC6473675 DOI: 10.3390/medicina55030069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 11/24/2022]
Abstract
Background and objectives: The Honda Walking Assistive device® (HWA) is a light and easy wearable robot device for gait training, which assists patients’ hip flexion and extension movements to guide hip joint movements during gait. However, the safety and feasibility of robot-assisted gait training after total hip arthroplasty (THA) remains unclear. Thus, we aimed to evaluate the safety and feasibility of this gait training intervention using HWA in a patient who underwent THA. Materials and methods: The patient was a 76-year-old woman with right hip osteoarthritis. Gait training using HWA was implemented for 20 sessions in total, five times per week from 1 week to 5 weeks after THA. Self-selected walking speed (SWS), step length (SL), cadence, timed up and go (TUG), range of motion (ROM) of hip extension, and hip abduction and extension torque were measured preoperatively, and at 1 (pre-HWA), 2, 3, 4, 5 (post-HWA), and 10 weeks (follow-up) after THA. The gait patterns at SWS without HWA were measured by using three-dimensional (3D) gait analysis and an integrated electromyogram (iEMG). Results: The patient completed 20 gait training sessions with no adverse event. Hip abduction torque at the operative side, hip extension torque, SWS, SL, and cadence were higher at post-HWA than at pre-HWA. In particular, SWS, TUG, and hip torque were remarkably increased 3 weeks after THA and improved to almost the same levels at follow-up. Maximum hip extension angle and hip ROM during gait were higher at post-HWA than at pre-HWA. Maximum and minimum anterior pelvic tilt angles were lower at post-HWA than at pre-HWA. The iEMG of the gluteus maximus and gluteus medius in the stance phase were lower at post-HWA than preoperatively and at pre-HWA. Conclusions: In this case, the gait training using HWA was safe and feasible, and could be effective for the early improvement of gait ability, hip function, and gait pattern after THA.
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Pincheira PA, De La Maza E, Silvestre R, Guzmán-Venegas R, Becerra M. Comparison of total hip arthroplasty surgical approaches by Statistical Parametric Mapping. Clin Biomech (Bristol, Avon) 2019; 62:7-14. [PMID: 30639965 DOI: 10.1016/j.clinbiomech.2018.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/15/2018] [Accepted: 12/31/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The most common surgical approaches in use for total hip arthroplasty are the lateral and posterior. When comparing these approaches in terms of gait biomechanics, studies usually rely on pre-defined discrete variables related to the events of gait cycle. However, this analysis may miss differences in other parts of the movement pattern that are not explored. We applied Statistical Parametric Mapping to compare hip kinematics between patients who underwent arthroplasty using either a lateral or posterior approach, contrasting these results with discrete variable analysis. METHODS Twenty-two participants (11 lateral, 11 posterior; age between 50 and 80 years) underwent gait analysis before, 3 weeks and 12 weeks after hip arthroplasty. One-dimensional (e.g. time-varying) trajectories and zero-dimensional (e.g. peak extension) discrete variables were used to assess differences between groups in each plane of hip movement (sagittal, frontal, and transverse). FINDINGS One-dimensional and zero-dimensional analyses found no significant differences between groups. Statistical Parametric Mapping revealed that both groups presented significant changes over time in hip adduction at 11-43% of the gait cycle. Zero-dimensional analysis seems to overstate sagittal plane changes over time since no such changes were found by Statistical Parametric Mapping. INTERPRETATION Our results agreed with previous studies suggesting that surgical approach do not affect hip kinematics at the early post-operative stage after arthroplasty. However, Statistical Parametric Mapping revealed changes in frontal plane kinematics over time that were underestimated by the zero-dimensional variables. These findings suggest hip adduction impairment up to 12 weeks after arthroplasty.
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Affiliation(s)
- Patricio A Pincheira
- Facultad de Ciencias, Escuela de Kinesiología, Universidad Mayor, Camino la pirámide 5750, Huechuraba, Santiago, Chile; Facultad de Medicina, Escuela de Kinesiología, Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo (LIBFE), Universidad de los Andes, Mons. Álvaro del Portillo 12455, Las Condes, Santiago, Chile; School of Human Movement and Nutrition Sciences, Centre for Sensorimotor Performance, The University of Queensland, Blair Dr, Building 26b, St Lucia, Brisbane, Australia.
| | - Eduardo De La Maza
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martín 771, Santiago Centro, Santiago, Chile
| | - Rony Silvestre
- Unidad de Biomecánica Deportiva, Clínica Meds, Isabel La Católica 3740, Providencia, Santiago, Chile
| | - Rodrigo Guzmán-Venegas
- Facultad de Medicina, Escuela de Kinesiología, Laboratorio Integrativo de Biomecánica y Fisiología del Esfuerzo (LIBFE), Universidad de los Andes, Mons. Álvaro del Portillo 12455, Las Condes, Santiago, Chile
| | - Manuel Becerra
- Instituto Traumatológico Dr. Teodoro Gebauer, San Martín 771, Santiago Centro, Santiago, Chile
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Martz P, Bourredjem A, Maillefert JF, Binquet C, Baulot E, Ornetti P, Laroche D. Influence of body mass index on sagittal hip range of motion and gait speed recovery six months after total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2019; 43:2447-2455. [PMID: 30612173 DOI: 10.1007/s00264-018-4250-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/25/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE In practice, obesity leads to poor functional outcomes after total hip arthroplasty (THA). However, in clinical research, the influence of body mass index (BMI) on the gait recovery and kinematics for THA is not well documented. The purpose of this study was to assess the influence of BMI on gait parameters pre-operatively and six months after THA for hip osteoarthritis (OA) patients. METHODS We included 76 THA for hip OA: non-obese group (G1): 49 (BMI < 30 kg/2) and obese group (G2): 37 (BMI ≥ 30 kg/m2) with a control group of 61 healthy people. Clinical evaluation (HOOS) and a 3D gait analysis (gait speed and flexion range of the hip (ROM)) were performed before and six months after THA: The gains between the two visits were calculated and we looked for correlations between outcomes and BMI. RESULTS Preoperative gait speed and hip ROM were significantly lower in obese patients (speed G1: 0.81 ± 0.22 m/s vs. G2: 0.64 ± 0.23 m/s, p = 0.004 and hip ROM G1: 26.1° ± 7.3 vs. G2: 21.4° ± 6.6, p = 0.005), and obese patients were more symptomatic. At six months, gait speed and hip ROM were significantly lower for all patients compared with the control group. No correlation between gait velocity, hip ROM, and BMI was found. Biomechanical and clinical gains were comparable in the two groups. CONCLUSIONS All patients, including obese patients, have significant functional improvement after THA, objectively assessed by gait speed. Even if patients did not fully recover to the level of a healthy control person after THA, functional gain is comparable irrespective of BMI.
