Comparison of Gait Symmetry and Joint Moments in Unilateral and Bilateral Hip Osteoarthritis Patients and Healthy Controls

The effect of foot position on hip and ankle kinematics and kinetics during walking in static calibration trials

Three-dimensional gait analysis has been used extensively in research. During walking, the external hip adduction moment (EHAM) has been used as a surrogate measure of joint loading in individuals with hip osteoarthritis and inconsistency between previous studies could be attributed to the inconsistency of static standing trials. The present study was designed to examine the effects of static trial foot position on hip and ankle kinetics and kinematics variables during walking. Twelve participants were recruited and completed three static trials: 20° toe-out, straight (0°), and 20° toe-in. Five walking trials (own pace and shoes) were collected. The dynamic trials were analysed using three static trials. The first-peak, trough, and second-peak EHAMs and other hip and ankle kinematics and kinetics were compared between the conditions using repeated-measures analysis of variance. The first peak, trough, and second peak EHAMs showed a significant increase during movement from 20° toe-in to 20° toe-out by 5.87 %, 7.74 %, and 7.68 %, respectively. Furthermore, significant changes were found in hip flexion angle, hip sagittal plane range of motion angle, hip adduction and abduction angles, hip internal and external rotation angles, hip internal rotation moment, ankle dorsiflexion and plantarflexion moments, and ankle inversion and eversion moments. In this study, the change in foot position during the within-subject trials affected the first peak, trough, and second peak EHAMs and other kinetic and kinematic variables during walking. Therefore, this study highlights the importance to standardise the foot position in static trials to avoid masking or accentuating the actual changes.

Walking on different inclines affects gait symmetry differently in the anterior-posterior and vertical directions: implication for future sensorimotor training

A symmetric gait pattern in humans reflects near-identical movement in bilateral limbs during walking. However, little is known about how gait symmetry changes on different inclines. This study aimed to address this knowledge gap using the central pattern generator and internal model hypotheses. Eighteen healthy young adults underwent five 2-minute walking trials (inclines of +15%, +8%, 0%, -8%, and -15%). Dependent variables included step time, step length, step width, maximum heel clearance, time to peaks of maximum heel clearance, their corresponding coefficients of variation (CV), and respective symmetry indices (SI). Significant differences were observed in SI of step length (p = .022), step length variability (p < .001), step width variability (p =.001), maximum heel clearance (p < .001), and maximum heel clearance variability (p = .049). Compared to level walking, walking at -8% and -15% inclines increased SI of step length (p = .011, p = .039 respectively) but decreased SI of maximum heel clearance (p = .025, p = .019 respectively). These observations suggested that incline walking affected gait symmetry differently, possibly due to varied internal models used in locomotion. Downhill walking improved vertical gait symmetry but reduced anterior-posterior symmetry compared to level walking. Downhill walking may be a preferable rehabilitation protocol for enhancing gait symmetry, as it activates internal model controls. Even slight downhill inclines could increase active control loading, beneficial for the elderly and those with impaired gait.

Effects of T1p Characteristics of Load-Bearing Hip Cartilage on Bilateral Knee Patellar Cartilage Subregions: Subjects With None to Moderate Radiographic Hip Osteoarthritis

BACKGROUND

The polyarticular nature of Osteoarthritis (OA) tends to manifest in multi-joints. Associations between cartilage health in connected joints can help identify early degeneration and offer the potential for biomechanical intervention. Such associations between hip and knee cartilages remain understudied.

PURPOSE

To investigate T1p associations between hip-femoral and acetabular-cartilage subregions with Intra-limb and Inter-limb patellar cartilage; whole and deep-medial (DM), deep-lateral (DL), superficial-medial (SM), superficial-lateral (SL) subregions.

STUDY TYPE

Prospective.

SUBJECTS

Twenty-eight subjects (age 55.1 ± 12.8 years, 15 females) with none-to-moderate hip-OA while no radiographic knee-OA.

FIELD STRENGTH/SEQUENCE

3-T, bilateral hip, and knee: 3D-proton-density-fat-saturated (PDFS) Cube and Magnetization-Prepared-Angle-Modulated-Partitioned-k-Space-Spoiled-Gradient-Echo-Snapshots (MAPSS).

