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Menascu S, Vinogradsky A, Baransi H, Kalron A. Range of motion abnormalities in the lower limb joints during gait in youth with multiple sclerosis. Mult Scler Relat Disord 2024; 82:105417. [PMID: 38198988 DOI: 10.1016/j.msard.2023.105417] [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: 10/11/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The major objective of this study was to examine whether differences occur in the joint angles of the major lower limb joints while walking in youth with multiple sclerosis (YwMS) compared to age-gender-matched healthy youngsters. METHODS Gait analysis was collected using a six-camera Cartesian Optoelectronic Dynamic Anthropometer (CODA) 3D motion analysis system. To determine the gait normality in the YwMS group, we compared our results to reference gait data from normal youngsters. Gait data was divided according to gender and age subgroups (8-14, 15-18 years old). RESULTS The total sample included 26 YwMS (12 girls, 14 boys), 11 in the 8-14 age subgroup, and 15 in the 15-18 age subgroup. The mean expanded disability status scale score was 1.3 (S.D=1.0), indicating minimal disability. The total range of hip motion was significantly less in the YwMS group aged 15-18 (both genders) compared with the normative values. Additionally, the maximum flexion in the knee joint during gait was significantly less in boys in the 15 to 18 age subgroup (p<0.001). No differences were found in the hip and knee joint angles in the 8-14 age subgroup. CONCLUSIONS YwMS experience modifications in their gait pattern compared with age-gender-matched healthy youngsters. The MS teenagers demonstrated less range of movement in the hip joints and walked slower at a decreased pace than the healthy teenagers. By tracking gait patterns, healthcare providers can identify subtle changes that might facilitate timely interventions to prevent further mobility impairment in this young population.
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Affiliation(s)
- Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel; School of Medicine, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Vinogradsky
- School of Medicine, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hani Baransi
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel Hashomer, Israel; Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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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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Walha R, Gaudreault N, Dagenais P, Boissy P. Spatiotemporal parameters and gait variability in people with psoriatic arthritis (PsA): a cross-sectional study. J Foot Ankle Res 2022; 15:19. [PMID: 35246222 PMCID: PMC8895502 DOI: 10.1186/s13047-022-00521-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Foot involvement is a major manifestation of psoriatic arthritis (PsA) and can lead to severe levels of foot pain and disability and impaired functional mobility and quality of life. Gait spatiotemporal parameters (STPs) and gait variability, used as a clinical index of gait stability, have been associated with several adverse health outcomes, including risk of falling, functional decline, and mortality in a wide range of populations. Previous studies showed some alterations in STPs in people with PsA. However, gait variability and the relationships between STPs, gait variability and self-reported foot pain and disability have never been studied in these populations. Body-worn inertial measurement units (IMUs) are gaining interest in measuring gait parameters in clinical settings. Objectives To assess STPs and gait variability in people with PsA using IMUs, to explore their relationship with self-reported foot pain and function and to investigate the feasibility of using IMUs to discriminate patient groups based on gait speed-critical values. Methods Twenty-one participants with PsA (age: 53.9 ± 8.9 yrs.; median disease duration: 6 yrs) and 21 age- and sex-matched healthy participants (age 54.23 ± 9.3 yrs) were recruited. All the participants performed three 10-m walk test trials at their comfortable speed. STPs and gait variability were recorded and calculated using six body-worn IMUs and Mobility Lab software (APDM®). Foot pain and disability were assessed in participants with PsA using the foot function index (FFI). Results Cadence, gait speed, stride length, and swing phase were significantly lower, while double support was significantly higher, in the PsA group (p < 0.006). Strong correlations between STPs and the FFI total score were demonstrated (|r| > 0.57, p < 0.006). Gait variability was significantly increased in the PsA group, but it was not correlated with foot pain or function (p < 0.006). Using the IMUs, three subgroups of participants with PsA with clinically meaningful differences in self-reported foot pain and disability were discriminated. Conclusion STPs were significantly altered in participants with PsA, which could be associated with self-reported foot pain and disability. Future studies are required to confirm the increased gait variability highlighted in this study and its potential underlying causes. Using IMUs has been useful to objectively assess foot function in people with PsA. Trial registration ClinicalTrials.gov, NCT05075343, Retrospectively registered on 29 September 2021.