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Affiliation(s)
- Pierre Martz
- Department of Orthopaedic Surgery, CHU Dijon Bourgogne, F-21000, Dijon, France.
- INSERM UMR1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences de Santé, F-21000, Dijon, France.
| | - Abderrahmane Bourredjem
- INSERM CIC1432, Clinical Investigation Centre, Clinical Epidemiology Unit, F-21000, Dijon, France
| | - Jean Francis Maillefert
- INSERM UMR1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences de Santé, F-21000, Dijon, France
- INSERM CIC1432, Clinical Investigation Centre, Clinical Epidemiology Unit, F-21000, Dijon, France
| | - Christine Binquet
- INSERM CIC1432, Clinical Investigation Centre, Clinical Epidemiology Unit, F-21000, Dijon, France
| | - Emmanuel Baulot
- Department of Orthopaedic Surgery, CHU Dijon Bourgogne, F-21000, Dijon, France
- INSERM UMR1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences de Santé, F-21000, Dijon, France
| | - Paul Ornetti
- INSERM UMR1093-CAPS, Bourgogne Franche-Comté University, UFR des Sciences de Santé, F-21000, Dijon, France
- Department of Rheumatology, CHU Dijon Bourgogne, F-21000, Dijon, France
- INSERM CIC1432, Plurithematic Unit, Technologic Investigation Platform, F-21000, Dijon, France
| | - Davy Laroche
- INSERM CIC1432, Plurithematic Unit, Technologic Investigation Platform, F-21000, Dijon, France
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Cezarino L, Vieira W, Silva J, Silva-Filho E, Souza F, Scattone R. Gait and functionality following unilateral and bilateral hip replacement. FISIOTERAPIA EM MOVIMENTO 2019. [DOI: 10.1590/1980-5918.032.ao30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Total Hip Replacement (THR) is a surgical procedure used to minimize symptoms generated by orthopedic pathologies, such as osteoarthritis. It is emphasized that there is no agreement if gait parameters are restored after surgery. Objective: To compare gait space-time and functionality between individuals submitted to unilateral or bilateral THR in relation to healthy controls. Method: A cross-sectional study was conducted with 23 subjects, eight submitted to Bilateral THR (BG), eight submitted to Unilateral THR (UG) and seven healthy individuals (CG). For the gait analysis, the 10-meter walk test was used, with the subjects walking in their Habitual (HS) and Maximal (MS) gait Speeds. Variables of interest included average speed, number of steps, test duration, cadence and Inter-Stride Time Variability (ISTV). Functionality was assessed by the Harris Hip Score and the WOMAC questionnaire. Comparisons were made between the three groups. Results: At the HS condition, the average gait speed was significantly lower in the BG compared to the CG. Similarly, during the MS condition, the BG showed a lower gait speed compared to the CG. During MS gait, the BG performed significantly worse regarding ISTV compared to both the UG, and the CG. The functionality results showed that both the BG and UG scored significantly worse than the CG. Conclusion: Hip functionality and gait mechanics are impaired even after several years of surgery in subjects submitted to THR.
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Affiliation(s)
| | | | | | | | - Felipe Souza
- Universidade Federal do Rio Grande do Norte, Brazil
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O'Connor JD, Rutherford M, Bennett D, Hill JC, Beverland DE, Dunne NJ, Lennon AB. Long-term hip loading in unilateral total hip replacement patients is no different between limbs or compared to healthy controls at similar walking speeds. J Biomech 2018; 80:8-15. [PMID: 30227951 DOI: 10.1016/j.jbiomech.2018.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 06/15/2018] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Abstract
Variation in hip joint contact forces directly influences the performance of total hip replacements (THRs). Measurement and calculation of contact forces in THR patients has been limited by small sample sizes, wide variation in patient and surgical factors, and short-term follow-up. This study hypothesised that, at long-term follow-up, unilateral THR patients have similar calculated hip contact forces compared to controls walking at similar (self-selected) speeds and, in contrast, THR patients walking at slower (self-selected) speeds have reduced hip contact forces. It was further hypothesised that there is no difference in calculated hip contact forces between operated and non-operated limbs at long-term follow-up for both faster and slower patients. Gait analysis data for THR patients walking at faster (walking speed: 1.29 ± 0.12 m/s; n = 11) and slower (walking speed: 0.72 ± 0.09 m/s; n = 11) speeds were used. Healthy subjects constituted the control group (walking speed: 1.36 ± 0.12 m/s; n = 10). Hip contact forces were calculated using static optimisation. There was no significant difference (p > 0.31) in hip contact forces between faster and control groups. Conversely, force was reduced at heel strike by 19% (p = 0.002), toe-off by 31% (p < 0.001) and increased at mid-stance by 15% (p = 0.02) for the slower group compared to controls. There were no differences between operated and non-operated limbs for the slower group or the faster group, suggesting good biomechanical recovery at long-term follow-up. Loading, at different walking speeds, presented here can improve the relevance of preclinical testing methods.