ASSESSMENT

Ages of subjects were categorized into Group-1 (≤40), Group-2 (41-50), Group-3 (51-60), Group-4 (61-70), Group-5 (71-80), and Group-6 (≥81). Hip T1p maps, co-registered to Cube, underwent an atlas-based algorithm to quantify femoral and acetabular subregional (R2-R7) cartilage T1p. For knee Cube, a combination of V-Net architectures was used to segment the patellar cartilage and subregions (DM, DL, SM, SL). T1p values were computed from co-registered MAPSS.

STATISTICAL TESTS

For Intra-and-Inter-limb, 5 optimum predictors out of 13 (Hip subregional T1p, age group, gender) were selected by univariate linear-regression, to predict outcome (patellar T1p). The top five predictors were stepwise added to six linear mixed-effect (LME) models. In all LME models, we assume the data come from the same subject sharing the same random effect. The best-performing models (LME-modelbest) selected via ANOVA, were tested with DM, SM, SL, and DL subregional-mean T1p. LME assumptions were verified (normality of residuals, random-effects, and posterior-predictive-checks).

RESULTS

LME-modelbest (Intra-limb) had significant negative and positive fixed-effects of femoral-R5 and acetabular-R2 T1p, respectively (conditional-R2 = 0.581). LME-modelbest (Inter-limb) had significant positive fixed-effects of femoral-R3 T1p (conditional-R2 = 0.26).

DATA CONCLUSION

Significant positive and negative T1p associations were identified between load-bearing hip cartilage-subregions vs. ipsilateral and contralateral patellar cartilages respectively. The effects were localized on medial subregions of Inter-limb, in particular.

EVIDENCE LEVEL

1 TECHNICAL EFFICACY: Stage 1.

Influence of altered torsional stiffness through sole modification of air pressure shoes on lower extremity biomechanical behaviour during side-step cutting maneuvers

Directional changes in cutting maneuvers are critical in sports, where shoe torsional stiffness (STS) is an important factor. Shoes are designed based on different constructions and movement patterns. Hence, it is unclear how adjustable spacers into the sole constructions of air pressure chambers (APC) affect the STS in side-step cutting. Therefore, this study investigated the effects of altered STS through adjustable sole spacers on ground reaction force (GRF) and ankle and knee joint moments in side-step cutting. Seventeen healthy recreational athletes performed side-step cutting with experimental conditions including (i) barefoot (BF), (ii) unaltered shoes (UAS): soles consisting of APC, and (iii) altered shoes (AS): modified UAS by inserting elastomeric spacers into cavities formed by APC. Mechanical and biomechanical variables were measured. Significant differences were revealed across shoe conditions for impact peak (p = 0.009) and impulse (p = 0.018) in vertical GRF, time to achieve peak braking (p = 0.004), and peak propulsion (p = 0.025) for anterior-posterior GRF in ANOVA test. No significant differences were observed in GRF peaks and impulses between UAS and AS except for a trend of differences in impact peak (p = 0.087) for vertical GRF. At the ankle and knee joint, peak ankle power absorption (p = 0.019), peak knee internal rotation moment (p = 0.042), peak knee extension moment (p = 0.001), peak knee flexion moment (0.000), peak knee power absorption (p = 0.047) showed significant difference across three shoe conditions. However, no significant differences between the UAS and AS were noticed for peak joint moments and power. Altered shoe torsional stiffness did not significantly affect the peak forces and peak ankle and knee joint moments or powers; hence sole adjustment did not influence the cutting performance. This study might be insightful in sports footwear design, and adjusting shoe torsional stiffness by sole modification might be advantageous for athletes playing sports with cutting maneuvers to reduce the risk of injuries by controlling the twisting force at the ankle that frequently happens during cutting maneuvers.