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Affiliation(s)
- Roua Walha
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nathaly Gaudreault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pierre Dagenais
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick Boissy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. .,Research Center on Aging, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada.
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Shema-Shiratzky S, Beer Y, Mor A, Elbaz A. Smartphone-based inertial sensors technology - Validation of a new application to measure spatiotemporal gait metrics. Gait Posture 2022; 93:102-106. [PMID: 35121485 DOI: 10.1016/j.gaitpost.2022.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Smartphones are increasingly recognized as the future technology for clinical gait assessment. RESEARCH QUESTION To determine the concurrent validity of gait parameters obtained using the smartphone technology and application in a group of patients with musculoskeletal pathologies. METHODS Patients with knee, lower back, hip, or ankle pain were included in the study (n = 72). Spatiotemporal outcomes were derived from the walkway and the smartphone simultaneously. Pearson's correlations and limits of agreement (LoA) determined the association between the two methods. RESULTS Cadence and gait cycle time showed excellent correlation and agreement between the smartphone and the walkway (cadence: r = 0.997, LoA=1.4%, gait cycle time: r = 0.996, LoA = 1.6%). Gait speed, double-limb support and left and right step length demonstrated strong correlations and moderate agreement between methods (gait speed: r = 0.914, LoA=15.4%, left step length: r = 0.842, LoA = 17.0%, right step length: r = 0.800, LoA=16.4%). The left and right measures of single-limb support and stance percent showed a consistent 4% bias across instruments, yielding moderate correlation and very good agreement between the smartphone and the walkway (r = 0.532, LoA = 9% and r = 0.460, LoA=9.8% for left and right single-limb support; r = 0.463, LoA = 5.1% and r = 0.533, LoA = 4.4% for left and right stance). SIGNIFICANCE The examined application appears to be a valid tool for gait analysis, providing clinically significant metrics for the assessment of patients with musculoskeletal pathologies. However, additional studies should examine the technology amongst patients with severe gait abnormalities.
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Affiliation(s)
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
| | - Amit Mor
- AposTherapy Research Group, Herzliya, Israel.
| | - Avi Elbaz
- AposTherapy Research Group, Herzliya, Israel.
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5
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Martines GA, Tamanini JTN, Mota GMDS, Barreto ET, Santos JLF, Sartori MGF, Girão MJBC, Castro RDA. Urinary incontinence, overactive bladder, and quality of life in women submitted to total hip replacement. Neurourol Urodyn 2022; 41:830-840. [PMID: 35114028 DOI: 10.1002/nau.24888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Hip osteoarthritis (OA) compromises functioning. Total hip replacement (THR) is the indicated treatment and may improve urinary incontinence (UI) and symptoms of overactive bladder (OAB). OBJECTIVES Assess UI, OAB symptoms, and quality of life (QoL) impact in preoperative and postoperative periods of women submitted to THR and investigate associated factors. METHODS A prospective cohort was conducted with 183 women submitted to THR. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) and SF-12 questionnaires were administered pre- and 3 and 6 months after surgery. RESULTS Significant improvements were found in UI and QoL 3- and 6-month postoperatively in the overall sample and in the subgroup with preoperative UI. The multivariate regression revealed that the preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI 6-month postoperatively. The factors the best predicted the occurrence of UI 6-month following THR were the preoperative ICIQ-OAB scores and preoperative UI. Each unit of increase in the ICIQ-OAB increases the chances of UI by 26.9% and preoperative UI increases the chances of postoperative UI by 18.7-fold. A weak but significant negative correlation was found between the ICIQ-SF score and the SF-12 score. CONCLUSION Significant improvements in UI, OAB and QoL were found at 3- and 6-month postoperatively. Preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI at 6 months after surgery. We found significant association between urinary symptoms and THR, but this association is partially explained by current literature.
