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Ouendi N, Avril E, Dervaux B, Pudlo P, Wallard L. Effectiveness of Telerehabilitation Programs in Elderly with Hip or Knee Arthroplasty: A Systematic Review. Telemed J E Health 2024; 30:1507-1521. [PMID: 38574249 DOI: 10.1089/tmj.2023.0622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Background: Lower limb osteoarthritis (OA) often generates musculoskeletal pain causing functional impairment and decreasing mobility, autonomy, and quality of life. Patients with OA are commonly prescribed specific care for total hip arthroplasty or total knee arthroplasty (THA or TKA), when patients present symptoms that are refractory to nondrug treatments. Currently, when patients are discharged from orthopedic surgery, they are either referred to a rehabilitation department, or sent directly home with assistance such as remote monitoring by teleconsultation or a mobile application. In recent years, there has been an evolution in digital health and in particular telerehabilitation. To determine utility and effectiveness, the aim of this systematic review was to highlight and evaluate different telerehabilitation programs using new information and communication technologies. Methods: Five databases, ScienceDirect, PubMed, Web of Sciences, Scopus, and Google scholar, were searched until 30 June 30, 2023. All studies written in English and meeting our inclusion criteria were included. Databases were screened for "Total Hip Arthroplasty," "Total Knee Arthroplasty," "Total Hip Replacement," "Total Knee Replacement," "Rehabilitation," "Physical Activity," "Physiotherapy," "Telerehabilitation," "Telecommunication*," "Senior*," and "Elderly" in accordance with PRISMA-ScR guideline. Results: Fourteen articles were selected according to inclusion criteria. Telerehabilitation was offered in seven different ways (video call, applications smartphones, website, etc.). Assessments included were mainly quality of life questionnaires, perceived effort after exercises, field surveys on the tool experience, and physical tests to assess motor functions. Conclusion: This review highlights the importance and relevance of evaluating the contributions and limits of new health technologies to improve patient monitoring and thus enable better remote clinical care.
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Affiliation(s)
- Nawel Ouendi
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
- Pôle SSR - Maison Sport Santé - Institut Jean Stablinski, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Eugénie Avril
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
| | - Benjamin Dervaux
- Pôle SSR - Maison Sport Santé - Institut Jean Stablinski, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Philippe Pudlo
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
| | - Laura Wallard
- Laboratoire LAMIH - UMR CNRS 8201, Département de Recherche Sciences de l'Homme et du Vivant, Univ Polytechnique Hauts-de-France, Valenciennes, France
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2
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Chen G, Yu D, Wang Y, Ma Z, Bi M, Lu L, Zhang S, Liu J, Chen H, Shen H, Zhang H, Luo X, Si Y, Zhang P. A Prospective Randomized Controlled Trial Assessing the Impact of Preoperative Combined with Postoperative Progressive Resistance Training on Muscle Strength, Gait, Balance and Function in Patients Undergoing Total Hip Arthroplasty. Clin Interv Aging 2024; 19:745-760. [PMID: 38736563 PMCID: PMC11088839 DOI: 10.2147/cia.s453117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose The aim of this study is to investigate the effects of a preoperative combined with postoperative moderate-intensity progressive resistance training (PRT) of the operative side in patients with hip osteoarthritis (HOA) who are undergoing total hip arthroplasty (THA). The study seeks to evaluate the impact of this combined intervention on muscle strength, gait, balance, and hip joint function in a controlled, measurable, and objective manner. Additionally, the study aims to compare the outcomes of this combined intervention with those of preoperative or postoperative muscle strength training conducted in isolation. Methods A total of 90 patients with HOA scheduled for unilateral primary THA were randomly assigned to three groups: Pre group (preoperative PRT), Post group (postoperative PRT), and Pre& Post group (preoperative combined with postoperative PRT) focusing on hip flexion, extension, adduction, and abduction of operated side. Muscle strength, gait parameters, balance, and hip function were assessed at specific time points during a 12-month follow-up period. Results All three groups showed significant improvements in muscle strength, with the Pre& Post group demonstrating the most pronounced and sustained gains. Gait velocity and cadence were significantly improved in the Pre& Post group at 1-month and 3-month postoperative follow-ups compared to the other groups. Similarly, the Pre& Post group exhibited superior balance performance at 3-month and 12-month postoperative follow-ups. The Harris Hip Score also showed better outcomes in the Pre& Post group at all follow-up intervals. Conclusion Preoperative combined with postoperative moderate-intensity PRT in HOA patients undergoing THA led to superior improvements in muscle strength, gait, balance, and hip joint function compared to preoperative or postoperative PRT alone. This intervention shows significant promise in optimizing postoperative rehabilitation and enhancing patient outcomes following THA.
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Affiliation(s)
- Guo Chen
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Duoduo Yu
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Yichen Wang
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Zou Ma
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Mengna Bi
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Lisha Lu
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Shangshang Zhang
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Jiaxin Liu
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Hu Chen
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Hai Shen
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Huiwu Zhang
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Xiaobing Luo
- Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Yan Si
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
| | - Peng Zhang
- Department of Geriatric Orthopedics(1), Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, 610041, People’s Republic of China
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3
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Mercer RW, Peter CA, Habib U, Xie J, Graeber A, Simeone FJ, Chang CY. Anterior and posterior hip osteoarthritis: prevalence and potential value of CT compared to radiographs. Skeletal Radiol 2024; 53:473-479. [PMID: 37632549 DOI: 10.1007/s00256-023-04434-0] [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: 07/27/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE To determine the added value of computed tomography (CT) to identify severe hip osteoarthritis (OA). MATERIALS AND METHODS A retrospective query of all cases of hip or knee arthroplasty planning CTs between January 2018 and March 2022 was performed. Age, sex, and symptoms were collected from the medical record. CTs were evaluated for the degree of osteoarthritis and classified using an adapted Kellgren-Lawrence (KL) grading system in the anterior, posterior, superior, and superomedial hip. Frontal hip or pelvis radiographs within 1 year of the CT were also graded. RESULTS There were 265 eligible hips in 178 subjects, age 66 ± 11 (range 31-93) years, with 85/178 (48%) males and 93/178 (52%) females, and 127/265 (48%) right and 138/265 (52%) left hips. The posterior hip joint was the most common location for grade 2/3 OA (20%), followed by superior hip joint (14%). Anterior or posterior grade 2/3 OA occurred concurrently with superior or superomedial grade 2/3 OA in 32/68 (47%) of hips. Grade 2/3 OA was detected on CT more commonly than on XR both in the superior (14 vs 8.6%, P = 0.0016) and superomedial (8.7 vs 4.8%, P = 0.016) hip joint. Of the 71 symptomatic hips, 22 (31%) hips demonstrated either anterior and/or posterior grade 2/3 OA on CT, and 9 (9/22, 41%) of these hips had superior or superomedial grade 0/1 OA. CONCLUSION CT may be warranted when the patient has pain suggestive of osteoarthritis not detected on radiographs.
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Affiliation(s)
- Ronald W Mercer
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Cynthia Assimta Peter
- Department of Radiology, Sengkang General Hospital, East Way, Sengkang, 110, Singapore
| | - Ukasha Habib
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Juliana Xie
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Adam Graeber
- Department of Radiology, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
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Garcia WJ, Sorensen M, Diana LT, Green E. The addition of body weight supported treadmill training to manual therapy and exercise in the management of Hip osteoarthritis: A case series. Physiother Theory Pract 2024; 40:408-417. [PMID: 36036381 DOI: 10.1080/09593985.2022.2115329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND AND PURPOSE Patients with mild-to-moderate hip OA can present with pain, a decline in function, altered gait mechanics, and pain with ambulation. Body weight supported treadmill training (BWSTT) has been utilized for patients with total hip arthroplasty, hip fracture, and lumbar spinal stenosis. The purpose of this case series was to report the outcomes of patients with hip OA that received guideline adherent physical therapy care with the addition of BWSTT. Our aim was to assess changes in pain, disability, and physical performance. CASE DESCRIPTIONS Seven patients participated in eight 1-h treatment sessions consisting of: manual therapy, therapeutic exercise, and BWSTT. Pre- and post-treatment outcome measures included: average pain rating via the Numeric Pain Rating Scale (NPRS), Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and the Global Rate of Change (GROC). Physical performance measures included: 6-minute walk test (6MWT), stair climbing test, and 5 time sit-stand. OUTCOMES The mean improvement in NPRS score for all subjects was 2.9 points. Mean improvement on the WOMAC was 18.5 + 24.8 pts, and the mean GROC score was +5.0 indicating a rating of "quite a bit better." The mean increase in 6MWT distance was 60.5 + 80.1 meters (median 39 m, range -3 to 230). CONCLUSIONS Though patients participating in a multimodal rehabilitation approach including manual therapy, exercise, and BWSTT demonstrated clinically important improvements in pain and function, these changes may not correspond with gait endurance improvements in the short term.
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Affiliation(s)
- William J Garcia
- Department of Physical Therapy, California State University, Sacramento, CA, USA
| | - Matthew Sorensen
- Department of Physical Therapy, California State University, Sacramento, CA, USA
- Rehabilitation Department, Community Memorial Health System, Ventura, CA, USA
| | - Lam-Tran Diana
- Department of Physical Therapy, California State University, Sacramento, CA, USA
| | - Erin Green
- Department of Physical Therapy, California State University, Sacramento, CA, USA
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5
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Steingrebe H, Spancken S, Sell S, Stein T. Effects of hip osteoarthritis on lower body joint kinematics during locomotion tasks: a systematic review and meta-analysis. Front Sports Act Living 2023; 5:1197883. [PMID: 38046934 PMCID: PMC10690786 DOI: 10.3389/fspor.2023.1197883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Motion analysis can be used to gain information needed for disease diagnosis as well as for the design and evaluation of intervention strategies in patients with hip osteoarthritis (HOA). Thereby, joint kinematics might be of great interest due to their discriminative capacity and accessibility, especially with regard to the growing usage of wearable sensors for motion analysis. So far, no comprehensive literature review on lower limb joint kinematics of patients with HOA exists. Thus, the aim of this systematic review and meta-analysis was to synthesise existing literature on lower body joint kinematics of persons with HOA compared to those of healthy controls during locomotion tasks. Methods Three databases were searched for studies on pelvis, hip, knee and ankle kinematics in subjects with HOA compared to healthy controls during locomotion tasks. Standardised mean differences were calculated and pooled using a random-effects model. Where possible, subgroup analyses were conducted. Risk of bias was assessed with the Downs and Black checklist. Results and Discussion A total of 47 reports from 35 individual studies were included in this review. Most studies analysed walking and only a few studies analysed stair walking or turning while walking. Most group differences were found in ipsi- and contralateral three-dimensional hip and sagittal knee angles with reduced ranges of motion in HOA subjects. Differences between subjects with mild to moderate and severe HOA were found, with larger effects in severe HOA subjects. Additionally, stair walking and turning while walking might be promising extensions in clinical gait analysis due to their elevated requirements for joint mobility. Large between-study heterogeneity was observed, and future studies have to clarify the effects of OA severity, laterality, age, gender, study design and movement execution on lower limb joint kinematics. Systematic Review Registration PROSPERO (CRD42021238237).
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Affiliation(s)
- Hannah Steingrebe
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Sina Spancken
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Stefan Sell
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Joint Center Black Forest, Hospital Neuenbürg, Neuenbürg, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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6
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Inai T, Takabayashi T. Lower-limb sagittal joint angles during gait can be predicted based on foot acceleration and angular velocity. PeerJ 2023; 11:e16131. [PMID: 37744216 PMCID: PMC10512936 DOI: 10.7717/peerj.16131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Background and purpose Continuous monitoring of lower-limb movement may help in the early detection and control/reduction of diseases (such as the progression of orthopedic diseases) by applying suitable interventions. Therefore, it is invaluable to calculate the lower-limb movement (sagittal joint angles) while walking daily for continuous evaluation of such risks. Although cameras in a motion capture system are necessary for calculating lower-limb sagittal joint angles during gait, the method is unrealistic considering the setting is difficult to achieve in daily life. Therefore, the estimation of lower-limb sagittal joint angles during walking based on variables, which can be measured using wearable sensors (e.g., foot acceleration and angular velocity), is important. This study estimates the lower-limb sagittal joint angles during gait from the norms of foot acceleration and angular velocity using machine learning and validates the accuracy of the estimated joint angles with those obtained using a motion capture system. Methods Healthy adults (n = 200) were asked to walk at a comfortable speed (10 trials), and their lower-limb sagittal joint angles, foot accelerations, and angular velocities were obtained. Using these variables, we established a feedforward neural network and estimated the lower-limb sagittal joint angles. Results The average root mean squared errors of the lower-limb sagittal joint angles during gait ranged between 2.5°-7.0° (hip: 7.0°; knee: 4.0°; and ankle: 2.5°). Conclusion These results show that we can estimate the lower-limb sagittal joint angles during gait using only the norms of foot acceleration and angular velocity, which can help calculate the lower-limb sagittal joint angles during daily walking.