The Effectiveness of Preoperative Outpatient and Home Rehabilitation and the Impact on the Results of Hip Arthroplasty: Introductory Report

A total hip replacement is the treatment of choice for end-stage hip osteoarthritis. Rehabilitation performed before surgery (called prehabilitation) is used to improve the results of surgical treatment. However, the results of studies have not unquestionably confirmed the effectiveness of preoperative rehabilitation and its impact on the outcome of surgery. The aim of this study is to assess the effectiveness of preoperative outpatient and home rehabilitation in relation to a control group not subject to these forms of influence. A total of 61 patients qualified for primary hip arthroplasty were randomly assigned to a group with outpatient rehabilitation before surgery, exercises performed at home, or a group without any intervention before surgery. Three weeks after surgery, the patients were re-qualified and underwent three weeks of outpatient rehabilitation in the day rehabilitation department. The patients from all three groups were evaluated in terms of functionality and pain using point scales upon enrolment in the study, on admission to the day rehabilitation department, and after 3 weeks of rehabilitation in the department. A total of 50 subjects completed the study. The study results did not reveal statistically significant differences between preoperative rehabilitation and no intervention. Patients rehabilitated at home gave up self-therapy more often than those undergoing outpatient rehabilitation.

Effects of hip osteoarthritis on lower body joint kinematics during locomotion tasks: a systematic review and meta-analysis

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).

Individual muscle contributions to the acceleration of the centre of mass during gait in people with mild-to-moderate hip osteoarthritis

BACKGROUND

People with mild-to-moderate hip osteoarthritis (OA) exhibit hip muscle weakness, alterations in hip kinematics and kinetics and hip contact forces during gait compared to healthy controls. However, it is unclear if those with hip OA use different motor control strategies to coordinate the motion of the centre of mass (COM) during gait. Such information could provide further critical assessment of conservative management strategies implemented for people with hip OA.

RESEARCH QUESTION

Do muscle contributions to the acceleration of the COM during walking differ between individuals with mild-to-moderate hip OA and controls?

METHODS

Eleven individuals with mild-to-moderate hip OA and 10 healthy controls walked at a self-selected speed while whole-body motion and ground reaction forces were measured. Muscle forces during gait were obtained using static optimisation and an induced acceleration analysis was performed to determine individual muscle contributions to the acceleration of the COM during single-leg stance (SLS). Between-group comparisons were made using independent t-tests via Statistical Parametric Modelling.

RESULTS

There were no between-group differences in spatial-temporal gait parameters or three-dimensional whole-body COM acceleration. The rectus femoris, biceps femoris, iliopsoas and gastrocnemius muscles in the hip OA group contributed less to the fore-aft accelerations of the COM (p < 0.05), and more to the vertical COM acceleration with the gluteus maximus (p < 0.05), during SLS, compared to the control group.

SIGNIFICANCE

Subtle differences exist in the way people with mild-to-moderate hip OA use their muscles to accelerate the whole-body centre of mass during the SLS phase of walking relative to healthy controls. These findings improve understanding of the complex functional consequences of hip OA and enhance our understanding of how to monitor the effectiveness of an intervention on biomechanical changes in gait in people with hip OA.

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

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.

Body mass affects kinetic symmetry and inflammatory markers in adolescent knees during gait

BACKGROUND

Early-onset osteoarthritis has been attributed to pro-inflammatory factors and biomechanical changes in obesity. However, research has yet to explore whether knee joint moments are asymmetrical in children with obesity and could precede the onset of knee osteoarthritis. The present study compares knee moment asymmetry between adolescents with and without obesity and examines the relationship between asymmetries and inflammatory biomarkers.

METHODS

Twenty-eight adolescents (13-16 years) were classified as with (n = 12) or without (n = 16) obesity. Lower extremity kinetics were measured using three-dimensional motion analysis. Bilateral knee joint moments were analyzed in the sagittal, frontal, and transverse planes across stance phase. Kinetic asymmetry was calculated between the right and left sides and represented by the R2 value. Enzyme-linked immunosorbent assays analyzed serum 25-hydroxy vitamin D, interferon gamma, tumor nercrosis factor alpha, interleukin-6, and C-reactive protein levels. Parametric and non-parametric tests determined significant group differences in asymmetries and biomarkers, respectively. Spearman's correlations identified relationships between biomarkers and asymmetries with statistically significant group differences.

