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Effects of Total Hip Arthroplasty on Gait
Abstract
The hip joint transfers upper body load to the lower limbs and plays an important role in maintaining balance and stability during locomotion. Muscles around the hip joint are also the major postural muscles in our body. A diseased hip joint experiences diminished function affecting the activity of daily living gravely. Furthermore, being a part of the closed kinetic chain, as the disease progresses, problems originating at the hip joint start showing effects on the neighboring joints including pelvis, knee, ankle and spine. The gold standard treatment for end-stage hip disease is total hip arthroplasty (THA). From a clinical perspective, total hip replacement is considered to be one of the most successful orthopedic surgeries in terms of patient outcome, based on self-reported questionnaires for health status. However, gait, being the major function of the hip joint, tends not to be assessed objectively in the outcome analysis of THA surgery. In research settings, THA has consistently shown a positive outcome with improved gait parameters compared to preoperative analysis. Note that this recovery is still not reported to be 100% in comparing to healthy controls and, as a result, objective assessment data during the early postoperative period can also be used to help design tailor-made rehabilitation protocols for individual patients, optimizing outcome results. This chapter details gait alteration in hip arthritis and improvement in gait following THA.
... Indirectly, due to the reduction of the minimal value for hip flexion/extension, a lower range of motion is relevant for classification. The effect has also been mentioned in previous studies [11,29]. KNEE_ANGLE_X_51 and KNEE_ANGLE_X_50 represent knee movement in the sagittal plane. ...
... The predictors KNEE_ANGLE_Y_39 and KNEE_ ANGLE_Y_57 show that, for class discrimination, knee abduction and adduction are important (movement in frontal plane). An altered varus has been reported in the literature [11]. The data revealed a bilateral valgus (abduction) for most patients, which was significantly increased for the operated side. ...
... The consideration above focuses on average characteristics, but individual patterns sometimes diverge (e.g., increased varus in patient 15). In line with the work of Chopra and Kaufman [11], the current study indicates a high variability in gait patterns (also see standard deviation) and possible subject-related differences and adaptions in patients after THA. Furthermore, the results for the singlesubject analysis show that for P4, the wrong side was predicted as the operated side. ...
Study aim: To find out, without relying on gait-specific assumptions or prior knowledge, which parameters are most important for the description of asymmetrical gait in patients after total hip arthroplasty (THA).
Material and methods: The gait of 22 patients after THA was recorded using an optical motion capture system. The waveform data of the marker positions, velocities, and accelerations, as well as joint and segment angles, were used as initial features. The random forest (RF) and minimum-redundancy maximum-relevance (mRMR) algorithms were chosen for feature selection. The results were compared with those obtained from the use of different dimensionality reduction methods.
Results: Hip movement in the sagittal plane, knee kinematics in the frontal and sagittal planes, marker position data of the anterior and posterior superior iliac spine, and acceleration data for markers placed at the proximal end of the fibula are highly important for classification (accuracy: 91.09%). With feature selection, better results were obtained compared to dimensionality reduction.
Conclusion: The proposed approaches can be used to identify and individually address abnormal gait patterns during the rehabilitation process via waveform data. The results indicate that position and acceleration data also provide significant information for this task.
... Overall, a ground truth of the automatically determined explanations is missing, and it therefore becomes more difficult to evaluate if the results are meaningful and appropriately map gait characteristics. In the literature, gait patterns of patients with THA are mostly described using simple descriptive statistics comparable with the V_simple input vector [36,46,47]. Consequently, it is harder to directly compare the effects respective to the determined relevant regions regarding the waveform data (V wave) with previous works. ...
... Further, it is not possible to evaluate all our findings with previous research because the literature often focuses on a few gait characteristics to describe group differences. In agreement with our findings, previous research reports a reduced ROM for knee and hip movement of the operated side in the sagittal plane compared with healthy subjects [36,44,[46][47][48]. Further, altered postoperative ankle rotation [46] and increased sagittal pelvic movement compared with healthy subjects was found [46,47]. ...
... In agreement with our findings, previous research reports a reduced ROM for knee and hip movement of the operated side in the sagittal plane compared with healthy subjects [36,44,[46][47][48]. Further, altered postoperative ankle rotation [46] and increased sagittal pelvic movement compared with healthy subjects was found [46,47]. ...
Many machine learning models show black box characteristics and, therefore, a lack of transparency, interpretability, and trustworthiness. This strongly limits their practical application in clinical contexts. For overcoming these limitations, Explainable Artificial Intelligence (XAI) has shown promising results. The current study examined the influence of different input representations on a trained model's accuracy, interpretability, as well as clinical relevancy using XAI methods. The gait of 27 healthy subjects and 20 subjects after total hip arthroplasty (THA) was recorded with an inertial measurement unit (IMU)-based system. Three different input representations were used for classification. Local Interpretable Model-Agnostic Explanations (LIME) was used for model interpretation. The best accuracy was achieved with automatically extracted features (mean accuracy M acc = 100%), followed by features based on simple descriptive statistics (M acc = 97.38%) and waveform data (M acc = 95.88%). Globally seen, sagittal movement of the hip, knee, and pelvis as well as transversal movement of the ankle were especially important for this specific classification task. The current work shows that the type of input representation crucially determines interpretability as well as clinical relevance. A combined approach using different forms of representations seems advantageous. The results might assist physicians and therapists finding and addressing individual pathologic gait patterns.
... Altered gait mechanics following unilateral osteoarthritis in lower extremity is well documented [1][2][3]. Gait asymmetry is shown to continue to exist postoperatively on both operated and non-operated sides [4][5][6][7]. Significant gait asymmetry not only affects balance but also increases the mechanical cost of walking [8]. Notably, with the age related decline in energy [9], such operations can lead to further decrease in physical activity levels in older adults. ...
Background
Gait asymmetries have been reported following ankle arthrodesis. However, similar reports do not exist for tibiotalocalaneal arthrodesis (TTCA), which involves further articular fusion. This study aimed to assess the extent of gait asymmetry following TTCA when compared to ankle arthrodesis.
Method
Gait assessment was performed on 36 participants, including 12 ankle arthrodesis, 12 TTCA and 12 controls – using 3-D inertial sensors and pressure insoles. 48 gait parameters were monitored on both operated and non-operated sides. Questionnaires including AOFAS, FAAM, EQ-5D were used to assess both operative groups, comparatively.
