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Grosklos M, Perry J, Elwood M, Jochimsen K, Di Stasi S. Dynamic joint stiffness in individuals with femoroacetabular impingement syndrome pre- and post-hip arthroscopy. Clin Biomech (Bristol, Avon) 2024; 112:106187. [PMID: 38280259 DOI: 10.1016/j.clinbiomech.2024.106187] [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: 09/26/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Patients with hip-related pain often fail to return to their desired level of activity following hip arthroscopy. Lasting biomechanics alterations may be one potential explanation. Dynamic joint stiffness assesses the mechanistic controls of the lower limb during high impact movements, and thus, may provide valuable clinical targets to improving movement and optimizing return to activity after surgery. METHODS Twenty-five participants (13 females) with hip-related pain underwent 3D motion capture during a drop jump task before surgery and six months post-operatively. Nineteen healthy controls (9 females) were collected for comparison. Sagittal plane dynamic joint stiffness was calculated during the initial landing phase. Baseline and 6-month dynamic joint stiffness data were compared 1) between males and females with hip-related pain and 2) between individuals with hip-related pain and controls using Wilcoxon Signed-Rank and Mann Whitney U tests. Sexes were analyzed separately. FINDINGS From baseline to 6 months post-operatively, females with hip-related pain demonstrated decreased dynamic ankle stiffness (2.26 Nm/deg. [0.61] to 1.84 Nm/deg. [0.43]) (p = .005) and males with hip-related pain demonstrated increased dynamic hip stiffness (2.73 [0.90] to 3.88 [1.73]) (p = .013). There were no differences in dynamic stiffness at any joint between individuals with hip-related pain at either timepoint when compared to controls (p ≥ .099). INTERPRETATION Females and males with hip-related pain may demonstrate unique changes in dynamic joint stiffness after surgery, indicating return to activity may follow different trajectories for each sex. Additional work should examine the relationship between hip joint stiffness and treatment outcomes and identify additional movement-related rehabilitation targets.
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Affiliation(s)
- Madeline Grosklos
- Department of Biomedical Engineering, The Ohio State University, 140 W 19th Ave, Columbus, OH 43210, USA; Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA.
| | - Jennifer Perry
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Department of Mechanical Engineering, The Ohio State University, 201 W 19th Ave, Columbus, OH 43210, USA.
| | - Megan Elwood
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH 43210, USA
| | - Kate Jochimsen
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH 43210, USA
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Sara LK, Lewis CL. Rehabilitation Phases, Precautions, and Mobility Goals Following Total Hip Arthroplasty. HSS J 2023; 19:494-500. [PMID: 37937096 PMCID: PMC10626929 DOI: 10.1177/15563316231192980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 11/09/2023]
Abstract
The prevalence of total hip arthroplasty (THA) for advanced hip osteoarthritis (OA) is both increasing and shifting toward a younger average age. However, THA alone does not typically normalize function in these patients. Postoperative rehabilitation is often recommended to optimize joint motion, strength, and function. To date, there are no peer-reviewed clinical practice guidelines for postoperative rehabilitation following THA. Thus, optimal postoperative rehabilitation requires consideration of the existing literature and clinical expertise. This review article summarizes current recommendations for postoperative management of THA, including phases of rehabilitation, postoperative hip precautions, the effect of rehabilitation setting and mode of delivery on postoperative outcomes, and gait mechanics.
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Affiliation(s)
- Lauren K Sara
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Cara L Lewis
- Department of Physical Therapy, Boston University, Boston, MA, USA
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Grosklos M, Lewis CL, Ceballos E, Perry J, Di Stasi S. Females with hip-related pain demonstrate reduced kinetics at the hip and ankle during terminal stance of gait. Gait Posture 2023; 105:99-103. [PMID: 37515892 PMCID: PMC10527984 DOI: 10.1016/j.gaitpost.2023.07.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Individuals with hip-related pain (HRP) commonly report pain with walking and demonstrate altered movement patterns compared to healthy controls (HCs). Individuals with HRP may attempt to reduce pain during walking by decreasing kinetics and joint forces at the hip through increased use of the ankle during pushoff. RESEARCH QUESTION Do individuals with HRP have increased kinetics at the ankle and decreased kinetics at the hip during pushoff in gait compared to HCs, and do kinetic patterns differ between males and females with HRP? METHODS This retrospective observational study included 42 individuals with HRP and 20 HCs. Participants completed overground gait trials at their self-selected speed while kinematics and kinetics were recorded through a motion capture system and force plates. Peak internal hip and ankle moments and hip flexion and ankle plantarflexion angular impulse during terminal stance were used in general estimating equations for comparison of group by limb interactions for males and females separately, as well as a comparison of males and females within the HRP group. RESULTS Females with HRP demonstrated reduced hip flexion impulse on their involved limb (.070 Nm*s/kg*m) compared to female HCs (.083Nm*s/kg*m; p = .032), as well as reduced peak ankle plantarflexion moment (-.94Nm/kg*m) compared to their contralateral limb (-.99Nm/kg*m) and the involved limb of HRP males (-1.00Nm/kg*m) (p ≤ .007). There were no between-limb or between-group differences in hip or ankle peak moments or impulses in males. SIGNIFICANCE Females with HRP show decreased kinetics at both the hip and ankle; these patterns were not identified in males. Future investigations should examine whether increasing ankle kinetics during pushoff reduces pain at the hip, as this may be a valuable clinical treatment strategy.