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Affiliation(s)
- John D O'Connor
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, UK
| | - Megan Rutherford
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, UK
| | | | - Janet C Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | | | - Nicholas J Dunne
- School of Mechanical & Manufacturing Engineering, Dublin City University, Dublin, Ireland; Centre for Medical Engineering Research, School of Mechanical & Manufacturing Engineering, Dublin City University, Dublin, Ireland; Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland; Queen's University Belfast, School of Pharmacy, Belfast, UK
| | - Alex B Lennon
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, UK.
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Jacksteit R, Mau-Moeller A, Völker A, Bader R, Mittelmeier W, Skripitz R, Stöckel T. The mental representation of the human gait in hip osteoarthrosis and total hip arthroplasty patients: A clinical cross-sectional study. Clin Rehabil 2018; 33:335-344. [PMID: 30322264 DOI: 10.1177/0269215518804294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: To explore differences in gait-specific long-term memory structures and actual gait performance between patients with hip osteoarthrosis, patients seen six months after total hip arthroplasty and healthy controls to gain insights into the role of the gait-specific mental representation for rehabilitation. DESIGN: Cross-sectional study. SUBJECTS: Twenty hip osteoarthrosis patients, 20 patients seen six months after total hip arthroplasty and 20 healthy controls. METHODS: Spatio-temporal (gait speed, step length) and temporophasic (stance time, swing time, single support time, total double support time) gait parameters, and gait variability were measured with an electronic walkway (OptoGait). The gait-specific mental representation was assessed using the structural dimensional analysis of mental representations (SDA-M). RESULTS: Hip osteoarthrosis patients showed significantly longer stance and total double support times, shorter swing and single support times, and a decreased gait speed as compared with healthy controls (all P < 0.01). The differences in double support times were still evident in patients seen six months after total hip arthroplasty ( P < 0.01). The gait-specific mental representation differed between hip osteoarthrosis patients and healthy controls with regard to mid-stance and mid-swing phases; the mid-stance phase was still affected six months after total hip arthroplasty (both P < 0.05). CONCLUSION: Our data indicated that actual gait performance and gait-specific long-term memory structures differ between hip osteoarthrosis patients and healthy controls. Important, some of these disease-related changes were still evident in patients seen six months after total hip arthroplasty.
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Affiliation(s)
- Robert Jacksteit
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Anett Mau-Moeller
- 2 Department of Sports Science, University of Rostock, Rostock, Germany
| | - Antje Völker
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Rainer Bader
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | | | - Ralf Skripitz
- 1 Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Tino Stöckel
- 2 Department of Sports Science, University of Rostock, Rostock, Germany
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Nagai K, Ikutomo H, Tagomori K, Miura N, Tsuboyama T, Masuhara K. Fear of Falling Restricts Activities of Daily Living after Total Hip Arthroplasty: A One-Year Longitudinal Study. Clin Gerontol 2018; 41:308-314. [PMID: 28990881 DOI: 10.1080/07317115.2017.1364682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the prevalence and time course in changes regarding the fear of falling and whether there are consequent restrictions in activities of daily living (ADL) after total hip arthroplasty (THA). METHODS This is 1-year longitudinal observational study. We recruited ninety-eight patients before and after THA. Fear of falling was assessed for 12 ADLs preoperatively and postoperatively at 3, 6, and 12 months following THA. In addition, we asked patients to answer whether they had refrained from performing each ADL because of fear of falling. RESULTS Fifty-two patients were enrolled for the analysis. The total fear of falling score during ADLs decreased with time after THA. The ADLs in which many patients (over 20%) felt fear even at 12 months were using the stairs (25%), sitting and standing from the floor (23%), and walking around the neighborhood (21%). Approximately 10% of patients were restricted in performing ADLs, such as sitting and standing from the floor, because of fear. CONCLUSIONS Patients undergoing THA frequently experience fear of falling during some ADLs even at 1 year after the operation, which could cause ADL restrictions. CLINICAL IMPLICATIONS Clinicians should evaluate fear of falling and institute rehabilitation programs individually to decrease excessive fear that might lead to ADL restrictions.
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Affiliation(s)
- Koutatsu Nagai
- a Department of Physical Therapy , School of Rehabilitation, Hyogo University of Health Sciences , Kobe , Japan
| | | | | | | | - Tadao Tsuboyama
- c Human Health Sciences, Graduate School of Medicine, Kyoto University , Kyoto , Japan
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Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2018; 26:847-863. [PMID: 29474993 DOI: 10.1016/j.joca.2018.02.897] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the change in walking gait biomechanics after total hip arthroplasty (THA) for osteoarthritis (OA) compared to the pre-operative gait status, and to compare the recovery of gait following THA with healthy individuals. METHODS Systematic review with meta-analysis of studies investigating changes in gait biomechanics after THA compared to (1) preoperative levels and (2) healthy individuals. Data were pooled at commonly reported time points and standardised mean differences (SMDs) were calculated in meta-analyses for spatiotemporal, kinematic and kinetic parameters. RESULTS Seventy-four studies with a total of 2,477 patients were included. At 6 weeks postoperative, increases were evident for walking speed (SMD: 0.32, 95% confidence intervals (CI) 0.14, 0.50), stride length (SMD: 0.40, 95% CI 0.19, 0.61), step length (SMD: 0.41, 95% CI 0.23, 0.59), and transverse plane hip range of motion (ROM) (SMD: 0.36, 95% CI 0.05, 0.67) compared to pre-operative gait. Sagittal, coronal and transverse hip ROM was significantly increased at 3 months (SMDs: 0.50 to 1.07). At 12 months postoperative, patients demonstrated deficits compared with healthy individuals for walking speed (SMD: -0.59, 95% CI -1.08 to -0.11), stride length (SMD: -1.27, 95% CI -1.63, -0.91), single limb support time (SMD: -0.82, 95% CI -1.23, -0.41) and sagittal plane hip ROM (SMD: -1.16, 95% CI -1.83, -0.49). Risk of bias scores ranged from seven to 24 out of 26. CONCLUSIONS Following THA for OA, early improvements were demonstrated for spatiotemporal and kinematic gait patterns compared to the pre-operative levels. Deficits were still observed in THA patients compared to healthy individuals at 12 months.
