Gait kinematics of the hip, pelvis, and trunk associated with external hip adduction moment in patients with secondary hip osteoarthritis: toward determination of the key point in gait modification

Hiroshige Tateuchi,Koji Goto,Haruhiko Akiyama,Yutaka Kuroda,Noriaki Ichihashi,Kazutaka So

doi:10.1186/s12891-019-3022-1

Hiroshige Tateuchi, Koji Goto + Show 4 more

Open Access

https://doi.org/10.1186/s12891-019-3022-1

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Abstract

BackgroundA larger daily cumulative hip loading, which is the product of the external hip adduction moment (HAM) impulse during gait and the number of steps per day has been identified as a factor associated with the progression of secondary hip osteoarthritis (OA). The cause of the increased HAM impulse in patients with hip OA has not been identified. The purpose of this study was to identify the gait parameters associated with HAM impulse during gait in patients with secondary hip OA.MethodsFifty-five patients (age 22–65 years) with mild-to-moderate secondary hip OA participated in this cross-sectional study. The HAM impulse during gait was measured using a three-dimensional gait analysis system. To identify the gait parameters associated with HAM impulse, hierarchical multiple regression analysis was performed. The first model (basic model) included body weight and stance phase duration. The second models included gait parameters (gait speed; ground reaction force [GRF] in frontal plane; and hip, pelvic, and trunk angle in frontal plane) and hip pain in addition to the basic model.ResultsBody weight and stance phase duration explained 61% of the variance in HAM impulse. In the second model, which took into account body weight and stance phase duration, hip adduction angle (9.4%), pelvic tilt (6.5%), and trunk lean (3.2%) in addition to GRF explained the variance in the HAM impulse. Whereas larger hip adduction angle and pelvic tilt toward the swing limb were associated with a larger HAM impulse, larger trunk lean toward the stance limb was associated with smaller HAM impulse.ConclusionIn patients with excessive hip adduction and pelvic tilt toward the swing limb during gait, gait modification may contribute to the reduction of hip joint loading.

Highlights

A larger daily cumulative hip loading, which is the product of the external hip adduction moment (HAM) impulse during gait and the number of steps per day has been identified as a factor associated with the progression of secondary hip osteoarthritis (OA)
Larger trunk lean toward the stance limb was associated with smaller HAM impulse (Fig. 2)
The results of our study provide support for our hypothesis, as we demonstrated that hip adduction and pelvic tilt toward the swing limb are important kinematic factors for HAM impulse during gait

Summary

Introduction

A larger daily cumulative hip loading, which is the product of the external hip adduction moment (HAM) impulse during gait and the number of steps per day has been identified as a factor associated with the progression of secondary hip osteoarthritis (OA). For hip OA, larger daily cumulative hip loading, which is the product of the external hip moment impulse during gait in the frontal plane (i.e., external hip adduction moment [HAM] impulse) and the mean number of steps per day, is a risk factor for subsequent radiographic progression of the secondary hip OA [2]. Maintaining daily physical activity is recommended for patients with OA [3], it may be important to control physical activity to prevent excessive daily cumulative hip loading and hip OA progression Reduction of both the HAM impulse during gait and the number of steps is required for reducing the daily cumulative hip loading. Identifying these factors in patients before they reach the terminal-stage of hip OA would be an important step toward preventing hip OA progression

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