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Affiliation(s)
- Madeline Grosklos
- Department of Biomedical Engineering, The Ohio State University, 140 W 19th Ave, Columbus, OH 43210, USA; Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA.
| | - Cara L Lewis
- Department of Physical Therapy, College of Health & Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA 02215, USA
| | - Elizabeth Ceballos
- The Ohio State University Wexner Medical Center Division of Sport Physical Therapy, 2835 Fred Taylor Dr, Columbus, OH 43202, USA
| | - Jennifer Perry
- Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Department of Mechanical Engineering, The Ohio State University, 201 W. 19th Avenue, Columbus, OH 43210, USA
| | - Stephanie Di Stasi
- Jameson Crane Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr, Columbus, OH 43202, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Ave, Columbus, OH 43210, USA
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Graber KA, Halverstadt AL, Gill SV, Kulkarni VS, Lewis CL. The effect of trunk and shank position on the hip-to-knee moment ratio in a bilateral squat. Phys Ther Sport 2023; 61:102-107. [PMID: 37001335 PMCID: PMC10518215 DOI: 10.1016/j.ptsp.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES The effect of knee position on joint moments during squats has been studied; however, the effect of trunk angle has been less well investigated. This study evaluated the effect of both trunk and knee sagittal plane position on the distribution of moments between the hip and knee extensors during the bilateral squat. DESIGN Observational study. SETTING Biomechanics laboratory. PARTICIPANTS One hundred individuals performed bilateral squats. MAIN OUTCOME MEASURES Motion and force data were collected using motion capture and force plates. Trunk and shank angles and hip and knee moments were calculated. A linear regression was used to associate the ratio between the hip and knee moments (hip-to-knee moment ratio) with the sagittal plane trunk and shank angles, while accounting for six squat depths (between 60° and 110° of knee flexion) and side. RESULTS Trunk angle and shank angle each contributed to the hip-to-knee moment ratio (P < .001) with trunk accounting for a higher proportion of variance than the other variables. The hip-to-knee moment ratio increased with increasing trunk angle and with decreasing shank angle. CONCLUSIONS This large cohort study supports the use of trunk position to instruct squat technique with the goal of modifying hip and knee moments.
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Affiliation(s)
- Kerri A Graber
- Department of Physical Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA, 02215, United States
| | - Anne L Halverstadt
- Department of Physical Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA, 02215, United States
| | - Simone V Gill
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA, 02215, United States
| | - Varsha S Kulkarni
- Department of Mathematics and Statistics, Boston University College of Arts and Sciences, Boston, MA, 02215, United States
| | - Cara L Lewis
- Department of Physical Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA, 02215, United States.
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Effect of Simulated Changes in Pelvic Tilt on Hip Joint Forces. J Biomech 2022; 135:111048. [PMID: 35325751 PMCID: PMC9255277 DOI: 10.1016/j.jbiomech.2022.111048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
Abstract
Musculoskeletal modeling is commonly used to simulate and compare various movements between individuals. For conditions such as femoroacetabular impingement syndrome (FAIS), individuals tend to walk with more anterior pelvic tilt than those without FAIS. However, it is unknown whether accounting for pelvic tilt in musculoskeletal modeling would lead to a change in muscle forces and in turn, joint forces. Gait data of six individuals were collected and processed using Vicon and Visual3D. Each participant's pelvic tilt was adjusted by ± 10° at all time points during gait. Three analyses were performed per individual: no adjustment in tilt, one posterior (positive) tilt, and one anterior (negative) tilt. The resulting data were imported into OpenSim to determine muscle forces and the resulting femur-on-acetabulum (hip joint) forces in the pelvic and femoral reference frames. Data for each participant were normalized for gait cycle and body weight in MATLAB, and statistical parametric mapping was used to determine if the differences in joint and muscle forces were significant across different pelvic orientations. Shifting from posterior to anterior pelvic tilt reduced resultant forces. In the pelvic reference frame, anteriorly-directed joint forces decreased, while medially-directed forces increased. In the femoral reference frame, anteriorly- and medially-directed joint forces increased, while superiorly-directed forces decreased. Anterior gluteus medius and iliacus muscle forces decreased, while quadratus femoris, piriformis, and gemellus muscle forces increased. Given these results, future studies using musculoskeletal modeling should account for pelvic tilt in musculoskeletal models to obtain more realistic comparisons between healthy and pathological conditions.
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