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Chen G, Nie Y, Xie J, Cao G, Huang Q, Pei F. Gait Analysis of Leg Length Discrepancy-Differentiated Hip Replacement Patients With Developmental Dysplasia: A Midterm Follow-Up. J Arthroplasty 2018; 33:1437-1441. [PMID: 29402716 DOI: 10.1016/j.arth.2017.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/06/2017] [Accepted: 12/12/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Few studies investigate gait characteristics and symmetry of developmental dysplasia of the hip patients (Crowe II and III) after total hip arthroplasty (THA) whose leg length discrepancy (LLD) is within 20 mm. Our study aimed to explore whether gait analysis parameters in these patients can return to the level of unaffected people and how bodies compensate for the discrepancy. METHOD A total of 45 patients who underwent cementless THA and 20 healthy controls were involved in this study prospectively. Group 1 includes patients whose LLD is <10 mm and group 2 includes patients whose LLD is 10-20 mm. Gait analysis was performed during 5-year midterm postoperative follow-up. RESULT The parameters, particularly the range of motion (ROM) in the hip, in both experimental groups (1 and 2) were significantly lower than healthy control group. For the nonoperated side, group 1 displayed significantly reduced ROM in the hip and knee compared with the age-matched controls. This was not observed in group 2. Greater bilateral symmetry can be seen in group 1 compared with group 2. CONCLUSION Despite LLD being limited to within 20 mm, THA patients in both groups showed a less efficient gait than that of healthy controls on 5-year midterm follow-up. The increased ROM in the nonoperated hip may act as a compensatory mechanism. LLD of 10 mm may be a cutoff value to assess whether compensation occurs in the contralateral limb. Reconstruction of equal limb length is recommended when surgeons perform THA for dysplastic hips.
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Affiliation(s)
- Guo Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yong Nie
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jinwei Xie
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Guorui Cao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Wesseling M, Meyer C, Corten K, Desloovere K, Jonkers I. Longitudinal joint loading in patients before and up to one year after unilateral total hip arthroplasty. Gait Posture 2018; 61:117-124. [PMID: 29324297 DOI: 10.1016/j.gaitpost.2018.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 12/22/2017] [Accepted: 01/04/2018] [Indexed: 02/02/2023]
Abstract
Abnormal kinematics and kinetics have been reported in hip osteoarthritis (OA) patients before and after total hip arthroplasty (THA). These changes can affect the loading of the ipsilateral hip, as well as the contralateral hip and knee joint. As it is not clear how hip and knee loading evolves in THA patients during the first year after surgery, the goal of this study is to define how joint loading changes in patients before and at three evaluation times after THA surgery. Musculoskeletal modelling in combination with gait analysis data was used to calculate hip and knee contact forces in 14 patients before and 3-, 6- and 12-months after unilateral THA, as well as in 18 healthy controls. Results showed that bilateral hip and knee loading were decreased compared to controls, both before and after THA surgery. Loading symmetry was altered compared to controls at 3-months post-surgery for the hip and at all evaluation times, except for 6-months post-surgery, for the knee, with ipsilateral joint loading decreased compared to the contralateral side. To conclude, 12-months after THA joint loading was not normalized, with both hip and knee loading in patients decreased compared to controls. Therefore, no overloading of the ipsi- or contralateral hip and knee joint was found before and up to one year after unilateral THA.
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Affiliation(s)
- Mariska Wesseling
- KU Leuven, Department of Kinesiology, Human Movement Biomechanics, Tervuursevest 101, Heverlee, Belgium.
| | - Christophe Meyer
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, Leuven, Belgium.
| | - Kristoff Corten
- Hip Unit, Orthopaedic Department, Ziekenhuis Oost-Limburg, Schiepse Bos 6, Genk, Belgium.
| | - Kaat Desloovere
- KU Leuven, Department of Rehabilitation Sciences, Tervuursevest 101, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Weligerveld 1, Pellenberg, Belgium.
| | - Ilse Jonkers
- KU Leuven, Department of Kinesiology, Human Movement Biomechanics, Tervuursevest 101, Heverlee, Belgium.
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Jaczewska-Bogacka J, Stolarczyk A. Improvement in Gait Pattern After Knee Arthroplasty Followed by Proprioceptive Neuromuscular Facilitation Physiotherapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1096:1-9. [PMID: 29594754 DOI: 10.1007/5584_2018_187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The aim of the study was to assess the influence of a physiotherapy program based on proprioceptive neuromuscular facilitation (PNF) on kinematic gait pattern after total knee arthroplasty. This comparative study included two groups of patients qualified for total surgical knee joint replacement due to osteoarthritis: a study group and a control group, either consisting of 28 patients of a matched age range of 55-90 years. Following surgery, 4 days after standard postoperative rehabilitation, the study patients were subjected to a 3-week-long therapist-assisted rehabilitation based on PNF principles (10 sessions of 75 min each), whereas control patients were discharged with instructions on how to exercise in the home setting. The outcome consisted of spatial-temporal gait parameters that were assessed at three time points: a day before surgery and then 1 month and 6 months after. The findings were that PNF caused substantial, sustained improvements in gait kinematics, shortening the stance phases, gait cycle duration, and double support phase and prolonging swing phase velocity, gait velocity, cadence, step length, and gait cycle length. Also, postsurgical pain was evidently less. We conclude that the individually tailored PNF rehabilitation program is superior compared to a standard recommendation of home-based physiotherapy in terms of improving gait kinematic pattern as well as psychological aspects related to pain perception in patients after knee arthroplasty.