Results
Both operative groups reported significantly smaller stride, slower walking speed, altered stance phase with longer loading and shorter push-off compared to controls. Joint range of motion was significantly reduced on the operated side of both operative groups at hindfoot, forefoot and toe intersegments. However, the ankle arthrodesis group reported a significantly higher alteration compared to controls in maximum contact force and pressure distribution. Furthermore, bilateral comparison showed extended gait asymmetry in the ankle arthrodesis group with 29 out of 48 parameters being significantly different between the two sides, whereas only 16 out of 48 gait parameters showed bilateral difference in the TTCA group.
Conclusion
Both ankle salvage operations led to significant gait alteration and bilateral asymmetry. However, extended joint restriction in TTCA does not seem to worsen the gait outcomes. Further investigation is needed to understand the long-term impact of altered gait, on neighboring joints, following TTCA.
EINLEITUNG
Krafttraining im Jugendfußball dient sowohl der Verbesserung der sportartspezifischen Leistungsfähigkeit (Sprint, Sprung, Schusskraft) als auch der Prävention von Verletzungen
durch eine stärkere muskuläre Grundstruktur der im Fußball beanspruchten Muskelgruppen (Brito et al., 2010; Ekstrand, Hägglund & Waldén, 2011). Steigende Trainingsumfänge aufgrund von erhöhten physiologischen Anforderungen
im Jugendfußball sowie der daraus resultierende Zeitaspekt in Kombination mit der schulischen Ausbildung erschweren allerdings die Integration eines zusätzlichen, systematischen Krafttrainings in den Trainingsalltag der Jugendlichen.
Ganzkörper-Elektromyostimulationstraining (GK-EMS) könnte hier eine Ergänzung zum klassischen Krafttraining im leistungsorientierten Jugendfußball sein, da es durch seinen
hochintensiven und zeitsparenden Charakter eine effiziente Trainingstechnologie darstellt (Filipovic et al., 2016; W. Kemmler, Kohl & S., 2016). Ziel der Studie war es daher zu
überprüfen, inwieweit ein 10-wöchiges GK-EMS einen positiveren Einfluss auf ausgewählte Kraftparameter als ein reguläres Athletiktraining im Jugend-Elitefußball haben könnte.
METHODIK
30 männliche Elite- Jugendfußballer (zweithöchste Liga der Altersklasse, Regionalliga) zwischen 15-17 Jahren wurden in die Studie aufgenommen. Zwölf Spieler (Kontrollgruppe) absolvierten ein 10-wöchiges konventionelles Krafttraining, wohingegen 18 Spieler (GK-EMS Gruppe) über den gleichen Zeitraum die identischen Übungen mit zusätzlicher GK-EMS durchführten. Beide Gruppen trainierten einmal wöchentlich für 20 Minuten zusätzlich zu ihrem gemeinsamen regulären Trainingsbetrieb. Zur Vermeidung einer potenziellen Überlastung der Spieler wurden regelmäßige Kreatinkinasekontrollen
sowie eine ausführliche Anamnese zum Ausschluss von Kontraindikationen durchgeführt, sodass eine sichere Trainingsdurchführung stets gewährleistet war (Kemmler, Fröhlich,
von Stengel & Kleinöder, 2016; Kemmler et al., 2019). Vor und nach der Intervention wurden die isometrischen Extensions- und Flexionskräfte von Rumpf und Knie sowie
die Adduktions- und Abduktionskräfte der Hüfte gemessen. Berechnet wurden ANOVAs, Friedman- und Post Hoc t-Tests zur Überprüfung der Kraftentwicklung während der Interventionsphase sowie potenziellen Gruppenunterschieden.
ERGEBNISSE
Die GK-EMS Gruppe verbesserte sich in 4 der 6 getesteten Muskelgruppen signifikant, es konnten Steigerungen von 20.68±21.55% der Kraftwerte der Knieflexoren, 31.43±37.02%
der Knieextensoren, 21.70±12.86% der Hüftadduktoren und 33.72±27.43% der Rumpfflexoren festgestellt werden. In der Kontrollgruppe wurden keine signifikanten Verbesserungen der getesteten Muskelgruppen durch die Trainingsintervention
festgestellt.
DISKUSSION
Ein 10-wöchiges zusätzliches GK-EMS Training verbessert die Kraftfähigkeiten bestimmter Bein-, Hüft- und Rumpfmuskeln bei jugendlichen Elite-Fußballern signifikant stärker als ein konventionelles Athletiktraining. Das GK-EMS Training stellt somit eine zeiteffiziente Trainingstechnologie mit guten Integrationsmöglichkeiten in den Spiel- und Trainingsbetrieb dar. Durch die Stärkung der beim Fußball maßgeblich beanspruchten muskulären Strukturen dient es des Weiteren der gezielten Verletzungsprophylaxe von fußballtypischen Verletzungen der unteren Extremitäten und kann ebenso in der Regenerationsphase nach einer Verletzung als effektive Maßnahme zum Wiederaufbau der Leistungsfähigkeit genutzt werden.