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Affiliation(s)
- Guilherme Augusto Martines
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, SP, Brazil
| | | | | | - Eduardo Tavares Barreto
- Department of Orthopedics, Evangelical Hospital of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Jair Lício Ferreira Santos
- Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Rodrigo de Aquino Castro
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, SP, Brazil
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Stensgaard Stoltze J, Pallari J, Eskandari B, Oliveira AS, Pirscoveanu CI, Rasmussen J, Andersen MS. Development and Functional Testing of An Unloading Concept for Knee Osteoarthritis Patients: A Pilot Study. J Biomech Eng 2021; 144:1114806. [PMID: 34286821 DOI: 10.1115/1.4051847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Indexed: 11/08/2022]
Abstract
This paper presents a knee brace design that applies an extension moment to unload the muscles in stance phase during gait, and thereby the knee, as alternative to conventional valgus braces for knee osteoarthritis patients. The concept was tested on one healthy subject during normal gait with a prototype, which was designed to activate and deactivate in order to apply the extension moment in the stance phase only and hereby avoid any interference during the swing phase. Electromyography measurements and musculoskeletal models were used to evaluate the brace effects on muscle activation and knee compressive forces respectively. Simulations predicted an ideal reduction of up to 36%, whereas experimental tests revealed a reduction of up to 24% with the current prototype. The prototype brace also reduced the knee joint force impulse up to 9% and EMG peak signal of the vasti muscles with up to 19%. Due to these reductions on a healthy subject, this bracing approach seem promising for reducing knee loads during normal gait. However, further clinical experiments on knee osteoarthritis patients are required to evaluate the effect on both pain and disease progression.
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Affiliation(s)
| | - Jari Pallari
- Aalborg University, Department of Material and Production, Fibigerstraede 16, DK-9220 Aalborg East, Denmark
| | - Behrokh Eskandari
- Newcastle University, School of Engineering, Newcastle upon Tyne NE1 7RU, United Kingdom
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7
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Olsen AL, Magnussen LH, Skjaerven LH, Assmus J, Sundal MA, Ostelo R, Strand LI. Movement quality evaluation and its correlation with recommended functional measures in hip osteoarthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1848. [PMID: 32449252 DOI: 10.1002/pri.1848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/07/2020] [Accepted: 04/29/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hip osteoarthritis may cause compensational movement strategies that require extra physical and mental effort. Such aberrant functioning can be captured in movement quality evaluation. The objective of this study was to explore whether movement quality, evaluated as a multiperspective phenomenon, is reflected in commonly used and recommended functional measures in this group of patients. METHODS A cross-sectional study design was used. Baseline included 80 female and 21 male participants with hip osteoarthritis. Movement quality was evaluated by the Body Awareness Rating Scale-Movement Quality and Experience (BARS-MQE), part one, including 12 movement items. Correlation analyses (Pearson and Spearman) were performed to explore associations between BARS-MQE (sum score and single item scores), and scores on measures of physical capacity (Chair test, Stairs test, 6 minutes walking test; 6MWT), self-reported activity level (UCLA), function (HOOS subscales), pain during walking (NRS), self-efficacy (ASES) and health (EQ-5D-5L). Based on previous evidence, we hypothesized moderate associations between BARS-MQE and these measures. RESULTS BARS-MQE's sum score showed moderate associations with Stairs test, 6MWT and UCLA (r = -0.425 to 0.304) and weak associations (r = 0.29 to 0.12) with ASES Pain and Symptoms, HOOS ADL, Chair test, NRS, HOOS Pain and Sports, and EQ-5D-5L. No association was found between BARS-MQE and HOOS Symptoms and Quality of life. Movement quality in item 12, walking, demonstrated moderate or weak association with all included measures. CONCLUSION In this study of participants diagnosed with hip osteoarthritis, movement quality evaluated by BARS-MQE was moderately reflected in measures of physical capacity and activity, but weakly reflected in self-reported measures of health problems. With its particular dynamic procedure and inclusion of the whole moving person, movement quality evaluation by the BARS-MQE was shown to provide supplementary information on functioning, scarcely captured by the commonly used and recommended measures.