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Affiliation(s)
- Takuma Inai
- National Institute of Advanced Industrial Science and Technology, Takamatsu City, Japan
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7
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Ibara T, Fujita K, Watanabe N, Takada R, Miyatake K, Nimura A, Akita K. Stabilization and compensation strategy of the hip angle during gait in hip-osteoarthritis patients from the perspective of whole-body movement synergy. Gait Posture 2023; 106:65-71. [PMID: 37660515 DOI: 10.1016/j.gaitpost.2023.08.015] [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: 03/13/2023] [Revised: 06/28/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The implementation of a strategy to control the hip angle during gait is important to avoid disease progression in patients with hip osteoarthritis (OA). RESEARCH QUESTION Do patients with hip OA tend to stabilize their hip angles by a combination of whole-body movements during gait in terms of variability? METHODS A public gait dataset comprising 80 asymptomatic participants and 106 patients with hip OA was used. Uncontrolled manifold analysis was performed using the joint angles as elemental variables and the hip joint angles as performance variables. The synergy index ΔV, variances of elemental variables that did not affect the performance variable (VUCM) and of those that affected the performance variable (VORT), and index of covariation strategy (COV) were calculated in sagittal and frontal plane. A one-sample t-test for statistical parametric mapping (SPM) analysis was used for ΔV and COV. Two-sample t-tests of SPM analyses were used for ΔV, VUCM, and VORT to compare the two groups. RESULTS In both planes, the ΔV and COV were significantly larger than zero in both groups (p < 0.001). In the sagittal plane, the VORT was higher in the hip OA group than in the control group after 77 % of stance phase. In the frontal plane, the hip OA group had larger ΔV and VUCM after last half and last quartile of stance phase compared to the control group, respectively. The VORT was smaller in the hip OA group than in the control group. SIGNIFICANCE The hip angle was stabilized in the hip OA group in the frontal plane but insufficiently stabilized in the sagittal plane; however, the patients changed their hip angle during the early phase of stance. The combination of whole-body movements contributed to the stabilization of hip angle.
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Affiliation(s)
- Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Naoto Watanabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Japan
| | - Ryohei Takada
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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8
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Raab D, Heitzer F, Liaw JC, Müller K, Weber L, Flores FG, Kecskeméthy A, Mayer C, Jäger M. Do we still need to screen our patients?-Orthopaedic scoring based on motion tracking. INTERNATIONAL ORTHOPAEDICS 2023; 47:921-928. [PMID: 36624129 PMCID: PMC10014817 DOI: 10.1007/s00264-022-05670-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Orthopaedic scores are essential for the clinical assessment of movement disorders but require an experienced clinician for the manual scoring. Wearable systems are taking root in the medical field and offer a possibility for the convenient collection of motion tracking data. The purpose of this work is to demonstrate the feasibility of automated orthopaedic scorings based on motion tracking data using the Harris Hip Score and the Knee Society Score as examples. METHODS Seventy-eight patients received a clinical examination and an instrumental gait analysis after hip or knee arthroplasty. Seven hundred forty-four gait features were extracted from each patient's representative gait cycle. For each score, a hierarchical multiple regression analysis was conducted with a subsequent tenfold cross-validation. A data split of 70%/30% was applied for training/testing. RESULTS Both scores can be reproduced with excellent coefficients of determination R2 for training, testing and cross-validation by applying regression models based on four to six features from instrumental gait analysis as well as the patient-reported parameter 'pain' as an offset factor. CONCLUSION Computing established orthopaedic scores based on motion tracking data yields an automated evaluation of a joint function at the hip and knee which is suitable for direct clinical interpretation. In combination with novel technologies for wearable data collection, these computations can support healthcare staff with objective and telemedical applicable scorings for a large number of patients without the need for trained clinicians.
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Affiliation(s)
- Dominik Raab
- Chair of Mechanics and Robotics, University of Duisburg-Essen, Lotharstraße 1, 47057, Duisburg, Germany.
| | - Falko Heitzer
- Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
| | - Jin Cheng Liaw
- Chair of Mechanics and Robotics, University of Duisburg-Essen, Lotharstraße 1, 47057, Duisburg, Germany
| | - Katharina Müller
- Chair of Mechanics and Robotics, University of Duisburg-Essen, Lotharstraße 1, 47057, Duisburg, Germany
| | - Lina Weber
- Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
| | - Francisco Geu Flores
- Chair of Mechanics and Robotics, University of Duisburg-Essen, Lotharstraße 1, 47057, Duisburg, Germany
| | - Andrés Kecskeméthy
- Chair of Mechanics and Robotics, University of Duisburg-Essen, Lotharstraße 1, 47057, Duisburg, Germany
| | - Constantin Mayer
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien-Hospital Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
| | - Marcus Jäger
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien-Hospital Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
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9
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Kaufmann M, Nüesch C, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Stoffel K, Mündermann A, Ismailidis P. Functional assessment of total hip arthroplasty using inertial measurement units: Improvement in gait kinematics and association with patient-reported outcome measures. J Orthop Res 2023; 41:759-770. [PMID: 35880355 DOI: 10.1002/jor.25421] [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: 01/09/2022] [Revised: 07/08/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023]
Abstract
Inertial measurement units (IMUs) are commonly used for gait assessment, yet their potential for quantifying improvements in gait function and patterns after total hip arthroplasty (THA) has not been fully explored. The primary aim of this study was to compare spatiotemporal parameters and sagittal plane kinematic patterns of patients with hip osteoarthritis (OA) before and after THA, and to asymptomatic controls. The secondary aim was to assess the association between dynamic hip range of motion (ROM) during walking and the Hip Osteoarthritis Outcome Scores (HOOS). Twenty-four patients with hip OA and 24 matched asymptomatic controls completed gait analyses using the RehaGait® sensor system. Patients were evaluated pre- and 1 year postoperatively, controls in a single visit. Differences in kinematic data were analyzed using statistical parametric mapping, and correlations between dynamic hip ROM and HOOS were calculated. Walking speed and stride length significantly increased (+0.08 m/s, p = 0.019; +0.06 m, p = 0.048) after THA but did not reach the level of asymptomatic controls (-0.11 m/s, p = 0.028; -0.14 m, p = 0.001). Preoperative hip and knee kinematics differed significantly from controls. After THA, they improved significantly and did not differ from controls. Dynamic hip flexion-extension ROM correlated positively with all HOOS subscores (r > 0.417; p ≤ 0.001). The change in HOOS symptoms in patients was explained by the combination of baseline HOOS symptoms and change in dynamic hip ROM (r2 = 0.748) suggesting that the additional information gained with IMU gait analysis helps to complement and objectify patient-reported outcome measures pre- and postoperatively and monitor treatment-related improvements.
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Affiliation(s)
- Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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10
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Huang CH, Aydemir B, Foucher KC. Sagittal plane ankle kinetics are associated with dynamic hip range of motion and gait efficiency in women with hip osteoarthritis. J Orthop Res 2023; 41:555-561. [PMID: 35689510 PMCID: PMC9741662 DOI: 10.1002/jor.25394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/25/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Loss of sagittal plane hip range of motion (ROM) is a commonly reported walking gait impairment in people with hip osteoarthritis (OA). The purpose of this study was to evaluate whether sagittal plane hip ROM reduction and the resulting altered sagittal plane ankle kinetics during gait influence the energy cost of walking in people with hip OA. We evaluated 24 women with unilateral hip OA (60 ± 9.1 years; 29.4 ± 6.1 kg/m2 ). Sagittal plane hip ROM and peak ankle dorsiflexion moment were assessed by instrumented gait analysis. We also used a portable metabolic system to measure the energy cost of walking. Pearson correlations and regression analyses were performed to test our hypotheses. We found that greater involved limb sagittal plane hip ROM was associated with a larger ankle peak dorsiflexion moment at push-off during gait (R = 0.50, p = 0.01). Greater involved limb peak ankle dorsiflexion moment at push-off was associated with a lower oxygen consumption during gait (R = -0.51, p = 0.01). Involved limb peak ankle dorsiflexion moment at push-off predicted 26% of the variance in O2 cost. Statement of Clinical Significance: Sagittal plane hip ROM was associated with peak ankle dorsiflexion moment at push-off during gait in women with hip OA. Moreover, peak ankle dorsiflexion moment at push-off was associated with the energy cost of walking. Therefore, modifying sagittal plane hip ROM and peak ankle dorsiflexion moment could be a possible rehabilitation strategy to improve gait efficiency in women with hip OA.
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Affiliation(s)
- Chun-Hao Huang
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University
| | - Burcu Aydemir
- Division of Rheumatology, Northwestern University Feinberg School of Medicine
| | - Kharma C. Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago
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Yuri T, Nankaku M, Kawano T, Murao M, Hamada R, Goto K, Kuroda Y, Kawai T, Ikeguchi R, Matsuda S. Evaluating the contribution of fat infiltration in anterior gluteus minimus muscle to walking ability in female with unilateral hip osteoarthritis and candidates for total hip arthroplasty. Clin Biomech (Bristol, Avon) 2023; 103:105909. [PMID: 36878079 DOI: 10.1016/j.clinbiomech.2023.105909] [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: 11/14/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The purpose of this study is to investigate the relationship between gait and fat infiltration in anterior and posterior gluteus minimus in the patients with hip osteoarthritis. METHODS Ninety-one female patients who were diagnosed as the unilateral hip osteoarthritis, classified into Kellgren-Lawrence global scoring system grades 3 or 4, and candidate for total hip arthroplasty were retrospectively reviewed. The horizontally cross-sectional regions of interest for the gluteus medius and anterior and posterior gluteus minimus were manually circumscribed in a single transaxial computed tomography image and muscle density of those regions were obtained. The gait was assessed as the step and speed with the 10-Meter Walk Test. The multiple regression analysis was used to compare the step and speed with age, height, range of motion in flexion, the muscle density of anterior gluteus minimus in the affected side, and that of gluteus medius muscle in both affected and unaffected sides. FINDINGS Multiple regression analysis for step revealed that the muscle density of anterior gluteus minimus in the affected side and height were the independent predictors for step (R2 = 0.389, p < 0.001). That for speed identified the muscle density of anterior gluteus minimus in the affected side as the only factor determining speed (R2 = 0.287, p < 0.001). INTERPRETATION The fatty infiltration of anterior gluteus minimus muscle in affected side can be a predictor for the gait in in female with unilateral hip osteoarthritis and candidates for total hip arthroplasty.
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Affiliation(s)
- Takuma Yuri
- Rehabilitation Unit, Kyoto University Hospital, Japan; Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan.
| | | | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Japan
| | | | - Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, Japan
| | - Kouji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Toshiyuki Kawai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Japan
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12
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Korytkin AA, El Moudni YM, Novikova YS, Kovaldov KA, Morozova EA. A prospective randomised comparison of earlier function after total hip arthroplasty with a mini posterior approach or supercapsular percutaneously-assisted total hip approach: a gait analysis study. Hip Int 2023; 33:169-177. [PMID: 34030517 DOI: 10.1177/11207000211018440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The supercapsular percutaneously-assisted total hip (SuperPATH) approach is a muscle sparing surgical technique for total hip arthroplasty (THA). The literature reports good clinical and functional results of the SuperPATH technique in the short term. We aimed to compare early outcomes and gait analysis of THA using the mini posterior approach (MPA) and supercapsular percutaneously-assisted total hip (SuperPATH) approach. METHODS 44 patients who underwent THA, were randomly allocated to either MPA or SuperPATH. The data were then collected prospectively (preoperatively and postoperatively at 6 weeks). Plain anteroposterior radiographs of the pelvis and instrumental gait analysis were obtained. The visual analogue scale (VAS), Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Scores (HOOS) were used to assess functional and clinical outcomes. RESULTS No significant difference was found in patients' surgical outcomes. Patients in the SuperPATH group had less pain according to the VAS score at follow-up than the MPA group (p < 0.01). There was also a significant improvement in HHS and HOOS scores for all patients (p < 0.001) with the SuperPATH group showing superior changes. The comparison of mean differences in gait velocity between preoperative and 6 weeks postoperative result, revealed improvement in the SuperPATH group over the MPA group (p = 0.06). Limping was more persistent in the MPA group. Kinematic parameters demonstrated improved hip joint excursion slightly higher in the MPA group. There was no significant improvement in kinetic and kinematic parameters at different walking moments for all patients at 6 weeks compared to preoperative gait patterns. CONCLUSIONS SuperPATH and MPA both show excellent results. This study reveals that the SuperPATH technique was associated with lower postoperative pain levels, and higher physical function and quality of life. Improved functional outcomes allowed earlier postoperative rehabilitation and faster recovery. Specific improvement in gait patterns were identified with nonsignificant differences between the 2 approaches at 6 weeks follow-up.