Die rasante Entwicklung und stete Verbreitung miniaturisierter Sensorik und deren Applikationen (z.B. Apps, Inertialsensoren, Smartphone etc.) beeinflusst (fast) alle Dimensionen unserer gesellschaftlichen und sozialen Lebenswelten und zunehmend auch diejenige des Sports und des Gesundheitswesens (Thompson, 2019). Da Computer und Interfaces nicht nur leistungsfähiger bei der Berechnung und Verarbeitung von ansteigenden Datenmengen, sondern auch immer kleiner werden (Waldrop, 2016), stellen sie somit eine wesentliche Grundlage für selbstlernende Automatisierungsprozesse dar. Im Kontext Sport sowie im Gesundheitswesen sind die Anwendungsfelder explizit im Trainingsmonitoring, im Wettkampf, im Bereich des Regenerationsmanagements sowie in der (Leistungs-) bzw. medizinischen Diagnostik zu sehen (Düking et al., 2020). Neben dem langjährigen Einsatz miniaturisierter Sensorik zur Leistungs- und Bewegungsanalyse direkt an der Schnittstelle Mensch und Sportgerät (z.B. Ruderboote, Fahrräder oder Bobs etc.), kommen zunehmend tragbare und/oder körpernahe (in Teilen im Körper getragene) Sensoren (engl. „wearables“ oder “wearable sensor technology“) zur Anwendung (Düking, Achtzehn, Holmberg, & Sperlich, 2018; Düking, Holmberg, & Sperlich, 2017). Athleten und sportlich Aktive nutzen Wearables heutzutage hauptsächlich als Smartwatches oder Fitness- bzw. Activity-Tracker beispielsweise zur Messung der Herzfrequenz, des Energieverbrauchs, zur Trainings- oder körperlichen Belastung bzw. Beanspruchungsanalyse, zur Bestimmung des Aktivitäts- bzw. Inaktivitätsstatus, zur Einschätzung des Fitnessstatus sowie zum Schlaf- und Erholungsmonitoring (Seshadri et al., 2019). Wearables kommen zunehmend aber auch in Form von „smarter“ Kleidung wie T‑Shirts, Socken oder Schuhen, im Ohr (Hearables) bzw. smarte Kopfhörer oder als „smartes“ Pflaster zur Anwendung. Des Weiteren gibt es in Pillen verbaute Sensorik (Ingestibles/Implantables), die Biosignale wie die Körperkerntemperatur oder ein Monitoring der Medikamenteneinnahme telemetrisch übermitteln. Die Relevanz und hohe Bedeutung von Wearables wird nicht nur jährlich durch eine Spitzenplatzbelegung in den weltweiten Fitnesstrends, welche vom American College of Sports Medicine veröffentlicht werden, bestätigt – Platz eins der Fitnesstrends in 2020 mit einem geschätzten Umsatz von 95 Milliarden Dollar – (Thompson, 2018, 2019), sondern auch verschiedene internationale Organisationen wie die Weltgesundheitsorganisation sprechen sich für den potentiellen Mehrwert von Wearables zur Erhaltung und/oder der Verbesserung bestimmter gesundheitlicher Aspekte aus. Zudem erlauben immer mehr Spitzenverbände den Einsatz von verschiedensten Wearables während der Wettkämpfe, um beispielsweise Rückmeldung über verschiedene Biosignale (u.a. Körperkerntemperatur, Herzfrequenz, Ermüdungsindex etc.) zu erhalten. Die Entwicklung und Anwendung von Wearables im sportlichen und gesundheitsbezogenen Kontext steckt zwar noch in ihren Anfängen, eröffnet Sportwissenschaftlern aber aufgrund steigender Marktzahlen, der Akzeptanz diverser Organisationen, Sportverbänden und -vereinen eine interessante Profilierung in der beruflichen Karriere (Sports Performance Analysis). Da kommerziell vermarktete Wearables (welche den Sportmarkt adressieren) in Deutschland derzeit nicht reguliert und einer unabhängigen Überprüfung der Reliabilität und Validität unterliegen, werden zukünftig Experten benötigt, welche die Qualität der zur Verfügung gestellten Daten bewerten und einschätzen können (Kobsar et al., 2020). Firmen drängen mit aggressiven Marketingbotschaften auf den Sportartikel- und Gesundheitsmarkt, und viele Wearables halten in der Praxis nicht das, was sie versprechen (Sperlich & Holmberg, 2017). Parameter von kommerziell erhältlichen Wearables müssen daher häufig mit äußerster Vorsicht interpretiert werden, und es bedarf hier eines hohen Maßes an Expertenwissen. Die zunehmende Zahl erhältlicher Wearables sowie die steigende Zahl der messbaren Parameter führt zu einer Datenflut, was u.a. die Interpretierbarkeit, das Datenmanagement, die Forschungsethik und die Datensicherheit betrifft (RatSWD [Rat für Sozial- und Wirtschaftsdaten], 2020). Entsprechend qualifiziertes und speziell ausgebildetes Personal wird daher benötigt, welches sowohl die Relevanz einzelner Parameter einschätzen, aber auch im Kontext einer jeweiligen Sportart und Trainings- bzw. Wettkampfphase interpretieren und beurteilen kann.
Literatur
Düking, P., Achtzehn, S., Holmberg, H.-C., & Sperlich, B. (2018). Integrated Framework of Load Monitoring by a Combination of Smartphone Applications, Wearables and Point-of-Care Testing Provides Feedback that Allows Individual Responsive Adjustments to Activities of Daily Living. Sensors, 18 (5), 1632. doi:10.3390/s18051632
Düking, P., Fröhlich, M., & Sperlich, B. (2020). Technologische Innovation in der Trainingswissenschaft: Digitalgestützte Trainingssteuerung mittels tragbarer Sensorik. In A. Güllich & M. Krüger (Hrsg.), Bewegung, Training, Leistung und Gesundheit (S. 1-16). Berlin, Heidelberg: Springer.
Düking, P., Holmberg, H.-C., & Sperlich, B. (2017). Instant biofeedback provided by wearable sensor technology can help to optimize exercise and prevent injury and overuse. Frontiers in Physiology, 8, 167. doi:10.3389/fphys.2017.00167
Kobsar, D., Charlton, J. M., Tse, C. T. F., Esculier, J.-F., Graffos, A., Krowchuk, N. M., et al. (2020). Validity and reliability of wearable inertial sensors in healthy adult walking: a systematic review and meta-analysis. Journal of NeuroEngineering and Rehabilitation, 17 (1), 62. doi:10.1186/s12984-020-00685-3
RatSWD [Rat für Sozial- und Wirtschaftsdaten]. (2020). Datenerhebung mit neuer Informationstechnologie. Empfehlungen zu Datenqualität und -management, Forschungsethik und Datenschutz. Berlin: Rat für Sozial- und Wirtschaftsdaten (RatSWD).
Seshadri, D. R., Li, R. T., Voos, J. E., Rowbottom, J. R., Alfes, C. M., Zorman, C. A., et al. (2019). Wearable sensors for monitoring the internal and external workload of the athlete. NPJ Digital Medicine, 2, 71-71. doi:10.1038/s41746-019-0149-2
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Thompson, W. R. (2019). Worldwide survey of fitness trends for 2020. ACSM's Health & Fitness Journal, 23 (6), 10-18. doi:10.1249/fit.0000000000000526
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In ihrem 50. Jubiläumsjahr lud die Technische Universität Kaiserslautern am 26. und 27. November 2020 zu einem Höhepunkt ein: dem Kongress #Sport #Gesundheit #Digital. Für zwei Tage wurden im Rahmen eines Online-Forums gemeinsam die Themenfelder Sport, Gesundheit und Digitalisierung diskutiert. Wir freuen uns sehr, dass die Techniker Krankenkasse die TUK als Ausrichter der Veranstaltung besonders unterstützt hat.
#SGD – Der Kongress setzte an der Schnittstelle von Sport, Gesundheit und Digitalisierung an und beleuchtete Chancen und Möglichkeiten, die durch das Zusammenspiel dieser Disziplinen entstehen können. Gleichzeitig wurden Risiken und Herausforderungen der digitalen Entwicklungen in Sport und Gesundheit betrachtet und perspektivisch mit Blick in die Zukunft analysiert. Hochkarätige Beiträge aus Wissenschaft und Praxis aus allen für das Themenspektrum relevanten Fachrichtungen sorgten für ein hohes Maß an Abwechslung und Transfer. Der Kongress richtete sich dabei nicht nur an Personen aus Wissenschaft und Praxis der Bereiche Gesundheitswesen und -management, Medizin und Psychologie. Ebenso angesprochen wurden Übungsleitende und Angehörige aus Hochschulsport und Sportwissenschaft, Studierende und Mitarbeitende aller bezogenen Fachrichtungen sowie alle allgemein interessierten Personen.