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Affiliation(s)
- Aarid Liland Olsen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Liv Heide Magnussen
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Liv Helvik Skjaerven
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jörg Assmus
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Mary-Anne Sundal
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Raymond Ostelo
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands.,Department of Health Sciences, VU University and Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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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: 14] [Impact Index Per Article: 2.8] [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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Zügner R, Tranberg R, Timperley J, Hodgins D, Mohaddes M, Kärrholm J. Validation of inertial measurement units with optical tracking system in patients operated with Total hip arthroplasty. BMC Musculoskelet Disord 2019; 20:52. [PMID: 30727979 PMCID: PMC6364439 DOI: 10.1186/s12891-019-2416-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 01/09/2019] [Indexed: 12/01/2022] Open
Abstract
Background Patient reported outcome measurement (PROMs) will not capture in detail the functional joint motion before and after total hip arthroplasty (THA). Therefore, methods more specifically aimed to analyse joint movements may be of interest. An analysis method that addresses these issues should be readily accessible and easy to use especially if applied to large groups of patients, who you want to study both before and after a surgical intervention such as THA. Our aim was to evaluate the accuracy of inertial measurement units (IMU) by comparison with an optical tracking system (OTS) to record pelvic tilt, hip and knee flexion in patients who had undergone THA. Methods 49 subjects, 25 males 24 females, mean age of 73 years (range 51–80) with THA participated. All patients were measured with a portable IMU system, with sensors attached lateral to the pelvis, the thigh and the lower leg. For validation, a 12-camera motion capture system was used to determine the positions of 15 skin markers (Oqus 4, Qualisys AB, Sweden). Comparison of sagittal pelvic rotations, and hip and knee flexion-extension motions measured with the two systems was performed. The mean values of the IMU’s on the left and right sides were compared with OTS data. Results The comparison between the two gait analysis methods showed no significant difference for mean pelvic tilt range (4.9–5.4 degrees) or mean knee flexion range (54.4–55.1 degrees) on either side (p > 0.7). The IMU system did however record slightly less hip flexion on both sides (36.7–37.7 degrees for the OTS compared to 34.0–34.4 degrees for the IMU, p < 0.001). Conclusions We found that inertial measurement units can produce valid kinematic data of pelvis- and knee flexion-extension range. Slightly less hip flexion was however recorded with the inertial measurement units which may be due to the difference in the modelling of the pelvis, soft tissue artefacts, and malalignment between the two methods or misplacement of the inertial measurement units. Trial registration The study has ethical approval from the ethical committee “Regionala etikprövningsnämnden i Göteborg” (Dnr: 611–15, 2015-08-27) and all study participants have submitted written approval for participation in the study.
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Affiliation(s)
- Roland Zügner
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University, 413 45, Göteborg, SE, Sweden. .,Lundberg Laboratory for Orthopaedic Research, Sahlgrenska University Hospital, Gröna stråket 12, SE-41345, Göteborg, Sweden.
| | - Roy Tranberg
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University, 413 45, Göteborg, SE, Sweden
| | - John Timperley
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | | | - Maziar Mohaddes
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University, 413 45, Göteborg, SE, Sweden
| | - Johan Kärrholm
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy,University of Gothenburg, Sahlgrenska University, 413 45, Göteborg, SE, Sweden
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10
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Loureiro A, Constantinou M, Diamond LE, Beck B, Barrett R. Individuals with mild-to-moderate hip osteoarthritis have lower limb muscle strength and volume deficits. BMC Musculoskelet Disord 2018; 19:303. [PMID: 30131064 PMCID: PMC6103991 DOI: 10.1186/s12891-018-2230-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/14/2018] [Indexed: 01/21/2023] Open
Abstract
Background Individuals with advanced hip osteoarthritis (OA) exhibit generalized muscle weakness of the affected limb and so clinical practice guidelines recommend strength training for the management of hip OA. However, the extent and pattern of muscle weakness, including any between-limb asymmetries, in early stages of the disease are unclear. This study compared hip and knee muscle strength and volumes between individuals with mild-to-moderate symptomatic and radiographic hip OA and a healthy control group. Methods Nineteen individuals with mild-to-moderate symptomatic and radiographic hip OA (n = 12 unilateral; n = 7 bilateral) and 23 age-matched, healthy controls without radiographic hip OA or hip pain participated. Isometric strength of the hip and knee flexors and extensors, and hip abductors and adductors were measured. Hip and thigh muscle volumes were measured from lower limb magnetic resonance images. A full-factorial, two-way General Linear Model was used to assess differences between groups and between limbs. Results Participants in the hip OA group demonstrated significantly lower knee flexor, knee extensor, hip flexor, hip extensor and hip abductor strength compared to controls and had significantly lower volume of the adductor, hamstring and quadriceps groups, and gluteus maximus and gluteus minimus muscles, but not tensor fasciae latae or gluteus medius muscles. There were no between-limb strength differences or volume differences within either group. Conclusions Atrophic, bilateral hip and knee muscle weakness is a feature of individuals with mild-to-moderate hip OA. Early interventions to target muscle weakness and prevent the development of strength asymmetries that are characteristic of advanced hip OA appear warranted.
