Abstract
Despite good clinical functional outcome, deficits in gait biomechanics exist 2 years after total hip replacement surgery. The aims of this research were (1) to group patients showing similar gait adaptations to hip osteoarthritis and (2) to investigate the effect of the surgical treatment on gait kinematics and external joint moments. In a secondary analysis, gait data of 51 patients with unilateral hip osteoarthritis were analyzed. A k-means cluster analysis was performed on scores derived via a principal component analysis of the gait kinematics. Preoperative and postoperative datasets were statistically tested between clusters and 46 healthy controls. The first three principal components incorporated hip flexion/extension, pelvic tilt, foot progression angle and thorax tilt. Two clusters were discriminated best by the peak hip extension during terminal stance. Both clusters deviated from healthy controls in spatio-temporal, kinematic and kinetic parameters. The cluster with less hip extension deviated significantly more. The clusters improved postoperatively but differences to healthy controls were still present one year after surgery. A poor preoperative gait pattern in patients with unilateral hip osteoarthritis is associated with worse gait kinematics after total hip replacement. Further research should focus on the identification of patients who can benefit from an adapted or individualized rehabilitation program.
Highlights
Hip osteoarthritis (OA) is one of the most common degenerative diseases of the musculoskeletal system [1] and a leading cause for disability in the older population.The prevalence of hip OA depends on age and sex: women are more often affected than men [2,3]
Andriacchi and Mündermann [9] demonstrated that the external knee adduction moment (KAM) during walking is a predictor of the progression of cartilage degeneration in the medial joint compartment and the development of OA in the knee joint
The most relevant finding of the present study are that the two clusters were discriminated best by the peak hip extension during terminal stance and that a poor preoperative gait pattern is associated with worse gait kinematics after total hip replacement (THR)
Summary
Hip osteoarthritis (OA) is one of the most common degenerative diseases of the musculoskeletal system [1] and a leading cause for disability in the older population.The prevalence of hip OA depends on age and sex: women are more often affected than men [2,3]. Hip OA is associated with joint pain and functional limitations [4]. When conservative therapy is not helping anymore and the personal suffering is too much, a total hip replacement (THR) is performed to reduce the pain and restore normal activity. Despite good clinical functional outcome [5] and a recovery of spatio-temporal gait parameters [6], gait kinematics and gait kinetics are not restored completely even two years after surgery [7,8]. Patients with hip and knee pathology present alterations in gait which have an effect on joint moments and loading [10,11]. Unfavorable kinematics and kinetics lead to higher joint loads in neighboring joints and are believed to play an important role in the development of OA in the neighboring joints in hip OA patients [12,13]
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