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Affiliation(s)
- Andrey A Korytkin
- Department of Research Organisation, Novosibirsk Research Institute of Traumatology and Orthopaedics, Novosibirsk, Russian Federation
| | - Younes M El Moudni
- Department of Trauma and Orthopaedic Surgery, University Hospital Ibn Rochd, Casablanca, Morocco
| | - Yana S Novikova
- Department of Research Organisation, Novosibirsk Research Institute of Traumatology and Orthopaedics, Novosibirsk, Russian Federation
| | - Kirill A Kovaldov
- Department of Adult Orthopaedics, University Clinic of Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
| | - Ekaterina A Morozova
- Department of Adult Orthopaedics, University Clinic of Privolzhsky Research Medical University, Nizhny Novgorod, Russian Federation
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Steingrebe H, Stetter BJ, Sell S, Stein T. Effects of Hip Bracing on Gait Biomechanics, Pain and Function in Subjects With Mild to Moderate Hip Osteoarthritis. Front Bioeng Biotechnol 2022; 10:888775. [PMID: 35898647 PMCID: PMC9309805 DOI: 10.3389/fbioe.2022.888775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Hip Osteoarthritis (HOA) is a common joint disease with serious impact on the quality of life of the affected persons. Additionally, persons with HOA often show alterations in gait biomechanics. Developing effective conservative treatment strategies is of paramount importance, as joint replacement is only indicated for end-stage HOA. In contrast to knee osteoarthritis, little is known about the effectiveness of hip bracing for the management of HOA. Studies analysing mechanically unloading hip braces partly showed beneficial results. However, methodological limitations of these studies, such as small sample sizes or lack of control groups, limit the applicability of the results. Additionally, mechanically unloading braces might impose restrictions on motion and comfort and thus, might not be suitable for people with only mild or moderate symptoms. The aim of this study was to comprehensively quantify the effects of unilateral HOA as well as functional hip bracing on gait biomechanics, pain, proprioception and functional capacity in people with mild to moderate HOA. Hip and pelvis biomechanics during walking were analysed in 21 subjects with mild to moderate HOA under three bracing conditions: unbraced, immediately after brace application and after 1 week of brace usage. Additionally, pain, hip proprioception and functional capacity were assessed. A matched group of 21 healthy subjects was included as reference. Kinematic and kinetic data were collected using a 16-camera infrared motion capturing system and two force plates. Visual analogue scales, an angle reproduction test and a 6-min walking test were applied to measure pain, hip proprioception and functional capacity, respectively. Subjects with HOA walked slower, with reduced step length, sagittal hip range of motion and peak extension angle and had a reduced functional capacity. After 1 week of brace application step length, walking speed and functional capacity were significantly increased. Additionally, pain perception was significantly lower in the intervention period. These results encourage the application of functional hip braces in the management of mild to moderate HOA. However, as key parameters of HOA gait such as a reduced peak extension angle remained unchanged, the underlying mechanisms remain partly unclear and have to be considered in the future.
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Affiliation(s)
- Hannah Steingrebe
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- *Correspondence: Hannah Steingrebe,
| | - Bernd J. Stetter
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Stefan Sell
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Joint Center Black Forest, Hospital Neuenbürg, Neuenbürg, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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14
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Maezawa K, Nozawa M, Gomi M, Sato H, Hayashi A, Maruyama Y, Sugimoto M, Ishijima M. Effect of limited range of motion of the hip joint and leg-length discrepancy on gait trajectory: an experiment to reproduce the asymmetric gait that occurs in patients with osteoarthritis of the hip joint. Hip Int 2022:11207000221102849. [PMID: 35765166 DOI: 10.1177/11207000221102849] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE Although some symptoms that often occur with hip joint osteoarthritis (OA) may be involved in the appearance of gait disturbance, the main cause has not been identified. We hypothesised that the abnormalities in gait trajectory of patients with hip joint OA are mainly caused by limited range of motion of the hip joint or the presence of leg-length discrepancy, or both. To investigate this hypothesis, we examined whether the abnormal gait trajectory in patients with hip joint OA can be reproduced in healthy individuals by asking them to wear a hip orthosis and shoe orthotic (insole). METHODS We recruited 2 groups of participants: patients with hip joint OA (OA group, 38 patients) and healthy individuals who imitated patients with OA of the hip joint by wearing a hip orthosis or shoe orthotic (10-mm or 20-mm insole) or both (simulated OA group, 6 individuals). For gait analysis, we used a portable, wearable gait analyser with inertial sensors to evaluate 3-dimensional (3D) changes in gait trajectory. RESULTS In the OA group, the patterns of gait trajectories that were drawn on the 3 planes (coronal, sagittal, and horizontal planes) could be roughly divided into 3 types. The gait trajectories that were drawn when wearing a hip orthosis in the simulated OA group were very similar to 1 of the 3 patterns of gait trajectory that occurs in the OA group. CONCLUSIONS We were able to reproduce the abnormal gait trajectory that is observed in ⅓ of patients with hip OA in healthy individuals, so we propose that an extreme reduction in hip joint ROM is 1 of the causes of abnormal gait pattern in patients with OA of the hip joint. A difference in leg length of 20 mm alone has little effect on gait trajectory.
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Affiliation(s)
- Katsuhiko Maezawa
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Masahiko Nozawa
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Motoshi Gomi
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Hironobu Sato
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Akito Hayashi
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Yuichiro Maruyama
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Munehiko Sugimoto
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Muneaki Ishijima
- Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan
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15
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Three-dimensional foot trajectory in female patients with end-stage hip osteoarthritis during walking. Sci Rep 2022; 12:9843. [PMID: 35701555 PMCID: PMC9198095 DOI: 10.1038/s41598-022-14070-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/31/2022] [Indexed: 12/02/2022] Open
Abstract
Osteoarthritis (OA) is a risk factor for falls. To decrease the fall risk, it is important to evaluate the detailed features of the gait of patients with OA. This study aimed to investigate the spatio-temporal parameters of gait in patients with end-stage hip OA, especially foot trajectory. We measured normal speed gait in patients with hip OA and in healthy controls (HCs) using inertial measurement units attached to shanks. The stride lengths in the affected and unaffected sides in the patients with hip OA were shorter than those in the HCs, but the position of maximum foot clearance was not significantly different between the two groups. The patients with hip OA compensated the position of maximum foot clearance to avoid fall risk. The horizontal plane foot trajectory in patients with hip OA suggests that the lateral bending of the trunk during walking, which is frequently seen in them, was a result of the lateral distance at swing down being located significantly more medially on the unaffected side than on the affected side. Herein, a new gait parameter of lateral distance at swing was discovered by a detailed evaluation of three-dimensional foot trajectory of female patients with end-stage hip OA.
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16
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Costa V, Ramirez O, Perea L, Velasquez A, Otero A, Rocon E, Raya R. Development and clinical validation of a rehabilitation platform for hip fracture in elderly population. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1340-1349. [PMID: 35580104 DOI: 10.1109/tnsre.2022.3175688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hip fracture is one of the most common traumatisms associated with falls in the elderly, severely affecting the patient's mobility and independence. In recent years, the use of robotic technology has proven to be effective in gait rehabilitation, especially for neurological disorders. However, there is a lack of research validating these devices for hip fracture in elderly patients. This paper presents the design and evaluation of a novel assistive platform for hip rehabilitation, SWalker, aimed at improving the rehabilitation of this condition. Functional validation of the SWalker platform was carried out with five healthy elderly subjects and two physiotherapists. Clinical validation was conducted with 34 patients with hip fracture. The control group (n=24, age=86.38±6.16 years, 75% female) followed conventional therapy, while the intervention group (n=10, age=86.80±6.32 years, 90% female) was rehabilitated using SWalker. The functional validation of the device reported good acceptability (System Usability Scale >85). In the clinical validation, the control group required 68.09±27.38 rehabilitation sessions compared to 22.60±16.75 in the intervention group (p<0.001). Patients in the control group needed 120.33±53.64 days to reach ambulation, while patients rehabilitated with SWalker achieved that stage in 67.11±51.07 days (p=0.021). FAC and Tinetti indexes presented a larger improvement in the intervention group when compared with the control group (p=0.007 and p=0.01, respectively). The SWalker platform can be considered an effective tool to enhance autonomous gait and shorten rehabilitation therapy in elderly hip fracture patients. This result encourages further research on robotic rehabilitation platforms for hip fracture.
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Stătescu C, Stoica D, Georgescu CV, Gavrilă BI, Popescu MN, Trăistaru MR, Căluianu EI, Bălşeanu TA, Bălşeanu TA. Osteoarthritis induces gender-related changes in the knee range of motion. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:449-457. [PMID: 36374150 PMCID: PMC9801674 DOI: 10.47162/rjme.63.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In time, osteoarthritis (OA) generates the misalignment of the affected joint structures. However, due to the nature of bipedal gait, OA in the lower limb can also cause pathological gait patterns, which can generate instability and falls, with great consequence, especially in the aged population. With goniometry used to evaluate the range of motion (ROM) of joints, we wanted to evaluate how gender impacts gait dynamics in OA patients. For this study, we have compared 106 OA patients (74 females and 32 males) to age matched controls. All participants had their right leg as dominant. Video recording of normal gait was analyzed with a digital goniometry tool phone application, and the knee's ROM was measured in midstance and midswing moment of the gait. During midstance, significant extension and flexion of the knee excursion have been observed in both males and females. During midswing, knee OA presents more differences, whereas subjects with hip and knee OA present changes on the dominant knee. Midstance changes suggest that the knee's joint degenerative changes, such as synovitis, can be linked to hip OA secondary changes. Midswing changes in lower limb OA suggest a connection to the activities of daily life. Gender differences generated by OA must furthermore be studied in both lower limbs so that the best therapeutic approach can be chosen.
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Affiliation(s)
- Carmen Stătescu
- Department of Theory and Methodology of Motor Activities, Faculty of Physical Education and Sport, University of Craiova, Romania; ; Department of Nursing Surgery, University of Medicine and Pharmacy of Craiova, Romania;
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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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Buehler C, Koller W, De Comtes F, Kainz H. Quantifying Muscle Forces and Joint Loading During Hip Exercises Performed With and Without an Elastic Resistance Band. Front Sports Act Living 2021; 3:695383. [PMID: 34497999 PMCID: PMC8419330 DOI: 10.3389/fspor.2021.695383] [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: 04/14/2021] [Accepted: 07/21/2021] [Indexed: 01/13/2023] Open
Abstract
An increase in hip joint contact forces (HJCFs) is one of the main contributing mechanical causes of hip joint pathologies, such as hip osteoarthritis, and its progression. The strengthening of the surrounding muscles of the joint is a way to increase joint stability, which results in the reduction of HJCF. Most of the exercise recommendations are based on expert opinions instead of evidence-based facts. This study aimed to quantify muscle forces and joint loading during rehabilitative exercises using an elastic resistance band (ERB). Hip exercise movements of 16 healthy volunteers were recorded using a three-dimensional motion capture system and two force plates. All exercises were performed without and with an ERB and two execution velocities. Hip joint kinematics, kinetics, muscle forces, and HJCF were calculated based on the musculoskeletal simulations in OpenSim. Time-normalized waveforms of the different exercise modalities were compared with each other and with reference values found during walking. The results showed that training with an ERB increases both target muscle forces and HJCF. Furthermore, the ERB reduced the hip joint range of motion during the exercises. The type of ERB used (soft vs. stiff ERB) and the execution velocity of the exercise had a minor impact on the peak muscle forces and HJCF. The velocity of exercise execution, however, had an influence on the total required muscle force. Performing hip exercises without an ERB resulted in similar or lower peak HJCF and lower muscle forces than those found during walking. Adding an ERB during hip exercises increased the peak muscle and HJCF but the values remained below those found during walking. Our workflow and findings can be used in conjunction with future studies to support exercise design.