Der vorliegende Kongressband stellt die Sammlung der Kongressinhalte dar. Neben den schriftlichen Beiträgen lassen sich hier auch Impressionen der Kongresstage und die Vorträge als interaktiv eingebundene Videos finden.
Predictions from biomechanical models of gait may be sensitive to joint center locations. Most often, the hip joint center (HJC) is derived from locations of reflective markers adhered to the skin. Here, predictive techniques use regression equations of pelvic anatomy to estimate the HJC, whereas functional methods track motion of markers placed at the pelvis and femur during a coordinated motion. Skin motion artifact may introduce errors in the estimate of HJC for both techniques. Quantifying the accuracy of these methods is an area of open investigation. In this study, we used dual fluoroscopy (DF) (a dynamic X-ray imaging technique) and three-dimensional reconstructions from computed tomography images, to measure HJC locations in vivo. Using dual fluoroscopy as the reference standard, we then assessed the accuracy of three predictive and two functional methods. Eleven non-pathologic subjects were imaged with DF and reflective skin marker motion capture. Additionally, DF-based solutions generated virtual markers placed on bony landmarks, which were input to the predictive and functional methods to determine if estimates of the HJC improved. Using skin markers, functional methods had better mean agreement with the HJC measured by DF (11.0 ± 3.3 mm) than predictive methods (18.1 ± 9.5 mm); estimates from functional and predictive methods improved when using the DF-based solutions (1.3 ± 0.9 and 17.5 ± 8.6 mm, respectively). The Harrington method was the best predictive technique using both skin markers (13.2 ± 6.5 mm) and DF-based solutions (10.6 ± 2.5 mm). The two functional methods had similar accuracy using skin makers (11.1 ± 3.6 and 10.8 ± 3.2 mm) and DF-based solutions (1.2 ± 0.8 and 1.4 ± 1.0 mm). Overall, functional methods were superior to predictive methods for HJC estimation. However, the improvements observed when using the DF-based solutions suggest that skin motion artifact is a large source of error for the functional methods.
Gait analysis using wearable sensors is an inexpensive, convenient, and efficient manner of providing useful information for multiple health-related applications. As a clinical tool applied in the rehabilitation and diagnosis of medical conditions and sport activities, gait analysis using wearable sensors shows great prospects. The current paper reviews available wearable sensors and ambulatory gait analysis methods based on the various wearable sensors. After an introduction of the gait phases, the principles and features of wearable sensors used in gait analysis are provided. The gait analysis methods based on wearable sensors is divided into gait kinematics, gait kinetics, and electromyography. Studies on the current methods are reviewed, and applications in sports, rehabilitation, and clinical diagnosis are summarized separately. With the development of sensor technology and the analysis method, gait analysis using wearable sensors is expected to play an increasingly important role in clinical applications.
Estimates of objectively measured physical activity among older adults differ depending on the cut points used to define intensity. Our objective was to assess 1) moderate to vigorous physical activity (MVPA), exploring differences in prevalence depending on the cut point used, and 2) sedentary behavior, among US adults aged 60 years or older.
We used the most recently available accelerometer data (2003-2004 and 2005-2006) from the National Health and Nutrition Examination Survey. The sample included 2,630 adults aged 60 or older who wore an ActiGraph accelerometer for 1 week. We defined MVPA using 4 cut points (≥500, ≥1,000, ≥1,500, and ≥2,000 counts/min) and sedentary behavior as fewer than 100 counts per minute. All estimates were weighted to reflect the US population.
The overall average counts per minute was 216. Mean MVPA ranged from 10.8 minutes per day (based on 2,000 counts/min) to 106.8 minutes per day (based on 500 counts/min). Regardless of the cut point used, MVPA was lower with each successive age group (60-69, 70-79, and ≥80) and higher among men than women. At any cut point, MVPA was highest for Hispanics and "other" racial/ethnic groups, followed by non-Hispanic whites and non-Hispanic blacks. The average time spent in sedentary behavior was 8.5 hours per day. The amount of sedentary time was greater among participants who were aged 80 or older compared to younger groups and among men compared to women.
MVPA estimates vary among adults aged 60 or older, depending on the cut point chosen, and most of their time is spent in sedentary behaviors. These considerations and the data presented suggest more research is necessary to identify the appropriate method of setting accelerometer cut points for MVPA in older adults.
Standard total hip arthroplasty (THA) is the established surgical treatment for patients older than 65 years with progressive osteoarthritis but survivorship curves wane in patients younger than 50. Resurfacing hip arthroplasty (RHA) is an alternative for younger, active patients reportedly providing superior range of motion. Quantitative investigation of functional recovery following arthroplasty may elucidate limitations that aid in device selection. Although limited long-term kinematic data are available, the early rate of recovery and gait compensations are not well described. This information may aid in refining rehabilitation protocols based on limitations specific to the implant. We presumed hip motion and forces for subjects receiving RHA are more similar to age-matched controls during physically demanding tasks, such as stair negotiation, at early time points than those for THA. In a pilot study, we quantified walking and stair negotiation preoperatively and 3 months postoperatively for seven patients with RHA (mean age, 49 years), seven patients with standard THA (mean age, 52 years), and seven age-matched control subjects (mean age, 56 years). Although both treatment groups demonstrated trends toward functional recovery, the RHA group had greater improvements in hip extension and abduction moment indicating typical loading of the hip. Further investigation is needed to determine if differences persist long term or are clinically meaningful.
Human movement analysis using stereophotogrammetry is based on the reconstruction of the instantaneous laboratory position of selected bony anatomical landmarks (AL). For this purpose, knowledge of an AL's position in relevant bone-embedded frames is required. Because ALs are not points but relatively large and curved areas, their identification by palpation or other means is subject to both intra- and inter-examiner variability. In addition, the local position of ALs, as reconstructed using an ad hoc experimental procedure (AL calibration), is affected by photogrammetric errors. The intra- and inter-examiner precision with which local positions of pelvis and lower limb palpable bony ALs can be identified and reconstructed were experimentally assessed. Six examiners and two subjects participated in the study. Intra- and inter-examiner precision (RMS distance from the mean position) resulted in the range 6-21 mm and 13-25 mm, respectively. Propagation of the imprecision of ALs to the orientation of bone-embedded anatomical frames and to hip, knee and ankle joint angles was assessed. Results showed that this imprecision may cause distortion in joint angle against time functions to the extent that information relative to angular movements in the range of 10 degrees or lower may be concealed. Bone geometry parameters estimated using the same data showed that the relevant precision does not allow for reliable bone geometry description. These findings, together with those relative to skin movement artefacts reported elsewhere, assist the human movement analyst's consciousness of the possible limitations involved in 3D movement analysis using stereophotogrammetry and call for improvements of the relevant experimental protocols.