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Affiliation(s)
- Aderson Loureiro
- Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Gold Coast, QLD, 4222, Australia.,Pontifical Catholic University (PUCRS), Porto Alegre, Brazil.,University of Rio dos Sinos (UNISINOS), São Leopoldo, Brazil
| | - Maria Constantinou
- Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Gold Coast, QLD, 4222, Australia.,Australian Catholic University, Brisbane, QLD, 4014, Australia
| | - Laura E Diamond
- Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Gold Coast, QLD, 4222, Australia. .,Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Belinda Beck
- Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Rod Barrett
- Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Gold Coast, QLD, 4222, Australia
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11
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Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2018; 26:847-863. [PMID: 29474993 DOI: 10.1016/j.joca.2018.02.897] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/04/2018] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the change in walking gait biomechanics after total hip arthroplasty (THA) for osteoarthritis (OA) compared to the pre-operative gait status, and to compare the recovery of gait following THA with healthy individuals. METHODS Systematic review with meta-analysis of studies investigating changes in gait biomechanics after THA compared to (1) preoperative levels and (2) healthy individuals. Data were pooled at commonly reported time points and standardised mean differences (SMDs) were calculated in meta-analyses for spatiotemporal, kinematic and kinetic parameters. RESULTS Seventy-four studies with a total of 2,477 patients were included. At 6 weeks postoperative, increases were evident for walking speed (SMD: 0.32, 95% confidence intervals (CI) 0.14, 0.50), stride length (SMD: 0.40, 95% CI 0.19, 0.61), step length (SMD: 0.41, 95% CI 0.23, 0.59), and transverse plane hip range of motion (ROM) (SMD: 0.36, 95% CI 0.05, 0.67) compared to pre-operative gait. Sagittal, coronal and transverse hip ROM was significantly increased at 3 months (SMDs: 0.50 to 1.07). At 12 months postoperative, patients demonstrated deficits compared with healthy individuals for walking speed (SMD: -0.59, 95% CI -1.08 to -0.11), stride length (SMD: -1.27, 95% CI -1.63, -0.91), single limb support time (SMD: -0.82, 95% CI -1.23, -0.41) and sagittal plane hip ROM (SMD: -1.16, 95% CI -1.83, -0.49). Risk of bias scores ranged from seven to 24 out of 26. CONCLUSIONS Following THA for OA, early improvements were demonstrated for spatiotemporal and kinematic gait patterns compared to the pre-operative levels. Deficits were still observed in THA patients compared to healthy individuals at 12 months.
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Tateuchi H, Koyama Y, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N. Daily cumulative hip moment is associated with radiographic progression of secondary hip osteoarthritis. Osteoarthritis Cartilage 2017; 25:1291-1298. [PMID: 28232145 DOI: 10.1016/j.joca.2017.02.796] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/16/2017] [Accepted: 02/14/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether higher daily cumulative hip moment at baseline is associated with subsequent radiographic progression of hip osteoarthritis (OA) over 12 months. DESIGN Fifty patients with secondary hip OA, excluding patients with end-stage hip OA, participated in this prospective cohort study. Joint space width (JSW) of the hip was measured at baseline and 12 months later. With radiographic progression of hip OA (>0.5 mm/year in JSW) as dependent variable (yes/no), univariable and multivariable logistic regression analyses were performed to assess the association between load-related parameters during gait (i.e., peak hip moment, hip moment impulse, and daily cumulative hip moment [product of hip moment impulse and mean steps/day]) and hip OA progression with and without adjustment for age, body weight, and minimum JSW. RESULTS Of the 50 patients (47.4 ± 10.7 years old), 21 (42.0%) were classified into the progression group. The higher daily cumulative hip moment in the frontal plane at baseline was statistically significantly associated with radiographic progression of hip OA (adjusted odds ratio (OR) [95% confidence interval (CI)], 1.34 [1.06-1.70]; P = 0.013). The higher daily cumulative hip moment in the sagittal plane was also approaching significance in its association with hip OA progression (adjusted OR, 1.80 [0.99-3.26]; P = 0.052). CONCLUSIONS In the female patients with secondary hip OA, higher daily cumulative hip moment, particularly in the frontal plane, was a predictor of radiographic progression of hip OA over 12 months. Reduction in daily cumulative hip moment by modification in gait and physical activity may potentially slow hip OA progression.
