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

S. van Drongelen,A. Meurer,F. Stief,S. Braun

doi:10.3389/fbioe.2021.756460

Abstract

Patients with unilateral hip osteoarthritis show a characteristic gait pattern in which they unload the affected leg and overload the unaffected leg. Information on the gait characteristics of patients with bilateral hip osteoarthritis is very limited. The main purposes of this study were to investigate whether the gait pattern of both legs of patients with bilateral hip osteoarthritis deviates from healthy controls and whether bilateral hip osteoarthritis patients show a more symmetrical joint load compared to unilateral hip osteoarthritis patients. In this prospective study, 26 patients with bilateral hip osteoarthritis, 26 patients with unilateral hip osteoarthritis and 26 healthy controls were included. The three groups were matched for gender, age and walking speed. Patients were scheduled for a unilateral total hip arthroplasty on the more affected/more painful side. All participants underwent a three-dimensional gait analysis. Gait kinematics and gait kinetics of patients and controls were compared using Statistical Parametric Mapping. Corrected for speed, the gait kinematics and kinetics of both legs of patients with bilateral hip osteoarthritis differed from healthy controls. Bilateral patients had symmetrical knee joint loading, in contrast to the asymmetrical knee joint loading in unilateral hip osteoarthritis patients. The ipsilateral leg of the bilateral patients could be included in studies in addition to unilateral hip osteoarthritis patients as no differences were found. Although patients with bilateral hip osteoarthritis show more symmetrical frontal plane knee joint moments, a pathological external knee adduction moment in the second half of stance was present in the ipsilateral leg in patients with unilateral and bilateral hip osteoarthritis. The lateral adjustment of the knee adduction moment may initiate or accelerate progression of degenerative changes in the lateral compartment of the knee.

Highlights

Patients with unilateral hip osteoarthritis (OA) show a characteristic asymmetric gait pattern in which they unload the affected leg (Schmidt et al, 2017; Wesseling et al, 2018; van Drongelen et al, 2020a)
The ipsilateral leg of the bilateral patients could be included in studies in addition to unilateral hip osteoarthritis patients as no differences were found
The present study showed that bilateral patients walk with a gait pattern, which has been previously published for unilateral patients: more thorax tilt and lean, more pelvic tilt, less hip extension and less knee extension (Shakoor et al, 2003; Foucher et al, 2007; van Drongelen et al, 2021)

Summary

Introduction

Patients with unilateral hip osteoarthritis (OA) show a characteristic asymmetric gait pattern in which they unload the affected leg (Schmidt et al, 2017; Wesseling et al, 2018; van Drongelen et al, 2020a). By doing so patients transfer load to the knee and hip joint of the contralateral leg. Large cohort studies have shown that unilateral hip OA patients have an increased risk for developing knee OA, in both the ipsilateral but especially in the contralateral knee (Gillam et al, 2013; Jungmann et al, 2015; Joseph et al, 2016). The external knee adduction moment is a commonly used surrogate measure for joint loading and has been related to the initiation and progression of knee OA (Miyazaki et al, 2002; Andriacchi and Mündermann, 2006). The external hip adduction moment has been identified as a major determinant for joint loading (Lenaerts et al, 2009; Wesseling et al, 2015)

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