To determine if compensatory actions take place at the pelvis and other joints of the affected lower limb in subjects who were in an early stage of hip osteoarthritis (OA).
Nonrandomized, case-control study.
A gait laboratory.
Seventeen patients with OA of the hip (clinical group) matched with 17 healthy elderly subjects (nonclinical group).
Video data obtained while subjects walked a 10-meter walkway twice and stepped across a forceplate.
Four phasic and temporal gait parameters (walking speed, stance phase relative duration, stride length, cadence) 10 pelvic (pelvic tilt, obliquity, rotation at push-off maximum range of motion for all 3) and hip (3 hip angles at push-off, maximum hip flexion) kinematic parameters, 3 hip moments, and twenty-seven 3-dimensional peak muscle powers (labeled by joint, peak power, plane) developed in the lower limb joints during the gait cycle.
Subjects in the clinical group were characterized by a 12.4% slower walking speed. The pelvis was more upwardly tilted (2.5 times) at push-off in the clinical group than in the nonclinical group. Obliquity, measured in the frontal plane, revealed that the pelvis dropped more (2.4 times) on the unsupported limb of the clinical group at push-off. In the sagittal plane, subjects in the clinical group absorbed less energy in their second hip peak power for decelerating the thigh extension and generated less hip pull (third hip peak power) than the nonclinical group by 34% and 29%, respectively. In the sagittal plane, the clinical group had 57% lower second knee peak power to straighten the joint shortly after heel strike, and 43% less knee absorption (third peak power) at push-off. During the push-off phase, the clinical group developed more than twice their third peak knee power in the frontal plane and 5 times more their third peak knee power in the transversal plane than the peak knee power of the nonclinical group in an attempt to control knee adduction and to facilitate body-weight transfer by an internal rotation. At the end of the swing phase, the fourth peak power in the sagittal plane showed the absorption power required to decelerate the leg; it was reduced by 35% in the clinical group, representing a strategy to increase walking speed by lengthening the stride length.
Even at an early stage of hip OA, joint degeneration was compensated by an increase in pelvis motion and muscle power generation or absorption modifications in other lower limb joints.
Aims:
We investigated changes in the axial alignment of the ipsilateral hip and knee after total hip arthroplasty (THA).
Patients and methods:
We reviewed 152 patients undergoing primary THA (163 hips; 22 hips in men, 141 hips in women) without a pre-operative flexion contracture. The mean age was 64 years (30 to 88). The diagnosis was osteoarthritis (OA) in 151 hips (primary in 18 hips, and secondary to dysplasia in 133) and non-OA in 12 hips. A posterolateral approach with repair of the external rotators was used in 134 hips and an anterior approach in 29 hips. We measured changes in leg length and offset on radiographs, and femoral anteversion, internal rotation of the hip and lateral patellar tilt on CT scans, pre- and post-operatively.
Results:
The mean internal rotation increased by 11° (-15° to 46°) and was associated with underlying disease (OA), pre-operative range of internal rotation, gender, surgical approach, leg lengthening, and change of femoral anteversion (adjusted R(2) : 0.253, p < 0.001). The mean lateral patellar tilt increased by 4° (-5° to 14°) and was associated with age, leg lengthening, and increment of hip internal rotation (adjusted R(2): 0.193, p < 0.001).
Conclusion:
Both internal rotation of the hip at rest and lateral patellar tilt are increased after THA. Changes in rotation after THA may affect gait, daily activities, the rate of dislocation of the hip, and ipsilateral knee pain.
Take home message:
Internal rotation of the hip at rest and lateral patellar tilt increase after THA. Cite this article: Bone Joint J 2016;98-B:349-58.
Several approaches may be used for hip replacement surgery either in combination with conventional total hip arthroplasty (THA) or resurfacing hip arthroplasty (RHA). This study investigates the differences in hip loading during gait one year or more after surgery in three cohorts presenting different surgical procedures, more specific RHA placed using the direct lateral (RHA-DLA, n = 8) and posterolateral (RHA-PLA, n = 14) approach as well as THA placed using the direct anterior (THA-DAA, n = 12) approach. For the DAA and control subjects, hip loading was also evaluated during stair ascent and descent to evaluate whether these motions can better discriminate between patients and controls compared to gait. Musculoskeletal modelling in OpenSim was used to calculate in vivo joint loading. Results showed that for all operated patients, regardless the surgical procedure, hip loading was decreased compared to control subjects, while no differences were found between patient groups. This indicates that THA via DAA results in similar hip loading as a RHA via DLA or PLA. Stair climbing did not result in more distinct differences in hip contact force magnitude between patients and controls, although differences in orientation were more distinct. However, patients after hip surgery did adjust their motion pattern to decrease the magnitude of loading on the hip joint compared to control subjects.
Minimally invasive surgery (MIS) is becoming increasingly popular. Supporters claim that the main advantages of MIS total hip replacement (THR) are less pain and a faster rehabilitation and recovery. Critics claim that safety and efficacy of MIS are yet to be determined. We focused on a biomechanical comparison between surgical standard and MIS approaches for THR during the early recovery of patients. A validated, parameterized musculoskeletal model was set to perform a squat of a 50th percentile healthy European male. A bilateral motion was chosen to investigate effects on the contralateral side. Surgical approaches were simulated by excluding the incised muscles from the computations. Resulting hip reaction forces and their symmetry and orientation were analyzed. MIS THR seemed less influential on the symmetry index of hip reaction forces between the operated and nonoperated leg when compared to the standard lateral approach. Hip reaction forces at peak loads of the standard transgluteal approach were 24% higher on the contralateral side when compared to MIS approaches. Our results suggest that MIS THR contributes to a greater symmetry of hip reaction forces in absolute value as well as force-orientation following THR. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
People with osteoarthritis (OA) often are physically inactive. Surgical treatment including total hip arthroplasty or total knee arthroplasty can substantially improve pain, physical function, and quality of life. However, their impact on physical activity levels is less clear.