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Affiliation(s)
- H Tateuchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Y Koyama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - H Akiyama
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - K Goto
- Department of Orthopaedics Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - K So
- Department of Orthopaedics Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y Kuroda
- Department of Orthopaedics Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - N Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Dabare C, Le Marshall K, Leung A, Page CJ, Choong PF, Lim KK. Differences in presentation, progression and rates of arthroplasty between hip and knee osteoarthritis: Observations from an osteoarthritis cohort study-a clear role for conservative management. Int J Rheum Dis 2017; 20:1350-1360. [PMID: 28493422 PMCID: PMC5655735 DOI: 10.1111/1756-185x.13083] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aim To describe the natural progression and the rates of arthroplasty of a cohort of hip and knee osteoarthritis (OA) patients. Methods An observational study of 247 consecutive patients who attended an OA clinic between May 2008 and August 2009. Follow‐up survey was conducted from July 2014 to December 2014, with the primary end point being joint replacement surgery. Results One hundred and sixty‐seven patients had knee OA and 80 patients had hip OA. When adjusted for other variables (age, gender, body mass index, Kellgren‐Lawrence stage, symptom duration, presence of OA elsewhere and pain score), patients with hip OA demonstrated 86% increased hazard of surgery compared to knee OA patients (95% CI increase of 19% to 193%). At 6 years after initial consultation, 67% of patients with knee OA did not require a knee replacement surgery, while 40% (30, 51) of hip OA patients did not undergo surgery (95% CI: 59–74%). Overall at 6 years, 58% of patients (95% CI: 51–64%) did not undergo joint replacement surgery. Conclusion Knee and hip OA patients appear to behave differently, with hip OA patients more likely to undergo arthroplasty. There is a significant number of both hip OA and knee OA patients who did not require arthroplasty at the end of 6 years, suggesting a major role for conservative therapy.
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Affiliation(s)
- Chamila Dabare
- Rheumatology Unit, Western Health, Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Le Marshall
- Rheumatology Unit, Western Health, Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia
| | - Albert Leung
- Rheumatology Unit, Western Health, Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Carolyn J Page
- Department of Physiotherapy, The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Peter F Choong
- Department of Orthopaedics, The University of Melbourne and Western Health, Melbourne, Victoria, Australia.,Department of Surgery, St. Vincent's Hospital, The University of Melbourne and Western Health, Melbourne, Victoria, Australia
| | - Keith K Lim
- Rheumatology Unit, Western Health, Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, The University of Melbourne and Western Health, Melbourne, Victoria, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, Melbourne, Victoria, Australia
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Moriya M, Fukushima K, Uchiyama K, Takahira N, Yamamoto T, Minegishi Y, Takaso M. Clinical results of arthroscopic surgery in patients over 50 years of age-what viability does it have as a joint preservative surgery? J Orthop Surg Res 2017; 12:2. [PMID: 28057012 PMCID: PMC5217539 DOI: 10.1186/s13018-016-0504-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/20/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To identify whether hip arthroscopy is a suitable option for treating hip pain in elderly patients and investigate the clinical outcomes of hip arthroscopic surgery for labrum tear and/or osteoarthritis in patients over 50 years of age. METHODS Between August 2009 and May 2014, a series of 23 patients (6 men and 17 women) with a mean age of 59 years underwent arthroscopy. We retrospectively examined the clinical records, radiographs, and outcome questionnaires from all patients. The mean follow-up period was 28 months. RESULTS The mean Japan Orthopedic Association hip score after surgery improved by a statistically significant amount. Eight patients (34.8%) were noted to have a progression of osteoarthritis (OA) diagnosed by radiograph, and one underwent THA after 13 months following arthroscopic surgery. The patients in which OA progression was noted were identified as having radiographical OA preoperatively and acetabular cartilage damage in the arthroscopic findings. CONCLUSIONS Arthroscopic surgery performed in selected patients over 50 years of age might be beneficial if classified as Tönnis grade 0 preoperatively and/or classified as Outerbridge grade II in the arthroscopic findings.
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Affiliation(s)
- Mitsutoshi Moriya
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Kensuke Fukushima
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Takeaki Yamamoto
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yojiro Minegishi
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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