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Affiliation(s)
- Callum Buehler
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Willi Koller
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Florentina De Comtes
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
| | - Hans Kainz
- Neuromechanics Research Group, Department of Biomechanics, Kinesiology and Computer Science in Sport, Centre for Sport Science and University Sports, University of Vienna, Vienna, Austria
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Nüesch C, Ismailidis P, Koch D, Pagenstert G, Ilchmann T, Eckardt A, Stoffel K, Egloff C, Mündermann A. Assessing Site Specificity of Osteoarthritic Gait Kinematics with Wearable Sensors and Their Association with Patient Reported Outcome Measures (PROMs): Knee versus Hip Osteoarthritis. SENSORS 2021; 21:s21165363. [PMID: 34450828 PMCID: PMC8398113 DOI: 10.3390/s21165363] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022]
Abstract
There is a great need for quantitative outcomes reflecting the functional status in patients with knee or hip osteoarthritis (OA) to advance the development and investigation of interventions for OA. The purpose of this study was to determine if gait kinematics specific to the disease—i.e., knee versus hip OA—can be identified using wearable sensors and statistical parametric mapping (SPM) and whether disease-related gait deviations are associated with patient reported outcome measures. 113 participants (N = 29 unilateral knee OA; N = 30 unilateral hip OA; N = 54 age-matched asymptomatic persons) completed gait analysis with wearable sensors and the Knee/Hip Osteoarthritis Outcome Score (KOOS/HOOS). Data were analyzed using SPM. Knee and hip kinematics differed between patients with knee OA and patients with hip OA (up to 14°, p < 0.001 for knee and 8°, p = 0.003 for hip kinematics), and differences from controls were more pronounced in the affected than unaffected leg of patients. The observed deviations in ankle, knee and hip kinematic trajectories from controls were associated with KOOS/HOOS in both groups. Capturing gait kinematics using wearables has a large potential for application as outcome in clinical trials and for monitoring treatment success in patients with knee or hip OA and in large cohorts representing a major advancement in research on musculoskeletal diseases.
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Affiliation(s)
- Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - David Koch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department for Sport, Movement and Health, University of Basel, 4052 Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Clarahof Clinic of Orthopaedic Surgery, 4058 Basel, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Correspondence:
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21
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Roach KE, Pedoia V, Lee JJ, Popovic T, Link TM, Majumdar S, Souza RB. Multivariate functional principal component analysis identifies waveform features of gait biomechanics related to early-to-moderate hip osteoarthritis. J Orthop Res 2021; 39:1722-1731. [PMID: 33615524 PMCID: PMC8180534 DOI: 10.1002/jor.24901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
Clinicians often examine movement patterns to design hip osteoarthritis (OA) interventions, yet traditional biomechanical analyses only report a single timepoint. Multivariate principal component analysis (MFPCA) analyzes the entire waveform (i.e., movement pattern), which clinicians observe to direct treatment. This study investigated hip OA indicators, by (1) employing MFPCA to characterize variance across the hip, knee, and ankle angles in healthy and early-to-moderate hip OA participants; and (2) investigating relationships between these waveform features and hip cartilage health. Bilateral hip magnetic resonance images from 72 participants with Kellgren-Lawrence grades ranging from 0 to 3 were used to calculate mean T 1ρ and T 2 relaxation times in the femoral and acetabular cartilage. MFPCA was performed on lower-limb gait biomechanics and used to identify primary modes of variation, which were related to T 1ρ and T 2 relaxation times. Here, a MFPC = mode of variation = waveform feature. In the femoral cartilage, transverse plane MFPCs 3 and 5 and body mass index (BMI) was related to T 1ρ , while MFPC 2 and BMI were related to T 2 relaxation times. In the acetabular cartilage, sagittal plane MFPC 1 and BMI were related to T 1ρ , while BMI was related to T 2 relaxation times. Greater internal rotation was related to increased T 1ρ and T 2 relaxation times in the femoral cartilage, while the greater extension was related to increased T 1ρ relaxation times in the acetabular cartilage. This study established a data-driven framework to assess relationships between multi-joint biomechanics and quantitative assessments of cartilage health and identified waveform features that could be evaluated in future hip OA intervention studies.
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Affiliation(s)
- Koren E. Roach
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Valentina Pedoia
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Jinhee J. Lee
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Tijana Popovic
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA
| | - Richard B. Souza
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California – San Francisco, San Francisco, CA, USA,Department of Physical Therapy and Rehabilitation Science, University of California – San Francisco, San Francisco, CA, USA
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22
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Ismailidis P, Kaufmann M, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Mündermann A, Nüesch C. Kinematic changes in severe hip osteoarthritis measured at matched gait speeds. J Orthop Res 2021; 39:1253-1261. [PMID: 32930435 DOI: 10.1002/jor.24858] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
Kinematic differences between patients with osteoarthritis (OA) and control participants have been reported to be influenced by gait speed. The purpose of this study was to experimentally detect the effect of walking speed on differences in spatiotemporal parameters and kinematic trajectories between patients with hip OA and age-matched asymptomatic participants using wearable sensors and statistical parametric mapping (SPM). Twenty-four patients with severe unilateral hip OA and 48 control participants were included in this study. Patients walked at a self-selected normal speed and control participants at self-selected normal and slow speeds. Spatiotemporal parameters and kinematic trajectories were measured with the inertial sensor system Rehagait®. Gait parameters were compared between patients with hip OA and control participants for normal and matched speed using SPM with independent sample t-tests. At self-selected normal speed, the patient group walked slower (-0.20 m/s, p < .001) and at lower cadence (-5.0 steps/minute, p < .001) as well as with smaller hip flexion (-7.4°, p < .001) and extension (-4.1°, p = .001), higher knee flexion during terminal stance (+8.0°, p < .001) and higher ankle dorsiflexion and plantarflexion (+7.1°, p < .001). While differences in spatiotemporal parameters and the ankle trajectory disappeared at matched speed, some clinically relevant and statistically significant differences in hip and knee trajectories remained. Most differences in sagittal plane gait kinematics between patients with hip OA and control participants were present for matched speed, and therefore appear to be associated with a disease rather than gait speed. Nevertheless, studies investigating hip kinematics in patients with hip OA should involve trials at matched speeds.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
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23
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Kataoka Y, Shimizu T, Takeda R, Tadano S, Saito Y, Osuka S, Ishida T, Samukawa M, Irie T, Takahashi D, Iwasaki N, Tohyama H. Effects of unweighting on gait kinematics during walking on a lower-body positive-pressure treadmill in patients with hip osteoarthritis. BMC Musculoskelet Disord 2021; 22:46. [PMID: 33419416 PMCID: PMC7792168 DOI: 10.1186/s12891-020-03909-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/23/2020] [Indexed: 12/30/2022] Open
Abstract
Background Hip osteoarthritis (OA) is a musculoskeletal condition that makes walking difficult due to pain induced by weight-bearing activities. Treadmills that support the body weight (BW) reduce the load on the lower limbs, and those equipped with a lower-body positive-pressure (LBPP) device, developed as a new method for unweighting, significantly reduce pain in patients with knee OA. However, the effects of unweighting on gait kinematics remain unclear in patients with hip OA. Therefore, we investigated the effects of unweighting on kinematics in patients with hip OA during walking on a treadmill equipped with an LBPP device. Methods A total of 15 women with hip OA and 15 age-matched female controls wore a three-dimensional (3-D) motion analysis system and walked at a self-selected speed on the LBPP treadmill. Data regarding self-reported hip pain using a numeric rating scale (NRS) in which the scores 0 and 10 represented no pain and the worst pain, respectively, under three different BW conditions (100, 75, and 50%) were collected. Moreover, 3-D peak joint angles during gait under each condition were calculated and compared. Results In the hip OA group, the NRS pain scores at 50 and 75% BW conditions significantly decreased compared with that at 100% BW condition (50%, P = 0.002; 75%, P = 0.026), and the peak hip extension angle decreased compared with that in the healthy controls (P = 0.044). In both groups, unweighting significantly decreased the peak hip (P < 0.001) and knee (P < 0.001) flexion angles and increased the peak ankle plantar flexion angle (P < 0.001) during walking. Conclusions Unweighting by the LBPP treadmill decreased pain in the hip OA group but did not drastically alter the gait kinematics compared with that in the control group. Therefore, regarding the use of the LBPP treadmill for patients with hip OA, clinicians should consider the benefits of pain reduction rather than the kinematic changes.
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Affiliation(s)
- Yoshiaki Kataoka
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo, 060-0812, Japan.,Department of Rehabilitation, Health Sciences University of Hokkaido Hospital, 2-5 Ainosato, Kita-ku, Sapporo, 002-8072, Japan
| | - Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Ryo Takeda
- Faculty of Engineering, Hokkaido University, Kita 12, Nishi 8, Kita-ku, Sapporo, 060-8628, Japan
| | - Shigeru Tadano
- Faculty of Engineering, Hokkaido University, Kita 12, Nishi 8, Kita-ku, Sapporo, 060-8628, Japan
| | - Yuki Saito
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo, 060-0812, Japan
| | - Satoshi Osuka
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo, 060-0812, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo, 060-0812, Japan
| | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo, 060-0812, Japan
| | - Tohru Irie
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Harukazu Tohyama
- Faculty of Health Sciences, Hokkaido University, Kita 12, Nishi 5, Kita-ku, Sapporo, 060-0812, Japan
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24
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Holder J, Trinler U, Meurer A, Stief F. A Systematic Review of the Associations Between Inverse Dynamics and Musculoskeletal Modeling to Investigate Joint Loading in a Clinical Environment. Front Bioeng Biotechnol 2020; 8:603907. [PMID: 33365306 PMCID: PMC7750503 DOI: 10.3389/fbioe.2020.603907] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022] Open
Abstract
The assessment of knee or hip joint loading by external joint moments is mainly used to draw conclusions on clinical decision making. However, the correlation between internal and external loads has not been systematically analyzed. This systematic review aims, therefore, to clarify the relationship between external and internal joint loading measures during gait. A systematic database search was performed to identify appropriate studies for inclusion. In total, 4,554 articles were identified, while 17 articles were finally included in data extraction. External joint loading parameters were calculated using the inverse dynamics approach and internal joint loading parameters by musculoskeletal modeling or instrumented prosthesis. It was found that the medial and total knee joint contact forces as well as hip joint contact forces in the first half of stance can be well predicted using external joint moments in the frontal plane, which is further improved by including the sagittal joint moment. Worse correlations were found for the peak in the second half of stance as well as for internal lateral knee joint contact forces. The estimation of external joint moments is useful for a general statement about the peak in the first half of stance or for the maximal loading. Nevertheless, when investigating diseases as valgus malalignment, the estimation of lateral knee joint contact forces is necessary for clinical decision making because external joint moments could not predict the lateral knee joint loading sufficient enough. Dependent on the clinical question, either estimating the external joint moments by inverse dynamics or internal joint contact forces by musculoskeletal modeling should be used.
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Affiliation(s)
- Jana Holder
- Faculty of Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany.,Movement Analysis Laboratory, Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt am Main, Germany
| | - Ursula Trinler
- Laboratory for Movement Analysis, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Andrea Meurer
- Department of Special Orthopedics, Orthopedic University Hospital Friedrichsheim gGmbH, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Stief
- Faculty of Medicine, Goethe University Frankfurt, Frankfurt am Main, Germany.,Movement Analysis Laboratory, Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt am Main, Germany
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25
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Ismailidis P, Nüesch C, Kaufmann M, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Mündermann A. Measuring gait kinematics in patients with severe hip osteoarthritis using wearable sensors. Gait Posture 2020; 81:49-55. [PMID: 32679463 DOI: 10.1016/j.gaitpost.2020.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The popularity of inertial sensors in gait analysis is steadily rising. To date, an application of a wearable inertial sensor system for assessing gait in hip osteoarthritis (OA) has not been reported. RESEARCH QUESTION Can the known kinematic differences between patients with hip OA and asymptomatic control subjects be measured using the inertial sensor system RehaGait®? METHODS The patients group consisted of 22 patients with unilateral hip OA scheduled for total hip replacement. Forty-five age matched healthy control subjects served as control group. All subjects walked for a distance of 20 m at their self-selected speed. Spatiotemporal parameters and sagittal kinematics at the hip, knee, and ankle including range of motion (ROM) were measured using the RehaGait® system. RESULTS Patients with hip OA walked at a slower walking speed (-0.18 m/s, P < 0.001) and with shorter stride length (-0.16 m, P < 0.001), smaller hip ROM during stance (-11.6°, P < 0.001) and swing (-11.3°, P < 0.001) and smaller knee ROM during terminal stance and swing (-9.0° and-11.5°, P < 0.001). Patients had a smaller hip ROM during stance and swing and smaller knee ROM during terminal stance and swing in the affected compared to the unaffected side (P < 0.001). SIGNIFICANCE The differences in spatiotemporal and kinematic gait parameters between patients with hip OA and age matched control subjects assessed using the inertial sensor system agree with those documented for camera-based systems. Hence, the RehaGait® system can measure gait kinematics characteristic for hip OA, and its use in daily clinical practice is feasible.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland; Clarahof Clinic of Orthopaedic Surgery, Clarahofweg 19a, 4058 Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik, Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik, Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
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26
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Changes in Knee and Trunk Alignment in People With Hip Pain and Healthy Controls When Using a Decline Board During Single-Leg Squat. J Sport Rehabil 2020; 29:886-896. [DOI: 10.1123/jsr.2019-0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/04/2019] [Accepted: 08/11/2019] [Indexed: 11/18/2022]
Abstract
Context: Hip pain is associated with reduced hip muscle strength, range of movement (ROM), and decreased postural stability. Single-leg squat is a reliable and valid method to measure dynamic balance. Objective: To evaluate the influence of physical characteristics and use of a decline board on squat performance in a hip pain population. Design: Cross-sectional study setting. Clinical Patients: In total, 33 individuals scheduled for arthroscopic hip surgery were matched with 33 healthy controls. Interventions: Hip and ankle ROM, hip strength, and trunk endurance were assessed, along with knee and trunk kinematics during squat on flat and 25° decline surfaces. Main Outcome Measures: Between-group and surface differences in alignment, between-group strength and ROM, and associations between alignment and physical characteristics were assessed and determined using mixed model analysis of variance and Pearson R. Results: The hip pain group had significantly less strength and ROM for all directions except abduction strength and ankle dorsiflexion (P > .02). No differences existed between the 2 groups for trunk (P < .70) or knee displacement (P < .46) during squat on either surface. When the 2 groups were combined (n = 66), decline squat significantly reduced knee medial displacement in both limbs by approximately 1 cm (P < .01). Decline squat reduced trunk lateral movement on 1 side only (P = .03). Reduced knee displacement during decline squat showed fair association with less hip-extension strength (r = −.29), hip-flexion strength (r = −.25), and less dorsiflexion (r = −.24). Strength and range were not associated with trunk displacement. Conclusions: Decline squat reduced medial knee and lateral trunk displacement regardless of hip pain. Reductions may be greater in those with lesser hip muscle strength and dorsiflexion. Use of a decline board during squat for improving knee and trunk alignment should be considered as a goal of exercise intervention.