We used accelerometers to measure levels of physical activity pre- and (6 months) postarthroplasty and to examine the proportion of people meeting the American Physical Activity Guidelines.
Sixty-three people with hip or knee OA awaiting arthroplasty were recruited from a major metropolitan hospital. Physical activity was measured using accelerometry before, and 6 months after, surgery. The ActiGraph GT1M (ActiGraph LLC, Fort Walton Beach, FL, USA) was used in this study and is a uniaxial accelerometer contained within a small activity monitor designed to measure human movement through changes in acceleration, which can then be used to estimate physical activity over time. Questionnaires were used to assess patient-reported changes in pain, function, quality of life, and physical activity. Complete data sets (including valid physical activity data) for both time points were obtained for 44 participants (70%). At baseline before arthroplasty, the activity level of patients was, on average, sedentary for 82% of the time over a 24-hour period (based on accelerometry) and self-rated as "sometimes participates in mild activities such as walking, limited shopping, and housework" according to the UCLA activity scale.
There was no change in objectively measured physical activity after arthroplasty. The majority of participants were sedentary, both before and after arthroplasty, and did not meet the American Physical Activity Guidelines recommended to promote health. This was despite significant improvements in self-reported measures of pain, function, quality of life, and physical activity after arthroplasty.
Despite patient-reported improvements in pain, function, and physical activity after arthroplasty, objectively measured improvements in physical activity may not occur. Clinicians should incorporate strategies for improving physical activity into their management of patients after hip and knee arthroplasty to maximize health status. Future research is needed to explore the factors that impact physical activity levels in people after arthroplasty.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
To investigate the differences in gait biomechanics on the basis of approach at one year after surgery.
This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment one year following total hip arthroplasty. Temporospatial, kinetic, and kinematic data as well as functional outcomes were collected. Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries.
Controlled Laboratory Study PARTICIPANTS: This study sought to examine thirty-five primary, unilateral total hip arthroplasty (THA) patients. The THA surgical approaches that were used in these patients included 12 direct lateral, 18 posterior and 11 anterolateral. All patients were assessed one year THA. Patients were excluded from the study if they had contralateral hip pain or pathology or any prior lower extremity total joint replacements.
Not Applicable MAIN OUTCOME MEASUREMENTS: Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected. In addition, a series of physical performance measures were collected.
No main effects for the physical performance measures or biomechanical variables were observed between approach groups. Significant limb-to-limb asymmetries were observed among all patients, with decreased sagittal plane range of motion, peak extension, and peak vertical ground reaction forces on the operative side.
The results of this study indicate that no significant differences existed between the different surgical approach group for any study variable. However, one year after THA, patients demonstrate asymmetric gait patterns regardless of surgical approach indicating the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry following THA.
Detailed assessment of activity before and after total hip arthroplasty (THA) including a long-term follow-up is lacking. Our objective was (1) to evaluate how patient's activity evolves: prior to disease onset, prior to THA, and at 5 and 10 years postoperative, and (2) to determine predictors of high activity 5 years postoperative.
We included elective primary THAs operated upon between 1996 and 2012. A cross-sectional analysis compared mean UCLA activity scores over four periods: prior to symptom onset of osteoarthritis, prior to surgery, 5- and 10-years postoperative. Stratified analyses were performed by sex, age, BMI, ASA classes and preoperative activity level. A prospective study was conducted to identify baseline characteristics associated with a high activity (UCLA ≥7) 5 years postoperative using logistic regression.
Mean UCLA scores prior to symptom onset (N=189), prior to THA (N=203) and 5 (N=1085) and 10 (N=757) years postoperative were 6.9, 3.5, 5.7 and 5.5, respectively. Postoperative scores were close to values prior to symptom onset in patients older than 55 years, but they were lower in those who were younger. High activity was reported by 49% prior to symptom onset, 5% prior to surgery, and 28% at five and ten years postoperative. Predictors of high activity at 5 years were age <65 years, male gender, lower BMI and ASA score, and an active lifestyle prior to surgery.
5 and 10 years after primary THA physical activity levels were substantially higher in men and women and in all age categories as compared to preoperative. © 2013 American College of Rheumatology.
Benefits of a direct anterior approach (DAA) versus a posterior-lateral (PA) approach to THA were assessed in a single-surgeon, IRB-approved, prospective, randomized clinical study. Subjects (43 DAA and 44 PA) were evaluated at 6weeks, and 3, 6 and 12months. The primary end point was ability to climb stairs normally and walk unlimited at each time point. Secondary end points included assessment by several outcome instruments. DAA subjects performed better during the immediate post-operative period; they had lower VAS pain scores on the first post-operative day, more subjects climbing stairs normally and walking unlimited at 6weeks, and higher HOOS Symptoms scores at 3months. There were no significant differences between groups at later time points. Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases.
Large head total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) are alternatives to standard THA that generally have head sizes larger than 36mm. This study examined 20 patients (10 large head THA and 10 HRA), at an average of 18months postoperatively, and 15 healthy control subjects during stair negotiation. Hip kinetic and kinematic variables and ground reaction forces were measured. The THA and HRA groups ascended the stairs with increased peak hip flexion angles and decreased hip extension angles as compared with controls. The operative groups also descended the stairs with decreased hip flexion moments. No differences between the operative groups were observed. Eighteen months postoperatively, patients with large head THA or HRA display abnormal flexion and extension during a physically-demanding task.
OBJECTIVE: To conduct a systematic review and critical evaluation of the literature to determine whether muscles of the affected legs of individuals with unilateral hip OA are weaker, smaller, of lesser quality and/or more inhibited than those of their contra-lateral limb and/or limbs of healthy controls. METHODS: Six electronic databases were searched to identify articles that compared muscle strength, size, quality and inhibition of the affected leg of persons with unilateral hip OA with their contra-lateral leg and/or legs of healthy controls. Included articles were assessed for bias and appraised for quality. Standardised effect sizes were calculated for measures of leg muscle strength, size, quality and inhibition. RESULTS: Thirteen articles met the inclusioncriteria. There was strong evidence for lesserstrength of muscles within the affected leg in persons with hip OA compared with their contra-lateral leg and/or healthy control legs. There was also moderate evidence for reduced muscle size and quality in the affected compared with the contra-lateral limb of hip OA participants. Evidence for muscle inhibition within the affected limb of persons with hip OA compared with their contra-lateral leg and/or the healthy control legs was limited. CONCLUSION: Individuals with hip OA experience generalised lower limb weakness primarily due to reduction in muscle size (muscle atrophy). Overall findings of this review suggest the need to address the issue of lower limb muscle weakness in the clinical management of hip OA.