FINDINGS

Adolescents with obesity had greater sagittal (loading, midstance) and frontal (midstance, pre-swing) plane kinetic knee asymmetry and higher concentrations of interleukin-6 and C-reactive protein. A moderately negative correlation existed between C-reactive protein and sagittal (loading, midstance) plane asymmetry, and also between interleukin-6 and frontal (pre-swing) plane asymmetry.

INTERPRETATION

Inflammatory response increases with greater knee joint asymmetry, suggesting knee joint damage and altered joint loading co-exist in adolescents with obesity. Increased risk to joint health may exist in sub-phases where knee joints are improperly loaded.

Do individuals with knee osteoarthritis walk with distinct knee biomechanics and muscle activation characteristics? An investigation of knee osteoarthritis, hip osteoarthritis, and asymptomatic groups

BACKGROUND

Biomechanical markers including reductions in sagittal plane kinematics and moments, increases in knee adduction moments (KAM), and altered muscle activations have been identified as hallmark indicators of knee osteoarthritis (OA). However, it remains unknown whether these features of knee OA gait are exclusive to the diseased joint.

RESEARCH QUESTION

To determine whether specific gait outcomes previously linked to symptomatic medial compartment knee OA are unique to knee OA by concurrently investigating a group of asymptomatic individuals and those with hip OA.

METHODS

16 individuals with moderate medial compartment knee OA, 16 individuals with moderate hip OA, and 16 asymptomatic controls were recruited. Participants walked on a treadmill while segment kinematics and ground reaction forces were recorded. Sagittal plane kinematics and sagittal and frontal plane moments were calculated. Surface electromyograms were recorded from lateral and medial hamstrings and gastrocnemius and vastus lateralis and medialis. Discrete variable analysis was used to investigate knee joint mechanics and muscle activation ratios. Analysis of Variance models using Bonferroni corrections determined between group differences (α = 0.0167).

RESULTS

Sagittal plane knee kinematics and moments were statistically similar among all groups (p > 0.0167). No differences were found for peak KAM and impulse between knee OA and asymptomatic groups (p > 0.0167) but peak KAM (p = 0.006 and impulse (p = 0.001) were greater in the knee OA group compared to hip OA. The hip OA group had a lower KAM impulse (p < 0.0167) compared to the knee OA and asymptomatic groups. A greater LH:MH activation ratio (p < 0.0167) was found in the knee OA group compared to hip OA and asymptomatic groups. No other activation ratio differences were found (p > 0.0167).

SIGNIFICANCE

Medial and lateral hamstring muscle activation levels may provide utility as a knee OA gait biomarker compared to biomechanical outcomes, quadriceps and gastrocnemius activation, when differentiating knee OA from asymptomatic and hip OA cohorts.

Is simultaneous bilateral total hip arthroplasty deleterious in a biomechanical point of view? A comparative gait analysis study

Purpose

Uni- or bilateral hip osteoarthritis is a common disease generating pain, stiffness, and functional disabilities. Changes in the normal walking with higher energy expenditures are observed. Facing a cruel lack of biomechanical data, we decided to analyse the impact on the walking of single and simultaneous bilateral total hip arthroplasties (THA).

Method

We conducted a prospective monocentric study, comparing two matched groups of 15 patients able to walk with symptomatic isolated uni- (group 1) or bilateral HO (group 2) and treated respectively by unilateral THA (UTHA) or simultaneous bilateral THA (SBTHA). Surgery was performed by a single surgeon with a direct anterior approach and approved by local ethical committee. Walking was assessed by a « 3D Gait analysis motion» pre and at 6 months post operatively.

Result

In the UTHA group, recovery, i.e., efficiency of locomotor mechanism (p < 0.001) and pelvis sagittal balance (p = 0.031) improved, while external and total work (p = 0.010) decreased post operatively. In the SBTHA group, speed (p = 0.035), step length (p = 0.046), range of motion of knee sagittal stance (p = 0.009) and hip frontal (p = 0.031), and internal work are significatively higher (p < 0.001) post operatively.

Conclusions

This original study attests that THA has a positive impact on walking and energetics outcome in UTHA and SBTHA.