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27
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Coordination Pattern of the Thigh, Pelvic, and Lumbar Movements during the Gait of Patients with Hip Osteoarthritis. JOURNAL OF HEALTHCARE ENGINEERING 2020; 2020:9545825. [PMID: 32774826 PMCID: PMC7396060 DOI: 10.1155/2020/9545825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 11/18/2022]
Abstract
There are limited reports on segment movement and their coordination pattern during gait in patients with hip osteoarthritis. To avoid the excessive stress toward the hip and relevant joints, it is important to investigate the coordination pattern between these segment movements, focusing on the time series data. This study aimed to quantify the coordination pattern of lumbar, pelvic, and thigh movements during gait in patients with hip osteoarthritis and in a control group. An inertial measurement unit was used to measure the lumbar, pelvic, and thigh angular velocities during gait of 11 patients with hip osteoarthritis and 11 controls. The vector coding technique was applied, and the coupling angle and the appearance rate of coordination pattern in each direction were calculated and compared with the control group. Compared with the control group, with respect to the lumbar/pelvic segment movements, the patients with hip osteoarthritis spent more rates in anti-phase and lower rates in in-phase lateral tilt movement. With respect to the pelvic/thigh segment movements, the patients with hip osteoarthritis spent more rates within the proximal- and in-phases for lateral tilt movement. Furthermore, patients with osteoarthritis spent lower rates in the distal-phase for anterior/posterior tilt and rotational movement. Patients with hip osteoarthritis could not move their pelvic and thigh segments separately, which indicates the stiffness of the hip joint. The rotational movement and lateral tilt movements, especially, were limited, which is known as Duchenne limp. To maintain the gait ability, it seems important to pay attention to these directional movements.
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28
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Hall M, Fox A, Bonacci J, Metcalf BR, Pua YH, Diamond LE, Allison K, Wrigley TV, Bennell KL. Hip joint kinematics and segment coordination variability according to pain and structural disease severity in hip osteoarthritis. J Orthop Res 2020; 38:1836-1844. [PMID: 31981236 DOI: 10.1002/jor.24609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/12/2019] [Accepted: 01/22/2020] [Indexed: 02/04/2023]
Abstract
This study aimed to evaluate hip joint kinematic variability and segment coordination variability during walking according to pain and radiographic disease severity in people with hip osteoarthritis. Fifty-five participants with hip osteoarthritis had pain severity assessed during walking using an item on the Western Ontario and McMasters Universities Osteoarthritis Index (no pain = 10; mild pain = 28; moderate pain = 17). Radiographic disease severity was graded by Kellgren and Lawrence scale (KL2 = 29; KL3 = 21; KL4 = 5). Hip kinematics variability was estimated as the curve coefficient of variation. Vector coding was used to calculate coordination variability for select joint couplings. One-way analysis of variances with planned adjusted post hoc comparisons were used to compare hip kinematics variability and coordination variability of select segment couplings (pelvis sagittal vs thigh sagittal; pelvis frontal vs thigh frontal; pelvis transverse vs thigh transverse; thigh sagittal vs shank sagittal; thigh frontal vs shank sagittal; thigh transverse vs shank sagittal) according to pain and radiographic disease severity. No main effect of pain severity was observed for sagittal or transverse plane hip kinematic variability (P ≥ .266), and although there was a main effect for frontal plane hip kinematic variability (P = .035), there were no significant differences when comparing between levels of pain severity (P > .006). There was no main effect of radiographic disease severity on hip kinematic variability in the sagittal (P = .539) or frontal (P = .307) plane. No significant differences in coordination of variability of segment couplings were observed (all P ≥ .229). Movement variability as assessed in this study did not differ according to pain severity during walking or radiographic disease severity.
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Affiliation(s)
- Michelle Hall
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Aaron Fox
- School of Exercise and Nutrition Sciences, Centre for Sports Research, Deakin University, Melbourne, Australia
| | - Jason Bonacci
- School of Exercise and Nutrition Sciences, Centre for Sports Research, Deakin University, Melbourne, Australia
| | - Ben R Metcalf
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Yong H Pua
- Department of Physiotherapy, Singapore General Hospital, Bukit Merah, Singapore
| | - Laura E Diamond
- School of Allied Health Sciences, Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coas, Australia
| | - Kim Allison
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Tim V Wrigley
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
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29
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Diamond LE, Hoang HX, Barrett RS, Loureiro A, Constantinou M, Lloyd DG, Pizzolato C. Individuals with mild-to-moderate hip osteoarthritis walk with lower hip joint contact forces despite higher levels of muscle co-contraction compared to healthy individuals. Osteoarthritis Cartilage 2020; 28:924-931. [PMID: 32360739 DOI: 10.1016/j.joca.2020.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare hip joint contact forces (HJCF), hip muscle forces, and hip muscle co-contraction levels between individuals with mild-to-moderate hip osteoarthritis (OA) and healthy controls during walking. DESIGN Eighteen participants with mild-to-moderate hip OA and 23 healthy controls walked at a self-selected speed while motion capture and electromyographic data were synchronously collected. HJCF were computed using a calibrated electromyography-informed neuromusculoskeletal model. Hip joint contact forces, muscle forces, and co-contraction indices for flexor/extensor and adductor/abductor muscle groups were compared between groups using independent sample t-tests (P < 0.05). RESULTS There was no between-group difference in self-selected walking speed. On average, participants with hip OA walked with 11% lower first peak (mean difference 235 [95% confidence interval (CI) 57-413] N) and 22% lower second peak (mean difference 574 [95%CI 304-844] N) HJCF compared to controls. Hip muscle forces were also significantly lower in the hip OA compared to control group at first (mean difference 224 [95%CI 66-382] N) and second (mean difference 782 [95%CI 399-1164] N) peak HJCF. Participants with hip OA exhibited higher levels of hip muscle co-contraction in both flexor/extensor and adductor/abductor muscle groups. Consistent with existing literature, hip joint angles (extension, adduction) and external moments (flexion, extension, adduction) were lower in hip OA compared to controls. CONCLUSION Lower HJCF were detected in mild-to-moderate hip OA, primarily due to lower hip muscle force production, and despite higher levels of hip muscle co-contraction. Findings suggest that lower loading of the hip joint during walking is a feature of mild-to-moderate hip OA, which could have implications for the pathogenesis of hip OA and/or disease progression.
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Affiliation(s)
- L E Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Queensland, Australia.
| | - H X Hoang
- Department of Movement Sciences, KU Leuven, Leuven, Belgium.
| | - R S Barrett
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - A Loureiro
- Faculty of Physical Education and Sports, UNISINOS, São Leopoldo, Brazil.
| | - M Constantinou
- School of Physiotherapy, Australian Catholic University, Brisbane, Australia.
| | - D G Lloyd
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - C Pizzolato
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
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Popovic T, Samaan MA, Link TM, Majumdar S, Souza RB. Patients with Symptomatic Hip Osteoarthritis Have Altered Kinematics during Stair Ambulation. PM R 2020; 13:128-136. [PMID: 32383300 DOI: 10.1002/pmrj.12398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Osteoarthritis (OA) is a degenerative joint disease. Understanding contributing factors to slowing or stopping disease progression is crucial. There has been no research describing lower extremity kinematics of the hip, knee, and ankle during stair ambulation in individuals with hip OA. OBJECTIVE To explore the differences in lower extremity kinematics between participants with clinical and morphological findings of hip OA and controls. DESIGN A cross-sectional study. SETTING Clinical research laboratory. PARTICIPANTS Participants with radiographic and symptomatic signs of hip OA (n = 42) and healthy controls (n = 30) were enrolled. INTERVENTIONS Participants underwent hip magnetic resonance imaging (MRI). The Scoring Hip Osteoarthritis with MRI (SHOMRI) method was used to assess cartilage abnormalities. Self-reported measures of hip pain and function were obtained using the Hip Disability and Osteoarthritis Outcome Score (HOOS). Participants were assigned into a symptomatic hip osteoarthritis group (HOA) with SHOMRI>0 and HOOS≤80, and a control group (CG) with SHOMRI = 0 and HOOS>90. Patients underwent 3D motion analysis during stair ascent/descent at self-selected speed. MAIN OUTCOME MEASURES The primary outcome measurements were peak hip, knee, and ankle kinematics. General Estimation Equations were used to compare kinematics between groups (P ≤ .05). RESULTS The HOA group ascended stairs with a more internally rotated hip (CG = 1.77 ± 6.3; HOA = 4.97 ± 4.2; P = .02), more abducted hip (CG = -5 ± 2.7, HOA = -3.5 ± 3; P = .02), and a more externally rotated knee (CG = -8.02 ± 3; HOA = -10.63 ± 6.3; P = .02) and ankle (CG = -11.8 ± 6.1; HOA = -16.3 ± 5.6; P = .01). Similarly, HOA participants descended stairs with a more extended knee (CG = -15.5 ± 4.9; HOA = -12 ± 4.9; P = .01), and more externally rotated knee (CG = -10.1 ± 4.4; HOA = -13.1 ± 6.6; P = .04) and ankle (CG = -13.5 ± 5.3; HOA = -17.9 ± 5.5; P = .002). CONCLUSION Participants with hip OA-related morphology and symptoms ambulate stairs utilizing abnormal lower extremity mechanics.
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Affiliation(s)
- Tijana Popovic
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Michael A Samaan
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA.,Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | - Thomas M Link
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Richard B Souza
- Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA.,Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, San Francisco, CA, USA
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Krauss I, Hein T, Steinhilber B, Janßen P. A 12-week exercise program for patients with hip osteoarthritis has no influence on gait parameters: A secondary analysis of a randomized controlled trial. Gait Posture 2020; 78:6-12. [PMID: 32151918 DOI: 10.1016/j.gaitpost.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/07/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip osteoarthritis is a major musculoskeletal disorder in the elderly. Evidence is given for the efficacy of exercise interventions in terms of self-reported physical functioning and pain. However, it has not yet been fully examined whether exercises influence gait. RESEARCH QUESTION The purpose of this RCT therefore was to evaluate effects of a 12-week exercise program on kinematic gait variables in subjects with hip osteoarthritis. METHODS 210 participants were randomly assigned to exercise, non-treated control, or placebo ultrasound groups. The 12-week exercise intervention combined a weekly group session with home-based exercises (2/week), which entailed exercises for motor learning, flexibility, strengthening, and balance. Placebo ultrasound was given once a week. A 6-camera motion capture system was used for data collection. Data were derived from shod walking at self-selected speeds. Spatio-temporal and hip and knee joint angles of the stance phase were calculated. Data were averaged across five trials. Measurements were taken prior to and immediately after the intervention period. ANOVA/Kruskall-Wallis-Tests were used to analyze between-group effects for differences between test days. Pairwise comparisons were subsequently conducted in case of significant model effects. Data were analyzed per protocol (n = 185). RESULTS No statistically significant differences were detected for any of the outcome measures. SIGNIFICANCE Although hip muscle strength and gait quality are related, strength training of the hip-surrounding musculature without specific gait training elements cannot improve spatio-temporal gait characteristics or hip and knee joint angles in subjects with mild to moderate hip osteoarthritis. If gait should explicitly be improved through exercise, interventions must incorporate a relevant portion of gait-related tasks.