The present single-centre prospective follow-up study assessed the objective changes in physical activity undertaken before and after total hip arthroplasty (THA) using accelerometry. We enrolled 12 female patients who underwent home-based accelerometry assessment one month before and six months after the THA procedure. We assessed the daily amount of physical activity and energy expenditure related to physical activities. We also recorded the intensity of the physical activity, and pre- and post-operative clinical evaluation with the Harris Hip Score (HHS). At 6 months after surgery, we found a statistically significant increase of the total energy cost of physical activity (DA) (P=0.02), without significant increase of activity time (P>0.05). The energy cost of moderate/vigorous activity was statistically significant increased after surgery (P=0.008). Finally, HHS improved form 53.9±15.3 pre-operatively to 78.1±12.2 post-operatively (P=0.03). In our patients, the improvement was significant only for the total energy cost of daily activity. Thus, although patients did not exhibit a more active lifestyle, as shown by the slight increase of the activity time, they significantly increased the amount of moderate or vigorous activities performed after surgery.
Both the hip and knee contralateral to a total hip replacement (THR) have an increased risk of osteoarthritis (OA) progression, and ultimate joint replacement. It is also known that abnormal gait contributes to OA progression. For these reasons, we conducted a longitudinal analysis of contralateral hip and knee gait during the first year after unilateral THR to determine whether abnormal contralateral gait biomechanics emerge after THR. We analyzed the sagittal plane dynamic range of motion and 3D peak external moments from the asymptomatic hip and knee contralateral to a THR in a group of 26 subjects, evaluated preoperatively, and 3, 12, 24, and 52 weeks after THR, and a group of control subjects. We used t-tests and repeated measures ANOVA to test the hypotheses that contralateral hip and knee gait parameters are normal preoperatively, but change after THR. Preoperatively, the contralateral hip abduction moment and the contralateral knee adduction, flexion, and external rotation moments were significantly higher than normal in the THR group (p ≤ 0.048). Apart from the peak hip extension moment, which decreased three weeks after surgery but returned to its preoperative value thereafter, there were no longitudinal changes during the study period (p ≥ 0.141). Preoperative gait abnormalities persisted postoperatively. Notably, the contralateral knee adduction moment was 32% higher than normal in the THR group. These results indicate a biomechanical basis for the increased contralateral OA risk after unilateral THR, and suggest that some patients may benefit from strategies to reduce loading on the contralateral limb.
Although total hip arthroplasty (THA) is known to be a successful surgical procedure to alleviate hip pain and to improve health-related quality of life, these outcome measures in THA patients do not reach those of the general population. As a result, several investigators have assessed THA patients' gait mechanics, but most of them have ignored adjacent joints, as well as the effect that THA may have on the non-operated limb. The purpose of this investigation was to determine the effect of THA on the pelvis, hip, knee and ankle joint kinematics, as well as the hip, knee and ankle kinetics of both the operated and non-operated limbs during walking. These data were recorded for 20 patients having undergone unilateral THA and 20 healthy, matched control participants. Results revealed that the gait mechanics of THA patients did not return to normal 10.6 months, on average (+/-2.6 mo), following surgery. THA patients walked with lower operated-hip abduction moments, sagittal-plane range of motion, as well as lower generated and absorbed power, that may be consequential to pain-avoidance strategies adopted pre-operatively or to apprehensions associated with their new prosthesis. They also displayed various kinematic adaptations at the ankle joint of the operated limb and at the non-operated hip joint that may be leaving them at risk of developing other joint diseases. Further investigation is needed to confirm the reasons why THA patients' gait mechanics do not return to normal following surgery to develop better surgical techniques and/or rehabilitation programs.
The motions, forces, and moments at the major joints of the lower limbs of ten men ascending and descending stairs were analyzed using an optoelectronic system, a force-plate, and electromyography. The mean values for the maximum sagittalplane motions of the hip, knee, and ankle were 42, 88, and 27 degrees, respectively. The mean maximum net flexion-extension moments were: at the hip, 123.9 newton-meters going up and 112.5 newton-meters going down stairs; at the knee, 57.1 newton-meters going up and 146.6 newton-meters going down stairs; and at the ankle, 137.2 newton-meters going up and 107.5 newton-meters going down stairs. When going up and down stairs large moments are present about weight-bearing joints, but descending movements produce the largest moments. The magnitudes of these moments are considerably higher than those produced during level walking.
It was the purpose of this study to investigate loading of the hip joint during various skiing activities and to compare the results with walking and running. The results are relevant to determine which skiing activities can be recommended for patients after total hip replacement.
Nine male subjects were instrumented with a 12-channel accelerometer system mounted on the upper body. Data were collected during walking, running, and six skiing activities and used as input for an inverse dynamic analysis that resulted in the time histories of the intersegmental force and moment at the supporting hip joint. Joint contact force was computed using a simple muscle model. Peak values were determined, averaged over all loading cycles, and compared between activities.
Intersegmental force, indicating the influence of upper body weight and accelerations, was highest during running. Intersegmental moments were highest during the alpine skiing activities and indicated large extensor muscle forces at the hip joint. The peak joint contact force during walking at 1.5 m x s(-1) was 2.5+/-0.3 times body weight (BW). Running at 3.5 m x s(-1) produced a joint contact force of 5.2+/-0.4 BW during the push-off phase. Joint contact forces during four different alpine skiing conditions ranged from 4.1+/-0.6 BW (long turns, flat slope) to 7.8+/-1.5 BW (short turns, steep slope). Cross-country skiing had lower hip joint loading than running but higher than walking: 4.0+/-1.1 BW for classical technique and 4.6+/-0.6 BW for skating technique.
Assuming that walking is a "safe" activity for a hip prosthetic patient, controlled alpine skiing and cross-country skiing appear relatively safe with respect to the magnitude of loading. However, the skiing activities showed considerably higher mediolateral and anterior-posterior forces than walking. Mechanical testing of prosthetic devices with loading conditions specific to these activities is needed to assess the effect of these force components on hip prostheses and to allow interpretation with respect to potential effects of skiing for a hip prosthetic patient.
To determine whether additional muscle fibre wasting of the ipsilateral vastus lateralis muscle occurs in the early postoperative period after total hip arthroplasty for osteoarthritis of the hip and whether there is an improvement in preoperative measures of quadriceps muscle thickness, strength, pain and function over a 5-month postoperative period.
Twelve patients had ipsilateral needle quadriceps biopsy for muscle morphology and bilateral quadriceps muscle thickness ultrasound preoperatively, 5 days and 4 weeks postoperatively and a further muscle thickness measurement at 5 months. Seven additional patients and five age-matched control subjects had bilateral quadriceps muscle ultrasound thickness preoperatively, 6 weeks and 5 months postoperatively, with assessment of quadriceps muscle dynamometry, pain scores and Timed Up and Go (TUG) test.
