Gait neuromechanics in women with and without joint hypermobility

Abstract

s / Gait & Posture 39S (2014) S1–S141 S7 legs, dependent on affected side, and three trials of participants were considered. Linear MixedModels were used to determine the main effects within retained principal components (PCs). Results: PatientsmeanAntetorsionwas38.6◦(SD6.1◦), basedon CT-scans. There were no significant group differences in sex, age, BMI and walking speed, but patients showed significant less hip external rotation in clinical examination. Group effects based on LinearMixedModels revealed that patientswalkedwith significant more internal foot progression angle (FPA) andmore external ankle rotation (ARA) than controls. There were no alterations observed in knee kinematics. Patients walked with significant more anterior pelvic tilt (SPA) and at hip joint level with more internally rotated (THA) and flexed (SHA) hips. Group effects in kinetics revealed that patients showed a significant lower knee adductionmoment (FKM) andhip adductionmoment (FHM).Differentiation into primary and secondary passive effects was derived from clinical considerations. Discussion and conclusions: Deviations in FPA and THA were stated as primary deviations. Due to the reduced hip external rotation patientswere not able to counterbalance for primary deviations. Passive secondary effects were detected in ARA, SHA, SPA, FKM and FHM. In order to achieve normal gait, patients walked with external ankle rotation, flexed hips and more anterior pelvic tilt. During gait internal hip rotation induced anterior pelvic tilt andmore hip flexion by straining iliofemoral ligaments. Moreover, anterior pelvic tilt may have wide-ranging consequences as it may induce increased lordosis of the lumbar spine and extension of the thoracic spine. Although in the current study FKM mean gait waveform indicated a tendency for an increased knee adduction moment in patients, the application of Linear Mixed Models on PC-scores of retained PCs showed a significant group effect in PC3 (explaining 16.74% of total variance), representing a lower knee adduction moment in patients. In hip the only significant group effect corresponded to a lower hip adduction moment in patients (PC2, explaining 15.32% of total variance), whereas mean gait waveform indicated a higher hip adduction moment. In summary coxa antetorta is not mainly a cosmetic problem in general. Modifications in kinematics and kinetics may cause physical complaints and osteoarthritis in future. Therefore, conducting 3DGA is recommended for individual clinical decision-making and planning surgical corrections in patients with coxa antetorta.