Hip kinematics in healthy adults during gait and squatting: Sex differences and asymmetry revealed through dynamic biplane radiography

Abstract

There is a lack of data unaffected by soft tissue artifact describing bilateral symmetry and sex differences in hip kinematics in asymptomatic individuals during activities of daily living. This study aimed to identify sex-based differences and to quantify bilateral symmetry in continuous hip kinematics during walking and bodyweight squatting using biplane radiography. Twenty-four asymptomatic young adults (13 women, 11 men; age: 21.9 ± 2.2 years) performed treadmill walking and squatting while synchronized biplane radiographs of the hip were collected at 50 frames/s. Pelvis and proximal femur bone tissue were segmented from CT images and reconstructed into subject-specific 3D bone models. Femoroacetabular kinematics were determined using a validated volumetric model-based tracking technique that matched digitally reconstructed radiographs generated from the CT-based bone models to the biplane radiographs. Symmetry was calculated as the average absolute side-to-side difference (SSD) in kinematic waveforms for each participant. Sex-based and phase-based (eccentric vs. concentric squatting) kinematic variations were assessed using linear mixed model analysis. Women were 0.2 mm more anteriorly translated and 0.1 mm more inferiorly translated than men across the gait cycle (both p < 0.04), but no sex-based or phase-based kinematic differences during squatting were identified. The maximum SSD across all movements was up to 18.6° (internal-external rotation) and 1.0 mm (superior-inferior translation), respectively. Asymmetry in internal rotation, superior translation, and medial translation was greater during squatting than during walking (all p < 0.002). This study provides a reference dataset of healthy young adults for evaluating hip kinematics and symmetry in symptomatic cohorts or in individuals undergoing surgery or rehabilitation.