Abstract
Summarizing results of three-dimensional (3D) gait analysis into a comprehensive measure of overall gait function is valuable to discern to what extent gait function is affected, and later recovered after surgery and rehabilitation. This study aimed to investigate whether preoperative gait function, quantified and summarized using the Cardiff Classifier, can predict improvements in postoperative patient-reported activities of daily living, and overall gait function 1 year after total hip arthroplasty (THA). Secondly, to explore relationships between pre-to-post surgical change in gait function versus changes in patient-reported and performance-based function. Thirty-two patients scheduled for THA and 25 nonpathological individuals were included in this prospective cohort study. Patients were evaluated before THA and 1 year postoperatively using 3D gait analysis, patient-reported outcomes, and performance-based tests. Kinematic and kinetic gait parameters, derived from 3D gait analysis, were quantified using the Cardiff Classifier. Linear regressions investigated the predictive value of preoperative gait function on postoperative outcomes of function, and univariate correlations explored relationships between pre-to-post surgical changes in outcome measures. Preoperative gait function, by means of Cardiff Classifier, explained 35% and 30% of the total variance in change in patient-reported activities of daily living, and in gait function, respectively. Moderate-to-strong correlations were found between change in gait function and change in patient-reported function and pain, while no correlations were found between change in gait function and performance-based function. Clinical significance: Preoperative gait function predicts postsurgical function to a moderate degree, while improvements in gait function after surgery are more closely related to how patients perceive function than their maximal performance offunctional tests.
Highlights
IntroductionOsteoarthritis (OA) is one of the leading causes of years lost to disability worldwide, and one of the most common chronic diseases of the musculoskeletal system.[1,2] Beside painful joints and decreased quality of life, patients with hip OA walk more slowly, walk with altered gait pattern characteristics[3,4] that are often reported as limping gait,[5] and have reduced hip muscle strength compared to healthy controls.[6,7,8,9] Total hip arthroplasty (THA) is a well‐accepted and frequently used surgical intervention for severe hip OA, and is considered one of the most successful orthopedic procedures.[10,11] The literature on THA typically investigates functional capacity using simple performance‐based activities such as short and long distance walking, stair negotiation,[12] and/or patient‐reported outcome measures.[13]
The trained classifier had an accuracy of 96.4% in distinguishing between gait patterns of individuals with hip OA and nonpathological individuals (Figure 3A)
This study investigated whether preoperative gait function, quantified and summarized by means of the novel Cardiff Classifier, could predict improvements in patient‐reported function, and gait function 1 year after Total hip arthroplasty (THA)
Summary
Osteoarthritis (OA) is one of the leading causes of years lost to disability worldwide, and one of the most common chronic diseases of the musculoskeletal system.[1,2] Beside painful joints and decreased quality of life, patients with hip OA walk more slowly, walk with altered gait pattern characteristics[3,4] that are often reported as limping gait,[5] and have reduced hip muscle strength compared to healthy controls.[6,7,8,9] Total hip arthroplasty (THA) is a well‐accepted and frequently used surgical intervention for severe hip OA, and is considered one of the most successful orthopedic procedures.[10,11] The literature on THA typically investigates functional capacity using simple performance‐based activities such as short and long distance walking, stair negotiation,[12] and/or patient‐reported outcome measures.[13]. The extensive datasets generated by instrumented 3D gait analysis are usually reduced into a substantially smaller set of discrete metrics (maximum, range, integral) calculated from selected waveforms. Discrete metrics from 3D gait analysis have demonstrated reduced hip adduction and extension angles in THA patients,[6,14,15] but are these discrete measures of functional importance to the degree where the overall gait function is affected, (i.e., summarized gait pattern and performance), and if so, to what extent? Discrete metrics from 3D gait analysis have demonstrated reduced hip adduction and extension angles in THA patients,[6,14,15] but are these discrete measures of functional importance to the degree where the overall gait function is affected, (i.e., summarized gait pattern and performance), and if so, to what extent? such discoveries on discrete metrics may in part be false‐positive findings due to multiplicity of potential endless numbers of variables.[16]
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