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Affiliation(s)
- Inga Krauss
- Medical Clinic, Department of Sports Medicine, University of Tuebingen, Germany; Interfaculty Research Institute for Sports and Physical Activity Tuebingen, Department of Sports Medicine, University Hospital Tuebingen, Germany.
| | | | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tuebingen, Germany
| | - Pia Janßen
- Medical Clinic, Department of Sports Medicine, University of Tuebingen, Germany; Interfaculty Research Institute for Sports and Physical Activity Tuebingen, Department of Sports Medicine, University Hospital Tuebingen, Germany
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Functional movement compensations persist in individuals with hip osteoarthritis performing the five times sit-to-stand test 1 year after total hip arthroplasty. J Orthop Surg Res 2020; 15:151. [PMID: 32299467 PMCID: PMC7164189 DOI: 10.1186/s13018-020-01663-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/02/2020] [Indexed: 01/22/2023] Open
Abstract
Background Methods to quantify and evaluate function are important for development of specific rehabilitation interventions. This study aimed to evaluate functional movement compensation in individuals with hip osteoarthritis performing the five times sit-to-stand test and change following total hip arthroplasty. To this end, trajectories of the body’s center of mass in the medial-lateral and anterior-posterior dimensions were quantified prior to and 1 year after total hip arthroplasty and compared to a healthy control group. Methods Twenty-eight individuals with hip osteoarthritis and 21 matched healthy controls were enrolled in this prospective study. Within 1 month prior to and 1 year after total hip arthroplasty, performance on the five times sit-to-stand test was evaluated using three-dimensional motion analysis and perceived pain using a visual analog scale. The center of mass trajectories for the medial-lateral and the anterior-posterior dimensions were identified, and the area under the curve was calculated, respectively. Repeated measures ANOVA were used to evaluate differences in the area under the curve, between pre- and postoperative performance, and between participants with hip osteoarthritis and controls. Results Preoperatively, individuals with hip osteoarthritis displayed a larger contralateral shift (p < 0.001) and forward displacement of the center of mass (p = 0.022) compared to controls. After surgery, deviations in both dimensions were reduced (medial-lateral p = 0.013; anterior-posterior p = 0.009). However, as compared to controls, the contralateral shift of the center of mass remained larger (p = 0.010), indicative of persistent asymmetric limb loading. Perceived pain was significantly reduced postoperatively (p < 0.001). Conclusions By quantifying the center of mass trajectory during five times sit-to-stand test performance, functional movement compensations could be detected and evaluated over time. Prior to total hip arthroplasty, individuals with hip osteoarthritis presented with an increased contralateral shift and forward displacement of the center of mass, representing a strategy to reduce pain by unloading the affected hip and reducing required hip and knee extension moments. After surgery, individuals with total hip arthroplasty displayed a persistent increased contralateral shift as compared to controls. This finding has implications for rehabilitation, where more focus must be directed towards normalizing loading of the limbs.
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Steele A, Gonzalez R, Garbalosa JC, Steigbigel K, Grgurich T, Parisi EJ, Feinn RS, Tommasini SM, Macica CM. Osteoarthritis, Osteophytes, and Enthesophytes Affect Biomechanical Function in Adults With X-linked Hypophosphatemia. J Clin Endocrinol Metab 2020; 105:5734494. [PMID: 32047911 PMCID: PMC8416779 DOI: 10.1210/clinem/dgaa064] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022]
Abstract
CONTEXT X-Linked hypophosphatemia (XLH) is a lifelong metabolic disease with musculoskeletal comorbidities that dominate the adult clinical presentation. OBJECTIVE The adult XLH disorder has yet to be quantified on the basis of the physical and functional limitations that can affect activities of daily living. Our goal was to report the impact of the musculoskeletal manifestations on physical function. DESIGN AND SETTING Musculoskeletal function was evaluated by validated questionnaires and in an interdisciplinary clinical space where participants underwent full-body radiologic imaging, goniometric range of motion (ROM) measurements, general performance tests, and kinematic gait analysis. PATIENTS Nine adults younger than 60 years with a diagnosis of XLH and self-reported musculoskeletal disability, but able to independently ambulate, were selected to participate. Passive ROM and gait analysis were also performed on age-approximated controls to account for differences between individual laboratory instrumentation. RESULTS Enthesophytes, degenerative arthritis, and osteophytes were found to be consistently bilateral and diffusely present at the spine and synovial joints across participants, with predominance at weight-bearing joints. Passive ROM in adults with XLH was decreased at the cervical spine, hip, knee, and ankle compared to controls. Gait analysis relative to controls revealed increased step width, markedly increased lateral trunk sway, and physical restriction at the hip, knees, and ankle joints that translated into limitations through the gait cycle. CONCLUSIONS The functional impact of XLH musculoskeletal comorbidities supports the necessity for creating an interprofessional health-care team with the goal of establishing a longitudinal plan of care that considers the manifestations of XLH across the lifespan.
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Affiliation(s)
- Amy Steele
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Ramon Gonzalez
- Department of Diagnostic Imaging, School of Health Sciences at Quinnipiac University, North Haven, Connecticut
| | - Juan C Garbalosa
- Department of Physical Therapy, School of Health Sciences at Quinnipiac University, North Haven, Connecticut
| | - Keith Steigbigel
- Department of Physical Therapy, School of Health Sciences at Quinnipiac University, North Haven, Connecticut
| | - Tania Grgurich
- Department of Diagnostic Imaging, School of Health Sciences at Quinnipiac University, North Haven, Connecticut
| | - Erika J Parisi
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard S Feinn
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Steven M Tommasini
- Department of Orthopaedics, Yale University School of Medicine at Quinnipiac University, New Haven, Connecticut
| | - Carolyn M Macica
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
- Correspondence and Reprint Requests: Carolyn M. Macica, PhD, Department of Medical Sciences, Frank H. Netter MD School of Medicine, Quinnipiac University, NH-MED, 275 Mt Carmel Avenue, Hamden, CT 06518. E-mail:
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Abnormal Joint Loading During Gait in Persons With Hip Osteoarthritis Is Associated With Symptoms and Cartilage Lesions. J Orthop Sports Phys Ther 2019; 49:917-924. [PMID: 31610757 PMCID: PMC7935417 DOI: 10.2519/jospt.2019.8945] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip joint loading in persons with hip osteoarthritis (OA) is not well studied, and its associations with symptoms and lesions are unknown. OBJECTIVES To determine whether hip joint loading differs between people with and without radiographic hip OA, and to identify its associations with patients' symptoms and cartilage morphology. METHODS Forty-eight patients (28 male; mean ± SD age, 56.0 ± 12.2 years) with hip OA and 95 controls (40 male; age, 43.2 ± 13.6 years) participated in this cross-sectional analysis. Pelvic radiographs, questionnaires, magnetic resonance imaging (MRI), and gait analysis were conducted. The Hip disability and Osteoarthritis Outcome Score (HOOS) was used to assess symptoms. Cartilage morphology was graded on MRI scans using the Scoring Hip Osteoarthritis with Magnetic Resonance Imaging (SHOMRI) system. Biomechanical variables included peak external hip joint moment (Newton meters per kilogram) and moment impulses (Newton meters times milliseconds per kilogram) in all planes. Generalized estimating equations were used to compare the biomechanical characteristics between groups. In the patients with OA, associations of moment impulses with HOOS and SHOMRI scores were assessed with partial correlations. RESULTS The OA group exhibited higher peak external hip flexion and adduction moments (P<.001) and higher hip flexion, adduction, and external rotation moment impulses (P = .001-.039). Increased hip flexion moment impulses were correlated with worse HOOS subscale scores (r = -0.361 to -0.424, P<.05) and worse femoral SHOMRI grades (ρ = 0.256-0.315, P<.05). Increased hip external rotation moment impulses were correlated with worse femoral SHOMRI grades (ρ = 0.283-0.372, P<.05). CONCLUSION Persons with hip OA exhibited abnormally high hip joint loads during walking, and high loads were associated with worse self-reported symptoms and cartilage morphology. J Orthop Sports Phys Ther 2019;49(12):917-924. Epub 14 Oct 2019. doi:10.2519/jospt.2019.8945.
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Inai T, Takabayashi T, Edama M, Kubo M. Decrease in walking speed increases hip moment impulse in the frontal plane during the stance phase. PeerJ 2019; 7:e8110. [PMID: 31763077 PMCID: PMC6873874 DOI: 10.7717/peerj.8110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022] Open
Abstract
Background Increased daily cumulative hip moment in the frontal plane (i.e., the product of hip moment impulse in the frontal plane during the stance phase and mean steps per day) is a risk factor for progression of hip osteoarthritis. Although hip osteoarthritis generally causes a decrease in the walking speed, its effect on hip moment impulse in the frontal plane is unclear. The purpose of this study was to examine the relationship between decrease in walking speed and hip moment impulse in the frontal plane. Methods We used a public dataset of treadmill walking in 17 older adults (mean (SD) age: 63.2 (8.0) years). The subjects walked on the treadmill for 30 s under five conditions: (1) 40% of comfortable non-dimensional speed (CNDS), (2) 55% CNDS, (3) 70% CNDS, (4) 85% CNDS, and (5) 100% CNDS. The hip moment impulse in the frontal plane non-normalized (or normalized) to step length (Nm s/kg [or Nm s/(kg m)]) for each condition was calculated. Furthermore, the relationship between walking speed and hip moment impulse in the frontal plane non-normalized (or normalized) to step length was examined using regression analysis based on a previous study. Results A decrease in non-dimensional speed (i.e., walking speed) significantly increased the non-normalized (or normalized) hip moment impulse in the frontal plane during the stance phase. The relationship between walking speed and non-normalized (or normalized) hip moment impulse in the frontal plane was fitted by a second-order polynomial. Discussion This study revealed that a decrease in walking speed increased the non-normalized (or normalized) hip moment impulse in the frontal plane in healthy older adults. This finding is useful for understanding the relationship between walking speed and hip moment impulse in the frontal plane and suggests that a decrease in walking speed may actually increase the daily cumulative hip moment in the frontal plane of patients with hip osteoarthritis.
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Affiliation(s)
- Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Japan
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Japan
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Japan
| | - Masayoshi Kubo
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata City, Japan
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Hall M, Chabra S, Shakoor N, Leurgans SE, Demirtas H, Foucher KC. Hip joint moments in symptomatic vs. asymptomatic people with mild radiographic hip osteoarthritis. J Biomech 2019; 96:109347. [DOI: 10.1016/j.jbiomech.2019.109347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 01/18/2023]
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Effects of walking speed on gait biomechanics in healthy participants: a systematic review and meta-analysis. Syst Rev 2019; 8:153. [PMID: 31248456 PMCID: PMC6595586 DOI: 10.1186/s13643-019-1063-z] [Citation(s) in RCA: 204] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the effects of gait speed on biomechanical variables is fundamental for a proper evaluation of alterations in gait, since pathological individuals tend to walk slower than healthy controls. Therefore, the aim of the study was to perform a systematic review of the effects of gait speed on spatiotemporal parameters, joint kinematics, joint kinetics, and ground reaction forces in healthy children, young adults, and older adults. METHODS A systematic electronic search was performed on PubMed, Embase, and Web of Science databases to identify studies published between 1980 and 2019. A modified Quality Index was applied to assess methodological quality, and effect sizes with 95% confidence intervals were calculated as the standardized mean differences. For the meta-analyses, a fixed or random effect model and the statistical heterogeneity were calculated using the I2 index. RESULTS Twenty original full-length studies were included in the final analyses with a total of 587 healthy individuals evaluated, of which four studies analyzed the gait pattern of 227 children, 16 studies of 310 young adults, and three studies of 59 older adults. In general, gait speed affected the amplitude of spatiotemporal gait parameters, joint kinematics, joint kinetics, and ground reaction forces with a decrease at slow speeds and increase at fast speeds in relation to the comfortable speed. Specifically, moderate-to-large effect sizes were found for each age group and speed: children (slow, - 3.61 to 0.59; fast, - 1.05 to 2.97), young adults (slow, - 3.56 to 4.06; fast, - 4.28 to 4.38), and older adults (slow, - 1.76 to 0.52; fast, - 0.29 to 1.43). CONCLUSIONS This review identified that speed affected the gait patterns of different populations with respect to the amplitude of spatiotemporal parameters, joint kinematics, joint kinetics, and ground reaction forces. Specifically, most of the values analyzed decreased at slower speeds and increased at faster speeds. Therefore, the effects of speed on gait patterns should also be considered when comparing the gait analysis of pathological individuals with normal or control ones.