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Affiliation(s)
| | - Artur Stolarczyk
- Department of Clinical Rehabilitation, Warsaw Medical University, Warsaw, Poland
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Wada O, Asai T, Hiyama Y, Nitta S, Mizuno K. Root mean square of lower trunk acceleration during walking in patients with unilateral total hip replacement. Gait Posture 2017; 58:19-22. [PMID: 28704684 DOI: 10.1016/j.gaitpost.2017.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 07/03/2017] [Accepted: 07/07/2017] [Indexed: 02/02/2023]
Abstract
Although several studies have described abnormal trunk motion before and after total hip arthroplasty (THA) surgery, few studies have examined trunk motion using accelerometry. The aim of this study was to determine whether abnormal trunk motion persisted after THA using accelerometry. A total of 24 female patients (61.0±6.9years) and 20 healthy female subjects (59.9±6.8years) participated in this study. Patients were assessed at 1 month prior to surgery and 12 months after surgery. Trunk acceleration during gait was measured using a triaxial accelerometer attached to the L3 spinous process. We calculated the root mean square (RMS) and RMS ratio (RMSR) in the vertical (VT), medio-lateral (ML), and anterior-posterior (AP) directions. Results revealed that the RMS in the VT and AP directions postoperatively was greater than that preoperatively, whereas there was no difference in the RMS in the ML direction. In addition, the preoperative RMSR in the ML direction was significantly greater compared with that of healthy individuals and the postoperative RMSR. There was no difference in the RMSR in the ML direction between healthy individuals and postoperatively. These findings suggested that the trunk motion in the frontal plane prior to surgery had improved and was comparable to that of healthy individuals following THA.
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Affiliation(s)
- Osamu Wada
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan.
| | - Tsuyoshi Asai
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, 518 Ikawadanicho, Arise, Nishi-ku, Kobe, Hyogo 651-2180, Japan
| | - Yoshinori Hiyama
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, 5-23-22, Nishikamata, Ota-ku, Tokyo, Japan
| | - Shingo Nitta
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kiyonori Mizuno
- Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
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Bennett D, Ryan P, O'Brien S, Beverland DE. Gait kinetics of total hip replacement patients-A large scale, long-term follow-up study. Gait Posture 2017; 53:173-178. [PMID: 28171843 DOI: 10.1016/j.gaitpost.2017.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/05/2017] [Accepted: 01/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is not known if lower limb gait kinetics of total hip replacement (THR) patients reach normal levels at long term follow-up post-operatively. METHODS Three-dimensional gait analysis was performed on 134 THR patients with identical implants 10-years post-operatively. Lower limb moments and powers were compared between different age strata (54-64 years, 65-69 years, 70-74 years, 75-79 years and over 80 years) and a normal elderly control group. RESULTS Hip extensor moment and hip power generation were significantly reduced in all age groups compared to normal. External hip rotation moment was significantly reduced in all age groups, apart from the youngest group, compared to normal. However, in contrast to previous short term follow-up studies there was no significant difference in hip abduction moment between any of the age groups and the normal group. CONCLUSION This large cohort study shows that, at long term follow-up following THR, some hip joint kinetics (hip extensor and external rotation moments and hip power generation) do not reach normal levels, but that peak abduction moment is preserved. THR patients recovery could potentially benefit from intensive rehabilitation focusing on hip extension and external rotation in the post-operative, and perhaps preoperative, period.
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Affiliation(s)
- Damien Bennett
- Outcome Assessment Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom.
| | - Paul Ryan
- School of Medicine, Queens University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Seamus O'Brien
- Outcome Assessment Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
| | - David E Beverland
- Outcome Assessment Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
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Foucher KC. Preoperative gait mechanics predict clinical response to total hip arthroplasty. J Orthop Res 2017; 35:366-376. [PMID: 27147554 DOI: 10.1002/jor.23282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/29/2016] [Indexed: 02/04/2023]
Abstract
Some patients do not have an adequate clinical response to total hip arthroplasty (THA) for reasons that are not fully understood. Identifying modifiable factors that are associated with nonresponse could lead to new ways to identify and treat potential nonresponders. This study investigated whether any preoperative gait characteristics were associated with THA clinical response, and whether or not there were corresponding postoperative gait differences in THA nonresponders compared to responders. A secondary analysis was conducted of 124 subjects (age 61 ± 10 years; 64 female/60 male), evaluated before and 1 year after primary unilateral THA, using quantitative gait analysis and Harris Hip Scores (HHS). Responders and nonresponders were identified using the OMERACT-OARSI responder criteria, modified for use with the HHS. Pre- and postoperative dynamic sagittal plane range of motion (ROM) and 3D peak external moments were compared, for responders and nonresponders, using t-tests and logistic regression. 11.3% of subjects were nonresponders. Before surgery, the ROM was 26% higher for nonresponders than responders, but the peak external rotation moment was 30% lower (p = 0.003-0.043). Preoperative gait and HHS predicted response with a sensitivity of 71.4% and a specificity of 99.1%. There were persistent postoperative deficits in the peak external rotation moment in nonresponders compared to responders (p = 0.028). This study showed that gait analysis, where available, can augment clinical scores in predicting THA response. Moreover, it suggests that further analysis of the subtle role of transverse plane hip mechanics could lead to interventions to promote better THA response. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:366-376, 2017.
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Affiliation(s)
- Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor St., 650 AHSB, Chicago, Illinois, 60612
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Factors associated with restricted hip extension during gait in women after total hip arthroplasty. Hip Int 2016; 25:543-8. [PMID: 26351118 DOI: 10.5301/hipint.5000286] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE A decreased peak hip extension angle in the late stance phase is a major gait abnormality in patients with THA. The purpose of this study was to determine the relationship between peak hip extension angle during gait and functional impairments such as muscle weakness and the limitation in joint range of motion and to identify the clinical factors influencing peak hip extension angle during gait. METHODS 67 female volunteers with THA were examined. Biomechanical gait analysis was performed to measure peak hip extension angle during gait. Maximal isometric strength of the hip and knee, passive hip extension range of motion, leg length discrepancy, and hip pain were assessed. RESULTS Peak hip extension angle during gait significantly correlated with passive hip extension range of motion (r = 0.259), hip pain (r = -0.264), isometric strengths of the hip musculature (r = 0.278-0.491), and knee extensor (r = 0.386). Stepwise multiple regression analysis revealed that hip abductor torque (β = 0.355, P = 0.001), hip pain (β = -0.353, P = 0.001), and passive hip extension range of motion (β = 0.258, P = 0.011) were significant contributors to peak hip extension angle during gait (R2 = 0.408). CONCLUSIONS Our findings suggest that THA rehabilitation aimed at improving gait ability should focus on strengthening the hip abductors, controlling hip pain and increasing range of motion of hip extension.
