Effects of Hip Bracing on Gait Biomechanics, Pain and Function in Subjects With Mild to Moderate Hip Osteoarthritis

Mild-to-moderate hip osteoarthritis and hip bracing influence hip and knee biomechanics during 90° turns while walking

BACKGROUND

Turning movements are frequently encountered during daily life and require more frontal and transverse hip mobility than straight walking. Thus, analysis of turning might be an insightful addition in the evaluation of conservative treatment approaches for hip osteoarthritis patients. The study objective was to quantify the effects of mild-to-moderate symptomatic hip osteoarthritis on lower-body turning biomechanics and evaluate the effects of hip bracing in this cohort.

METHODS

Biomechanical analysis of 90° step and spin turns in 21 persons with hip osteoarthritis and 21 healthy controls (case-control-study) and intervention study on the effects of hip bracing in hip osteoarthritis participants. Hip and knee kinematics and dynamics were compared using independent sample t-tests or one-way repeated measure ANOVAs.

FINDINGS

Persons with hip osteoarthritis have reduced peak hip extension and sagittal and transverse hip range of motion during turning. During the spin turn reduced hip adduction and frontal hip range of motion were found. Bracing increased the movement velocity at turn initiation and limited the transverse hip range of motion during both turns but increased knee peak adduction and internal rotation moments during spin turns.

INTERPRETATION

Persons with hip osteoarthritis present altered hip kinematics during 90° spin turns in all movement planes. Their inclusion during clinical movement analysis might facilitate the detection of mobility deficits at an early disease stage. Bracing led to higher movement velocity at turn initiation without increasing load at the hip joint and reduced transverse hip range of motion, avoiding the painful reaching of range of motion endpoints.

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.

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).

A review of quality-of-life in elderly osteoarthritis

INTRODUCTION

Osteoarthritis (OA) is the commonest joint disease in the world. Although aging is not invariably associated with OA, aging of the musculoskeletal system increases susceptibility to OA. Pain and reduced function due to OA, negatively impact health-related quality of life (HRQoL) in the elderly.

AREAS COVERED

We searched PubMed and Google Scholar with search term "osteoarthritis' combined with terms 'elderly' 'ageing' 'healthrelated quality of life' 'burden' "prevalence 'hip osteoarthritis' 'knee osteoarthritis' 'hand osteoarthritis' to identify relevant articles. This article discusses the global impact and joint-specific burden due to OA and the challenges in assessment of HRQoL in elderly with OA. We further describe some HRQoL determinants that particularly impact elderly persons with OA. These determinants include physical activity, falls, psychosocial consequences, sarcopaenia, sexual health, and incontinence. The usefulness of physical performance measures, as an adjunct to assessing HRQoL is explored. The review concludes by outlining strategies to improve HRQoL.

EXPERT OPINION

Assessment of HRQoL in elderly with OA is mandatory if effective interventions/treatment are to be instituted. But existent HRQoL assessments have shortcomings when used in elderly§. It is recommended that determinants of QoL which are unique to the elderly, be examined with greater detail and weightage in future studies.