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Tateuchi H, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N. Gait- and Posture-Related Factors Associated With Changes in Hip Pain and Physical Function in Patients With Secondary Hip Osteoarthritis: A Prospective Cohort Study. Arch Phys Med Rehabil 2019; 100:2053-2062. [PMID: 31054296 DOI: 10.1016/j.apmr.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/13/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify gait- and posture-related factors associated with changes in hip pain and physical function in patients with hip osteoarthritis (OA). DESIGN Prospective cohort study. SETTING Clinical biomechanics laboratory of a university. PARTICIPANTS Consecutive sampling of female patients with mild-to-moderate secondary hip OA (N=30). MAIN OUTCOME MEASURES Hip pain (visual analog scale) and physical function (physical component summary of the Medical Outcomes Study 36-Item Short-Form Health Survey) were measured at baseline and 12 months later. With changes in hip pain and physical function as dependent variables, linear regression analyses were performed with gait- and posture-related factors as independent variables with and without adjustment for age, joint space width, and hip pain or physical function at baseline. Posture-related factors included angles of thoracic kyphosis, lumbar lordosis, sacral inclination, spinal inclination, and spinal mobility. Gait-related factors were walking speed, steps per day, joint angles, external hip joint moment impulses, and daily cumulative hip moments. RESULTS Multiple linear regression analyses showed that limited hip extension (adjusted standardized B coefficient [95% confidence interval]: -0.52 [-0.88 to -0.17]) and limited external rotation angles (-0.51 [-0.85 to -0.18]) during walking were associated with the worsening of hip pain. An increased thoracic kyphosis (-0.54 [-0.99 to -0.09]), less sacral anterior tilt (0.40 [0.01-0.79]), reduced thoracic spine mobility (0.59 [0.23-0.94]), less steps per day (0.53 [0.13-0.92]), and a slower walking speed (0.45 [0.04-0.86]) were associated with deterioration in physical function. CONCLUSIONS Gait- and posture-related factors should be considered when assessing risk and designing preventive interventions for the clinical progression of secondary hip OA.
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Affiliation(s)
- Hiroshige Tateuchi
- Department of Preventive Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka So
- Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Xia C, Wang P, Fang L, Ge Q, Zou Z, Dong R, Zhang P, Shi Z, Xu R, Zhang L, Luo C, Ying J, Xiao L, Shen J, Chen D, Tong P, Jin H. Activation of β-catenin in Col2-expressing chondrocytes leads to osteoarthritis-like defects in hip joint. J Cell Physiol 2019; 234:18535-18543. [PMID: 30912140 PMCID: PMC6606325 DOI: 10.1002/jcp.28491] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 01/25/2023]
Abstract
Although osteoarthritis (OA) in the hip joint is a common and debilitating degenerative disease, the precise molecular mechanisms underlying its pathological process remains unclear. This study sets out to investigate whether β-catenin plays a critical role in hip OA pathogenesis. Here, we showed overexpressed β-catenin protein in human OA cartilage tissues. Then, we analyzed β-cat(ex3)Col2ER mice, in which β-catenin gene was conditionally activated in femoral head chondrocytes. At 2 months of age, β-cat(ex3)Col2ER mice already showed a phenotype of severe cartilage degeneration in the femoral head. More changes observed in β-cat(ex3)Col2ER mice with age included subchondral sclerosis and osteophyte formation along joint margins, resembling a hip OA phenotype in humans. In addition, cartilage degradation and chondrocyte apoptosis as the results of β-catenin activation possibly contributed to this hip OA-like phenotype. Overall our findings provide direct evidence about the importance of β-catenin in hip OA pathogenesis.
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Affiliation(s)
- Chenjie Xia
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Pinger Wang
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Liang Fang
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Qinwen Ge
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Zhen Zou
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Rui Dong
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Peng Zhang
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Zhenyu Shi
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Rui Xu
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Lei Zhang
- Department of Orthopedic SurgeryXiaoshan District Hospital of Traditional Chinese MedicineHangzhouChina
| | - Chen Luo
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
| | - Jun Ying
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
- The First College of Clinical MedicineZhejiang Chinese Medical UniversityHangzhouChina
- Department of Orthopedic SurgerySchool of Medicine, Washington UniversitySt. LouisMissouri
| | - Luwei Xiao
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Jie Shen
- Department of Orthopedic SurgerySchool of Medicine, Washington UniversitySt. LouisMissouri
| | - Di Chen
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinois
| | - Peijian Tong
- Department of Orthopedic SurgeryThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Hongting Jin
- Institute of Orthopedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
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Farkas GJ, Schlink BR, Fogg LF, Foucher KC, Wimmer MA, Shakoor N. Gait asymmetries in unilateral symptomatic hip osteoarthritis and their association with radiographic severity and pain. Hip Int 2019; 29:209-214. [PMID: 29734841 PMCID: PMC7333443 DOI: 10.1177/1120700018773433] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: Little is known about the loading patterns in unilateral hip osteoarthritis (OA) and their relationship to radiographic severity and pain. We aimed to examine the loading patterns at the hips of those with unilateral symptomatic hip OA and identify associations between radiographic severity and pain with loading alterations. METHODS: 61 subjects with symptomatic unilateral hip OA underwent gait analyses and evaluation for radiographic severity (Kellgren-Lawrence [KL]-grade) and pain (visual analogue scale) at bilateral hips. RESULTS: Hip OA subjects had greater range of motion and higher hip flexion, adduction, internal and external rotation moments at the contralateral, asymptomatic hip compared to the ipsilateral hip ( p < 0.05). Correlations were noted between increasing KL-grade and increasing asymmetry of contralateral to ipsilateral hip loading ( p < 0.05). There were no relationships with pain and loading asymmetry. DISCUSSION: Unilateral symptomatic hip OA subjects demonstrate asymmetry in loading between the hips, with relatively greater loads at the contralateral hip. These loading asymmetries were directly related to the radiographic severity of symptomatic hip OA and not with pain. CONCLUSION: Additional research is needed to determine the role of gait asymmetries in disease progression.
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Affiliation(s)
- Gary J Farkas
- Department of Physical Medicine and Rehabilitation, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Bryan R Schlink
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Louis F Fogg
- College of Nursing, Rush University Medical Center, Chicago, Illinois, USA
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Markus A Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Najia Shakoor
- Division of Rheumatology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
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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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Diamond LE, Allison K, Dobson F, Hall M. Hip joint moments during walking in people with hip osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2018; 26:1415-1424. [PMID: 29621605 DOI: 10.1016/j.joca.2018.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis investigated surrogate measures of hip joint loading during walking in people with hip osteoarthritis (OA). METHODS Five databases were searched up to January 14th, 2018. Studies that measured hip joint moments in the frontal or sagittal plane during walking in people with hip OA and used either a healthy control group or the unaffected leg to compare hip joint moments were included. Standardised mean differences (SMD) in sagittal and frontal plane moments were pooled as appropriate, using a random effect approach. Methodological quality was assessed using the Downs and Black checklist. RESULTS Thirteen studies with 1,141 participants were eligible and suitable for meta-analyses. Overall, people with hip OA had lower sagittal (SMD -0.55 (95% confidence interval (CI) -1.00 to -0.10) and frontal plane moments (SMD -0.63 (95% CI -0.92, -0.34) compared to controls. However, substantial heterogeneity was observed (I2 ≤ 89%). Results by disease stage suggest that people with end-stage hip OA have lower sagittal (SMD -0.96; -1.30, -0.61; I2 = 69%) and frontal (SMD -1.17; 95% CI -1.71, -0.64; I2 = 85%) plane moments compared to controls. People with less severe hip OA than end-stage disease have comparable sagittal (SMD 0.37; 95% CI -0.17, 0.90; I2 = 69%) and frontal (SMD -0.24; 95% CI -0.76, 0.27; I2 = 51%) plane moments compared to controls. CONCLUSION Hip joint loading may be dependent on disease stage. People with end-stage hip OA under-loaded compared to controls, while those who were not awaiting hip joint replacement had comparable hip joint loads to controls.
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Affiliation(s)
- L E Diamond
- Griffith University, Menzies Health Institute Queensland, School of Allied Health Sciences, Gold Coast, QLD 4222, Australia
| | - K Allison
- The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Parkville, VIC 3010, Australia; The University of Melbourne, Department of Physiotherapy, School of Health Sciences, Parkville, VIC 3010, Australia
| | - F Dobson
- The University of Melbourne, Department of Physiotherapy, School of Health Sciences, Parkville, VIC 3010, Australia
| | - M Hall
- The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Parkville, VIC 3010, Australia.
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Rutherford D, Buckingham L, Moreside J, Wong I, Richardson G. Knee motion and muscle activation patterns are altered in hip osteoarthritis: The effect of severity on walking mechanics. Clin Biomech (Bristol, Avon) 2018; 59:1-7. [PMID: 30099241 DOI: 10.1016/j.clinbiomech.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee function is impaired in individuals with moderate hip osteoarthritis. How this extends to those undergoing total hip arthroplasty is unknown despite the common requirement for knee arthroplasty in this population. The study purpose was to determine whether sagittal plane knee joint movements and quadriceps and hamstring activation patterns differ between individuals with either moderate or severe unilateral hip osteoarthritis, and between ipsilateral and contralateral knees. METHODS 20 individuals with moderate osteoarthritis and 20 with severe osteoarthritis were recruited. Sagittal knee motion and surface electromyograms from the hamstrings and quadriceps were collected during treadmill walking at a self-selected speed. Principal component analysis captured amplitude and temporal sagittal plane motion and EMG waveform features. Student's t-tests and Analysis of Variance determined between group differences and within/between group leg differences. FINDINGS The severe groups' contralateral knee was in greater flexion at initial contact and demonstrated a movement profile of a longer stance phase (p < 0.001). The severe group had reduced sagittal plane knee motion (p < 0.0001); more so in the ipsilateral knee (p < 0.0001). The severe group had greater hamstring (p = 0.009) and quadriceps activation (p < 0.001) overall, specifically mid-stance quadriceps bilaterally (p = 0.002). Ipsilateral sagittal plane knee motion was reduced in both groups. Compared with those with moderate osteoarthritis, individuals with severe osteoarthritis walk with reduced sagittal plane knee motion bilaterally, suggesting prolonged contralateral stance, and elevated mid-stance hamstring and quadriceps activation. INTERPRETATION Altered kinematics and muscle activity could contribute to a greater mechanical demand on the contralateral knee in those with more severe hip osteoarthritis.
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Affiliation(s)
- Derek Rutherford
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; School of Biomedical Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS B3H 4R2, Canada.
| | - Lindsey Buckingham
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Janice Moreside
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada.
| | - Ivan Wong
- Department of Surgery, Division of Orthopaedics, Nova Scotia Health Authority, Halifax, NS B3H 3G1, Canada.
| | - Glen Richardson
- Department of Surgery, Division of Orthopaedics, Nova Scotia Health Authority, Halifax, NS B3H 3G1, Canada.
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Sex-specific walking kinematics and kinetics in individuals with unilateral, symptomatic hip osteoarthritis: A cross sectional study. Gait Posture 2018; 65:234-239. [PMID: 30558937 DOI: 10.1016/j.gaitpost.2018.07.179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/20/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip osteoarthritis (OA) is a significant cause of disability, with hip pain and reduced external hip moments during walking being key features of the condition. The external hip adduction moment is greater in healthy women than men, however these between-sex differences are not evident in those with end-stage hip OA. Whether sex-specific hip kinetics are associated with early-midstage hip OA has not been investigated and may be a potential target for directed treatment. METHODS Thirty-eight women and twenty-eight men with a diagnosis of symptomatic, unilateral, mild-to-moderate hip OA (Kellegren-Lawrence Grade 2 or 3) underwent three-dimensional gait analysis of normal walking gait using Vicon motion capture. Hip joint, trunk and pelvic angles and hip moments were calculated using the Plug-in-Gait model. The external peak flexion moment, and the first peak, second peak and mid-stance minimum of the hip adduction moment during the stance phase of walking as well as hip, trunk and pelvic kinematics occurring at the three moment time points were compared between groups using an analysis of covariance. RESULTS Women with hip OA exhibited a greater external hip adduction moment (mean difference 0.8-1.3 N m/BW.Ht(%), P < 0.05) and greater hip adduction angles (mean difference 2.8-4.9 degrees, P < 0.05) throughout stance than men. Men walked with a greater forward trunk lean than women during early to midstance (mean difference 2.9-3.5 degrees, P < 0.05) than women. SIGNIFICANCE In contrastto late stage hip OA, between-sex difference in hip joint kinematics and kinetics are preserved in early-midstage hip OA.