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Heiberg KE, Figved W. Physical Functioning and Prediction of Physical Activity After Total Hip Arthroplasty: Five-Year Followup of a Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2016; 68:454-62. [PMID: 26239078 DOI: 10.1002/acr.22679] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 06/02/2015] [Accepted: 07/21/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To examine whether the 1-year effects from a previous walking skill training program on walking and stair climbing still persist 5 years following total hip arthroplasty (THA), to examine recovery of physical functioning from before to 5 years after surgery, and to identify predictors of physical activity 5 years after THA from preoperative measures. METHODS We performed a 5-year followup of a randomized controlled trial and a longitudinal study. Sixty participants with a mean age of 70 years (range 50-87 years; 95% confidence interval 68, 72 years) were assessed. Outcome measures were the 6-minute walk test, the stair climbing test (SCT), active hip range of motion (ROM), self-efficacy, Hip Dysfunction and Osteoarthritis Outcome Score (HOOS), and University of California, Los Angeles (UCLA) activity scale. Data were analyzed by Student's t-tests, generalized linear model, and multivariate regression analyses. RESULTS The training and control groups were approximately equal on outcome measures of physical functioning, pain, and self-efficacy at 5 years (P > 0.05). In the total group, the recovery course was unchanged from 1 to 5 years (P > 0.05), except for 9% improvement in ROM (P < 0.001) and an increase in time on SCT of 18% (P = 0.004). Preoperative HOOS pain (P = 0.022) and HOOS sport (P = 0.019) predicted UCLA activity scale 5 years after THA. CONCLUSION At 5 years after THA, the control group had caught up with the training group on physical functioning, and the participants led an active lifestyle. Those with worse preoperative scores on pain and physical functioning in sport were at risk of being less physically active in the long term following THA.
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Affiliation(s)
| | - Wender Figved
- Baerum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
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Wesseling M, Meyer C, De Groote F, Corten K, Simon JP, Desloovere K, Jonkers I. Gait alterations can reduce the risk of edge loading. J Orthop Res 2016; 34:1069-76. [PMID: 26632197 DOI: 10.1002/jor.23120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 11/28/2015] [Indexed: 02/04/2023]
Abstract
Following metal-on-metal hip arthroplasty, edge loading (i.e., loading near the edge of a prosthesis cup) can increase wear and lead to early revision. The position and coverage angle of the prosthesis cup influence the risk of edge loading. This study investigates the effect of altered gait patterns, more specific hip, and pelvis kinematics, on the orientation of hip contact force and the consequent risk of antero-superior edge loading using muscle driven simulations of gait. With a cup orientation of 25° anteversion and 50° inclination and a coverage angle of 168°, many gait patterns presented risk of edge loading. Specifically at terminal double support, 189 out of 405 gait patterns indicated a risk of edge loading. At this time instant, the high hip contact forces and the proximity of the hip contact force to the edge of the cup indicated the likelihood of the occurrence of edge loading. Although the cup position contributed most to edge loading, altering kinematics considerably influenced the risk of edge loading. Increased hip abduction, resulting in decreasing hip contact force magnitude, and decreased hip extension, resulting in decreased risk on edge loading, are gait strategies that could prevent edge loading. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1069-1076, 2016.
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Affiliation(s)
- Mariska Wesseling
- Department of Kinesiology, Human Movement Biomechanics, KU Leuven, Heverlee, Belgium
| | - Christophe Meyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Friedl De Groote
- Division PMA, Department of Mechanical Engineering, KU Leuven, Heverlee, Belgium
| | - Kristoff Corten
- Department of Orthopaedic, Ziekenhuis Oost-Limburg, Hip Unit, Genk, Belgium
| | - Jean-Pierre Simon
- Department of UZ Pellenberg Orthopedic, University Hospitals Leuven, Pellenberg, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Kinesiology, Human Movement Biomechanics, KU Leuven, Heverlee, Belgium
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Wright RL, Bevins JW, Pratt D, Sackley CM, Wing AM. Metronome Cueing of Walking Reduces Gait Variability after a Cerebellar Stroke. Front Neurol 2016; 7:84. [PMID: 27313563 PMCID: PMC4887482 DOI: 10.3389/fneur.2016.00084] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/16/2016] [Indexed: 11/13/2022] Open
Abstract
Cerebellar stroke typically results in increased variability during walking. Previous research has suggested that auditory cueing reduces excessive variability in conditions such as Parkinson's disease and post-stroke hemiparesis. The aim of this case report was to investigate whether the use of a metronome cue during walking could reduce excessive variability in gait parameters after a cerebellar stroke. An elderly female with a history of cerebellar stroke and recurrent falling undertook three standard gait trials and three gait trials with an auditory metronome. A Vicon system was used to collect 3-D marker trajectory data. The coefficient of variation was calculated for temporal and spatial gait parameters. SDs of the joint angles were calculated and used to give a measure of joint kinematic variability. Step time, stance time, and double support time variability were reduced with metronome cueing. Variability in the sagittal hip, knee, and ankle angles were reduced to normal values when walking to the metronome. In summary, metronome cueing resulted in a decrease in variability for step, stance, and double support times and joint kinematics. Further research is needed to establish whether a metronome may be useful in gait rehabilitation after cerebellar stroke and whether this leads to a decreased risk of falling.
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Affiliation(s)
- Rachel L Wright
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, UK; School of Psychology, University of Birmingham, Birmingham, UK
| | - Joseph W Bevins
- Institute of Sport and Exercise Science, University of Worcester , Worcester , UK
| | - David Pratt
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare Trust , Birmingham , UK
| | | | - Alan M Wing
- School of Psychology, University of Birmingham , Birmingham , UK
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Colgan G, Walsh M, Bennett D, Rice J, O'Brien T. Gait analysis and hip extensor function early post total hip replacement. J Orthop 2016; 13:171-6. [PMID: 27408491 DOI: 10.1016/j.jor.2016.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/06/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to systematically evaluate the sagittal kinematic and kinetic gait patterns in patients in this early post-operative period, to describe them and to better understand the deficiencies in that gait pattern that may help to develop targeted rehabilitation strategies. METHODS This study evaluated early gait patterns in 10 patients with isolated unilateral hip osteoarthritis who were post-operative for total hip replacement. Kinetic and kinematic assessments - focusing on sagittal plane abnormalities - were performed at 2 weeks pre-operatively and 8 weeks post-operatively. RESULTS Our results demonstrated that while clinical scoring for pain and functional ability significantly improved post-operatively, as did clinical assessment of range of motion passively, this did not translate to the degree of dynamic improvement in gait. Step length and stride length did not improve significantly. Lack of hip extension in terminal stance associated with excessive anterior pelvic tilt persisted and was associated with a worsening in hip extensor power post-operatively. CONCLUSION Based on our results, post-operative rehabilitation programmes should include extensor muscle exercises to increase power and to retain the operative gain in passive range of motion, which would help to improve gait patterns.
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Affiliation(s)
| | - Mike Walsh
- Central Remedial Clinic, Clontarf, Dublin 3, Ireland
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Wesseling M, Meyer C, Corten K, Simon JP, Desloovere K, Jonkers I. Does surgical approach or prosthesis type affect hip joint loading one year after surgery? Gait Posture 2016; 44:74-82. [PMID: 27004636 DOI: 10.1016/j.gaitpost.2015.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 10/21/2015] [Accepted: 11/15/2015] [Indexed: 02/07/2023]
Abstract
Several approaches may be used for hip replacement surgery either in combination with conventional total hip arthroplasty (THA) or resurfacing hip arthroplasty (RHA). This study investigates the differences in hip loading during gait one year or more after surgery in three cohorts presenting different surgical procedures, more specific RHA placed using the direct lateral (RHA-DLA, n=8) and posterolateral (RHA-PLA, n=14) approach as well as THA placed using the direct anterior (THA-DAA, n=12) approach. For the DAA and control subjects, hip loading was also evaluated during stair ascent and descent to evaluate whether these motions can better discriminate between patients and controls compared to gait. Musculoskeletal modelling in OpenSim was used to calculate in vivo joint loading. Results showed that for all operated patients, regardless the surgical procedure, hip loading was decreased compared to control subjects, while no differences were found between patient groups. This indicates that THA via DAA results in similar hip loading as a RHA via DLA or PLA. Stair climbing did not result in more distinct differences in hip contact force magnitude between patients and controls, although differences in orientation were more distinct. However, patients after hip surgery did adjust their motion pattern to decrease the magnitude of loading on the hip joint compared to control subjects.
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Affiliation(s)
- Mariska Wesseling
- KU Leuven, Department of Kinesiology, Human Movement Biomechanics, Heverlee, Belgium.
| | - Christophe Meyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Kristoff Corten
- Hip Unit, Orthopaedic Department, Ziekenhuis Oost-limburg, Genk, Belgium
| | - Jean-Pierre Simon
- UZ Pellenberg Orthopedic Department, University Hospitals Leuven, Pellenberg, Belgium
| | - Kaat Desloovere
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; Clinical Motion Analysis Laboratory, University Hospitals Leuven, Pellenberg, Belgium
| | - Ilse Jonkers
- KU Leuven, Department of Kinesiology, Human Movement Biomechanics, Heverlee, Belgium
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Abstract
There are no established benchmarks for gait mechanics after total hip arthroplasty (THA). This study sought to identify minimum clinically important postoperative (MCIP) or minimum clinically important improvement (MCII) values for self-selected walking speed, sagittal plane dynamic hip range of motion (HROM) (peak flexion-peak extension) and peak hip adduction moments measured during quantitative gait analysis. Preoperative and 1-year postoperative data collected during quantitative gait analysis, along with Harris Hip Scores (HHS), for 145 subjects were collected from a motion analysis data repository. The MCIP (or MCII) was defined as the 75th percentile mark on a plot of the cumulative percent of subjects with HHS ≥ 80 versus the postoperative value (or change) in the respective variable. 95% confidence intervals (CI) were calculated. Logistic regression was used to test the association of age, sex, BMI, and preoperative HHS with benchmarks. The MCIP of speed was 1.34 m/s (95%CI 1.30, 1.37); MCII was 0.32 (0.30, 0.35) m/s. The HROM MCIP was 30.0° (29.4°, 30.7°); MCII was 13.3° (12.1°, 14.8°). The adduction moment MCIP was 4.2% Body Weight × Height (4.0, 4.4); MCII was 0.87 (0.57, 1.17) % Body Weight × Height. Women were more likely to achieve MCII for HROM and MCIP for adduction moment (ORs 2.4-11.6, p ≤ 0.031). Lower BMI predicted HROM and adduction moment MCIPs (ORs 0.85-0.88, p ≤ 0.015). Lower preoperative HHS predicted speed, HROM and adduction moment MCIIs (ORs 0.95-0.97, p ≤ 0.012). With further validation, clinically-relevant gait benchmarks can enhance efforts to improve THA outcomes.