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Ng KCG, Mantovani G, Modenese L, Beaulé PE, Lamontagne M. Altered Walking and Muscle Patterns Reduce Hip Contact Forces in Individuals With Symptomatic Cam Femoroacetabular Impingement. Am J Sports Med 2018; 46:2615-2623. [PMID: 30074815 DOI: 10.1177/0363546518787518] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cam-type femoroacetabular impingement (FAI) is a causative factor for hip pain and early hip osteoarthritis. Although cam FAI can alter hip joint biomechanics, it is unclear what role muscle forces play and how they affect the hip joint loading. Purpose/Hypothesis: The purpose was to examine the muscle contributions and hip contact forces in individuals with symptomatic cam FAI during level walking. Patients with symptomatic cam FAI would demonstrate different muscle and hip contact forces during gait. STUDY DESIGN Controlled laboratory study. METHODS Eighteen patients with symptomatic cam FAI were matched for age and body mass index with 18 control participants. Each participant's walking kinematics and kinetics were recorded throughout a gait cycle (ipsilateral foot-strike to ipsilateral foot-off) by use of a motion capture system and force plates. Muscle and hip contact forces were subsequently computed by use of a musculoskeletal modeling program and static optimization methods. RESULTS The FAI group walked slower and with shorter steps, demonstrating reduced joint motions and moments during contralateral foot-strike, compared with the control group. The FAI group showed reduced psoas major (median, 1.1 newtons per bodyweight [N/BW]; interquartile range [IQR], 1.0-1.5 N/BW) and iliacus forces (median, 1.2 N/BW; IQR, 1.0-1.6 N/BW), during contralateral foot-strike, compared with the control group (median, 1.6 N/BW; IQR, 1.3-1.6 N/BW, P = .004; and median, 1.5 N/BW; IQR, 1.3-1.6 N/BW, P = .03, respectively), which resulted in lower hip contact forces in the anterior ( P = .026), superior ( P = .02), and medial directions ( P = .038). The 3 vectors produced a resultant peak force at the anterosuperior aspect of the acetabulum for both groups, with the FAI group demonstrating a substantially lower magnitude. CONCLUSION FAI participants altered their walking kinematics and kinetics, especially during contralateral foot-strike, as a protective mechanism, which resulted in reduced psoas major and iliacus muscle force and anterosuperior hip contact force estimations. CLINICAL RELEVANCE Limited hip mobility not only is attributed to bone-on-bone impingement, caused by cam morphology, but could be attributed to musculature as well. Not only would the psoas major and iliacus be able to protect the hip joint during flexion-extension, athletic conditioning could further strengthen core muscles for improved hip mobility and pelvic balance.
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Affiliation(s)
- K C Geoffrey Ng
- Department of Mechanical Engineering, Imperial College London, London, UK
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada
| | - Giulia Mantovani
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Luca Modenese
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Mario Lamontagne
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario, Canada
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Moreside J, Wong I, Rutherford D. Altered erector spinae activity and trunk motion occurs with moderate and severe unilateral hip OA. J Orthop Res 2018; 36:1826-1832. [PMID: 29251373 DOI: 10.1002/jor.23841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/14/2017] [Indexed: 02/04/2023]
Abstract
People with hip osteoarthritis (OA) demonstrate altered movement patterns in the hip joint, as well as the pelvis and spine. While kinematic changes have been described in the literature, little is known about the associated erector spinae (ES) activity. Increased or prolonged ES activity may contribute to the low back pain often associated with hip OA. Using a cross-sectional cohort study, 3D trunk motions and ES surface electromyography were recorded on 19 individuals with severe OA (SOA), 20 with moderate hip OA (MOA), and 19 asymptomatic (ASYM) individuals during treadmill walking, using standardized collection and processing procedures. Principal component analysis was used to derive electromyographic amplitude and temporal waveform features. Three-dimensional thoracic motion in a global system, and thoraco-lumbar motion was calculated. Various statistical analyses determined between group differences (α = 0.05). In the sagittal plane, thoracic motion was greater in the SOA group (p < 0.001), whereas the ASYM group used less thoraco-lumbar motion than either OA group (p ≤ 0.002). Greater frontal plane angular excursion during early stance was found in the thoracic region in the SOA group (p ≤ 0.001) . With increasing OA severity, bilateral ES activity increased during the swing phase of gait (p < 0.001), whereas during stance, the SOA ipsilateral ES activity was higher than other groups (p < 0.001). Statement of clinical significance: with moderate and severe OA, sagittal, and frontal trunk motion increases during gait. ES activity during the entire gait cycle is more sustained with increased disease severity, which may aide our understanding of low back pain associated with hip OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1826-1832, 2018.
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Affiliation(s)
- Janice Moreside
- Faculty of Health Professions, School of Health and Human Performance, Dalhousie University, Janice Moreside, 6230 South St., Halifax, Nova Scotia, B3H 4R2, Canada
- Faculty of Health Professions, School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Faculty of Health Professions, School of Health and Human Performance, Dalhousie University, Janice Moreside, 6230 South St., Halifax, Nova Scotia, B3H 4R2, Canada
- Faculty of Health Professions, School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Derek Rutherford
- Faculty of Health Professions, School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Faculty of Engineering, School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada
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Wallard L, Boulet S, Cornu O, Dubuc JE, Mahaudens P, Postlethwaite D, Van Cauter M, Detrembleur C. Intersegmental kinematics coordination in unilateral peripheral and central origin: Effect on gait mechanism? Gait Posture 2018; 62:124-131. [PMID: 29547792 DOI: 10.1016/j.gaitpost.2018.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/15/2018] [Accepted: 03/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The gait mechanism requires an efficient intersegmental coordination in order to ensure the displacement of the body while simultaneously maintaining the postural stability. However, intersegmental coordination may be disrupted by neurological or orthopaedic involvement, this increasing the metabolic cost associated with excessive or prolonged muscle co-contraction. RESEARCH QUESTION Our aim was to evaluate and to understand how hip OA affects lower limbs coordination during gait by using the kinematic segmental covariation law method and predict the energy expenditure. METHODS In order to evaluate the influence of unilateral alteration of the lower limbs on the gait mechanism, three groups namely 63 hip osteoarthritis patients, 65 chronic hemiparetic stroke patients and 72 healthy subjects performed an instrumented gait analysis. The subjects had to walk barefoot for at least 3 min at a self-selected speed on a force measuring motor-driven treadmill. The biomechanical variables (kinematic, kinetic and energetical cost) were simultaneously recorded. RESULTS The comparison between the three groups was tested using a repeated measure ANOVA. All biomechanical parameters show significant differences between the 3 groups highlighting the gait alteration for the patients groups. However, the energetic cost remains normal in the hip osteoarthritis group despite of the alteration of the other variables. A multivariate analysis allowed to identify the independent variables affecting more specifically their gait mechanisms. SIGNIFICANCE This study showed the importance of quantitative functional evaluation in order to better understand the impact of hip osteoarthritis on the gait mechanism. The biomechanical analysis provides objective evidence of the altered gait mechanism and more particularly of the intersegmental coordination in these patients. This gait analysis is therefore an interesting tool in the functional evaluation of the patient to better guide the diagnosis.
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Affiliation(s)
- Laura Wallard
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium.
| | - Sophie Boulet
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium
| | - Olivier Cornu
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Cliniques universitaires Saint-Luc, Service d'orthopédie et de traumatologie de l'appareil locomoteur, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Jean-Emile Dubuc
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium; Cliniques universitaires Saint-Luc, Service d'orthopédie et de traumatologie de l'appareil locomoteur, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Philippe Mahaudens
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium
| | - Didier Postlethwaite
- Cliniques de l'Europe, Service d'orthopédie et de traumatologie, Sainte Elisabeth, Avenue De Fré 206, 1180 Bruxelles, Belgium
| | - Maïté Van Cauter
- Cliniques universitaires Saint-Luc, Service d'orthopédie et de traumatologie de l'appareil locomoteur, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Christine Detrembleur
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium
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Kumar D, Wyatt C, Lee S, Okazaki N, Chiba K, Link TM, Souza RB, Majumdar S. Sagittal plane walking patterns are related to MRI changes over 18-months in people with and without mild-moderate hip osteoarthritis. J Orthop Res 2018; 36:1472-1477. [PMID: 29044677 PMCID: PMC5906210 DOI: 10.1002/jor.23763] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/27/2017] [Indexed: 02/04/2023]
Abstract
The purpose was to evaluate the association of sagittal plane gait mechanics with MRI changes in the hip joint over 18-months. Subjects with and without radiographic hip OA (n = 57) underwent MRI at baseline and 18 months for grading of cartilage lesions, bone marrow lesions (BML), cysts, and labral tears. 3D gait analyses at baseline were used for sagittal plane hip kinematics and kinetics during the stance phase. Subjects were classified as progressors or non-progressors based on increase in any MRI OA parameter. Multivariate ANOVA were used for differences in sagittal gait parameters between progressors and non-progressors at baseline while adjusting for age. Logistic regression was used to estimate the probability of being classified as a progressor or non-progressor with increasing hip flexion while adjusting for age, BMI, sex, and presence of radiographic hip OA. Of the 57, 35 were classified as non-progressors and 22 were classified as progressors. At baseline, the progressors walked with 4.5° greater hip flexion during early stance (p = 0.021) and 3.5° lesser hip extension in late stance that was nearly significant (p = 0.059). Walking with greater hip flexion at baseline was associated with a greater risk of increase in MRI defined structural changes in the hip joint (Odds Ratio = 1.1, p = 0.038). Greater hip flexion during walking was associated with a risk of structural progression of hip OA. The results may guide future interventions to alter the walking patterns and slow structural hip OA progression.© 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1472-1477, 2018.
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Affiliation(s)
- Deepak Kumar
- 635 Commonwealth Ave, Room 524B, Boston, MA 02215, Ph: 617-358-3037; Fax: 617-353-9463,
| | - Cory Wyatt
- Advanced Imaging Research Center, Oregon Health & Science University,
| | - Sonia Lee
- 185 Berry St, Suite 350, UCSF China Basin, San Francisco, CA, 94107,
| | - Narihiro Okazaki
- Department of Orthopedic Surgery, Nagasaki University School of Medicine,
| | - Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University School of Medicine,
| | - Thomas M. Link
- 185 Berry St, Suite 350, UCSF China Basin, San Francisco, CA, 94107,
| | - Richard B Souza
- 185 Berry St, Suite 350, UCSF China Basin, San Francisco, CA, 94107,
| | - Sharmila Majumdar
- 1700 4 Street, Suite 203, Byers Hall, UCSF Mission Bay, San Francisco, CA 94158,
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Evaluation of factors that affect hip moment impulse during gait: A systematic review. Gait Posture 2018; 61:488-492. [PMID: 29494823 DOI: 10.1016/j.gaitpost.2018.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/24/2018] [Accepted: 02/16/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Decreasing the daily cumulative hip moments in the frontal and sagittal planes may lower the risk of hip osteoarthritis. Therefore, it may be important to evaluate factors that affect hip moment impulse during gait. RESEARCH QUESTION It is unclear what factors affect hip moment impulse during gait. This systematic review aimed to evaluate different factors that affect hip moment impulse during gait in healthy adults and patients with hip osteoarthritis. METHODS Four databases (Scopus, ScienceDirect, PubMed, and PEDro) were searched up to August 2017 to identify studies that examined hip moment impulse during gait. Data extracted for analysis included the sample size, age, height, body mass, type of intervention, and main findings. RESULTS After screening, 10 of the 975 studies identified were included in our analysis. Several factors, including a rocker bottom shoe, FitFlop™ sandals, ankle push-off, posture, stride length, body-weight unloading, a rollator, walking poles, and a knee brace, were reviewed. The main findings were as follows: increasing ankle push-off decreased both the hip flexion and extension moment impulses; body-weight unloading decreased both the hip extension and adduction moment impulses; the FitFlop™ sandal increased the sum of the hip flexion and extension moment impulses; long strides increased the hip extension moment impulse; and the use of a knee brace increased hip flexion moment impulse. Of note, none of the eligible studies included patients with hip osteoarthritis. SIGNIFICANCE The hip moment impulses can be modified by person-specific factors (ankle push-off and long strides) and external factors (body-weight unloading and use of the FitFlop™ sandals and a knee brace). Effects on the progression of hip osteoarthritis remain to be evaluated.
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50
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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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