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Affiliation(s)
- Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois
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Meyer CAG, Corten K, Fieuws S, Deschamps K, Monari D, Wesseling M, Simon JP, Desloovere K. Biomechanical gait features associated with hip osteoarthritis: Towards a better definition of clinical hallmarks. J Orthop Res 2015; 33:1498-507. [PMID: 25982594 DOI: 10.1002/jor.22924] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 04/02/2015] [Indexed: 02/04/2023]
Abstract
Critical appraisal of the literature highlights that the discriminative power of gait-related features in patients with hip osteoarthritis (OA) has not been fully explored. We aimed to reduce the number of gait-related features and define the most discriminative ones comparing the three-dimensional gait analysis of 20 patients with hip osteoarthritis (OA) with those of 17 healthy peers. First, principal component analysis was used to reduce the high-dimensional gait data into a reduced set of interpretable variables for further analysis, including tests for group differences. These differences were indicative for the selection of the top 10 variables to be included into linear discriminant analysis models (LDA). Our findings demonstrated the successful data reduction of hip osteoarthritic-related gait features with a high discriminatory power. The combination of the top variables into LDA models clearly separated groups, with a maximum misclassification error rate of 19%, estimated by cross-validation. Decreased hip/knee extension, hip flexion and internal rotation moment were gait features with the highest discriminatory power. This study listed the most clinically relevant gait features characteristics of hip OA. Moreover, it will help clinicians and physiotherapists understand the movement pathomechanics related to hip OA useful in the management and design of rehabilitation intervention.
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Affiliation(s)
- Christophe A G Meyer
- Department of Rehabilitation Sciences, UZ Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium.,UZ Pellenberg Orthopedic Department, University Hospitals Leuven, Pellenberg, Belgium.,Laboratory for Clinical Motion Analysis (C-MAL), University Hospital Pellenberg, UZ Leuven, Belgium
| | - Kristoff Corten
- Orthopedic Association Genk, Ziekenhuis Oost-Limburg Genk, Belgium
| | - Steffen Fieuws
- I-Biostat, KU Leuven University and Universiteit Hasselt, Leuven, Belgium
| | - Kevin Deschamps
- Department of Rehabilitation Sciences, UZ Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium.,Laboratory for Clinical Motion Analysis (C-MAL), University Hospital Pellenberg, UZ Leuven, Belgium
| | - Davide Monari
- Department of Mechanical Engineering, KU Leuven, Faculty of Engineering, Leuven, Belgium
| | - Mariska Wesseling
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Jean-Pierre Simon
- UZ Pellenberg Orthopedic Department, University Hospitals Leuven, Pellenberg, Belgium.,Department of Development and Regeneration, KU Leuven, Faculty of Medicine, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, UZ Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium.,Laboratory for Clinical Motion Analysis (C-MAL), University Hospital Pellenberg, UZ Leuven, Belgium
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Tsai TY, Li JS, Dimitriou D, Kwon YM. Does component alignment affect gait symmetry in unilateral total hip arthroplasty patients? Clin Biomech (Bristol, Avon) 2015; 30:802-7. [PMID: 26117163 DOI: 10.1016/j.clinbiomech.2015.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Component malposition in total hip arthroplasty patients has been associated with adverse clinical outcomes. However, whether the component alignment influences hip dynamic performance following total hip arthroplasty remains unclear. The purpose of this study was to investigate the relationship between the component alignment and in vivo hip kinematics during gait. METHODS Nineteen unilateral total hip arthroplasty patients received CT scan for creation of 3D hip models. The component alignment between the non-implanted and implanted hips were measured and compared. Three-dimensional hip kinematics for both hips of the total hip arthroplasty patients during gait was quantified using a dual fluoroscopic imaging technique. The differences between the implanted and non-implanted hip kinematics during gait were calculated. A forward stepwise multiple linear regression was performed to evaluate the relationships between the changes in implanted hip kinematics and the differences in component alignment with respect to the non-implanted hips. FINDINGS An average 5.1° (SD 6.5°; range -11.1° to 18.3°) increase in internal rotation was observed in the implanted hip than the contralateral non-implanted hip and significantly correlated with a linear combination of the increase of cup anteversion, cup medial translation and leg lengthening (R=0.81). INTERPRETATION Results suggested that the total hip arthroplasty patients compensated the changes in hip geometry by altering the dynamic movement during gait. Restoration of the native hip geometry, including acetabular cup anteversion, position and leg length could be one of the factors that influence the hip kinematics symmetry in total hip arthroplasty patients during gait.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jing-Sheng Li
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Dimitris Dimitriou
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Wesseling M, de Groote F, Meyer C, Corten K, Simon JP, Desloovere K, Jonkers I. Gait alterations to effectively reduce hip contact forces. J Orthop Res 2015; 33:1094-102. [PMID: 25676535 DOI: 10.1002/jor.22852] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 02/03/2015] [Indexed: 02/04/2023]
Abstract
Patients with hip pathology present alterations in gait which have an effect on joint moments and loading. In knee osteoarthritic patients, the relation between medial knee contact forces and the knee adduction moment are currently being exploited to define gait retraining strategies to effectively reduce pain and disease progression. However, the relation between hip contact forces and joint moments has not been clearly established. Therefore, this study aims to investigate the effect of changes in hip and pelvis kinematics during gait on internal hip moments and contact forces which is calculated using muscle driven simulations. The results showed that frontal plane kinetics have the largest effect on hip contact forces. Given the high correlation between the change in hip adduction moment and contact force at initial stance (R(2) = 0.87), this parameter can be used to alter kinematics and predict changes in contact force. At terminal stance the hip adduction and flexion moment can be used to predict changes in contact force (R(2) = 0.76). Therefore, gait training that focuses on decreasing hip adduction moments, a wide base gait pattern, has the largest potential to reduce hip contact forces.
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Affiliation(s)
- Mariska Wesseling
- Department of Kinesiology, KU Leuven, Human Movement Biomechanics, Heverlee, Belgium
| | - Friedl de Groote
- Department of Mechanical Engineering, KU Leuven, Division PMA, Heverlee, Belgium
| | - Christophe Meyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kristoff Corten
- Department of Orthopaedic, Hip Unit, Ziekenhuis Oost-limburg, Genk, Belgium
| | - Jean-Pierre Simon
- Department of Orthopedic, UZ Pellenberg, University Hospitals Leuven, Pellenberg, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Kinesiology, KU Leuven, Human Movement Biomechanics, Heverlee, Belgium
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