Preoperatively, all 19 patients demonstrated significant atrophy of the ipsilateral compared with the contralateral quadriceps muscle (P = 1.8 x 10(-7)) on muscle ultrasound, which persisted at 5 months follow up (P = 0.009). Muscle morphology preoperatively showed type 2A and 2B muscle fibre atrophy on needle muscle biopsy, with further atrophy of all three fibre types (P = 0.029) at 5 days postoperatively associated with a fibre type shift from type 1 to 2A fibres (P = 0.0011) at 1 month. There was improvement in hip pain postoperatively and a significant improvement in the TUG test (P = 0.007). However, there was no improvement in muscle strength on dynamometry.
There is significant ipsilateral quadriceps atrophy and weakness with 2A and 2B fibre atrophy preoperatively in patients with osteoarthritis of the hip with exacerbation and further atrophy of all three fibre types 5 days postoperatively. Postoperative follow up showed that the reduction in ipsilateral quadriceps muscle thickness persisted at 5 months despite physical rehabilitation. Patients did note significant improvement in pain postoperatively and improvement on functional assessment with the TUG test. Other therapeutic strategies may have to be developed to reverse disuse muscle atrophy.
This study examined the effect of the surgical approach used in total hip arthroplasty (THA) on gait mechanics six months following surgery. Quantitative gait analysis was performed on 29 subjects: 10 anterolateral (A-L) and 10 posterolateral (P-L) THA patients and nine able-bodied, velocity-matched subjects. Discriminant function analysis was used to determine the distinction of the groups with respect to sagittal plane hip range of motion, index of symmetry, trunk inclination, pelvic drop, hip abduction, and foot progression angles. The A-L group had the largest trunk inclination (3.0+/-2.4 degrees) and the smallest hip range of motion (34.0+/-7.4 degrees). Both THA groups demonstrated greater asymmetry as expressed by the smaller symmetry index (0.97+/-0.04 for A-L and 0.98+/-0.05 for the P-L) than the able-bodied group (0.99+/-0.01). The classification procedure correctly classified 89% of the control group cases, 90% of the A-L cases, and 50% of the P-L cases. These results support the conclusion that six months following surgery, the gait of the majority (85%) of THA patients has not returned to normal. The A-L patients displayed distinct gait patterns, while a small percentage (30%) of the P-L patients demonstrated normal gait. While these differences are statistically significant, the clinical significance is unknown and linked to the duration that they persist.
A retrospective, age- and sex-matched radiographic study.
To investigate the spinopelvic alignment in patients with osteoarthosis of the hip (HOA) and those with low back pain (LBP) and to determine the characteristics and differences in both groups.
Hip-spine syndrome, first described by Offierski and MacNab, is quite an important pathology when treating patients with pain in their low back and lower extremities. However, despite it being a well-known entity, few papers have adequately investigated and assessed the spinopelvic alignment in patients with hip-spine syndrome.
Sagittal and coronal spinopelvic alignments were investigated in 150 patients with HOA and 150 with LBP using radiographs of the whole spine in both anteroposterior and lateral views. Parameters measured in this study were lumbar lordosis (LL), sacral slope (SS), the shift of the sagittal C7 plumb line, pelvic incidence (PI), and pelvic tilt (PT) on the lateral radiographs. On the anteroposterior (AP) films, lumbar scoliosis, pelvic obliquity, leg length discrepancy, the shift of the coronal C7 plumb line, and Sharp angle were measured. These parameters were compared between the two groups. In patients with HOA, the relationships between Sharp angle and other parameters were also analyzed to clarify the possible influence of sagittal and coronal spinopelvic alignments on HOA without acetabular dysplasia.
LL, SS, PI, and PO were found to be less in patients with LBP compared with those with HOA, and there was no significant difference in LS between the two groups. PI was significantly greater in HOA patients and strongly correlated to PT, SS, and LL (i.e., as the PI increased so did the PT, SS, and LL). Sharp angles were also significantly greater in HOA patients and strongly correlated to age, LL and SS (i.e., as Sharp angles increased so did LL and SS); however, age decreased in the hip patients.
These findings suggest that higher PI in the younger individual may contribute to the development of HOA in later life without both lumbar kyphosis and acetabular dysplasia because of the anterior uncovering of the acetabulum. More investigation will be expected to analyze the spinopelvic alignment in patients with hip spine syndrome.
Prospective clinical study on the effect of total hip replacement surgery (THR) on low back pain (LBP) in patients with severe hip osteoarthritis.
To assess the affect of THR on LBP.
Hip osteoarthritis causes abnormal gait and spinal sagittal alignment and is associated with LBP.
All consecutive adults scheduled for THR in our department due to severe hip osteoarthritis were assessed by an independent investigator before surgery and 3 months and 2 years post-THR. The Harris Hip Score and the Oswestry scores were used to evaluate hip- and spine-related symptoms, respectively, as were visual analogue scales (VAS) and sagittal spinal radiographs.
Twenty-five patients (10 males; age range, 32-84 years) were evaluated. Both spinal and hip pain and function were significantly better following THR. The mean preoperative LBP VAS score of 5.04 was 3.68 after THR (P = 0.006). The mean preoperative Oswestry score of 36.72 was 24.08 after THR (P = 0.0011). Clinical improvement was maintained and enhanced at the 2-year follow-up. The mean hip pain VAS score was 7.08 before THR and 2.52 after THR (P < 0.01). The mean Harris Hip Score was 45.74 before and 81.8 after surgery (P < 0.01). There were no changes in the radiographic measurements.
Both LBP and spinal function were improved following THR. This study demonstrates the clinical benefits of THR on back pain and is the first to clinically validate hip-spine syndrome as hypothesized by Offierski and MacNab in 1983.
Strong evidence suggests a link between physical inactivity and chronic disease prevalence in the adult population. To target the right groups for interventions in a population, accurate assessment of physical activity is important. The objective of this study was to assess the levels and pattern of physical activity and inactivity in an adult population sample using an objective method.
In total, 1114 adults (56% women, 45+/-15 yr), randomly recruited from the Swedish population across a year, used an accelerometer (Actigraph MTI) for seven consecutive days. Inactivity was defined as <100 counts per minute, and cutoff values for moderate and vigorous activity were 1952-5724 and >5724 counts per minute, respectively. Average intensity was measured as counts per minute.
The adults were active in at least moderate-intensity activity for a median (intraquartile range) of 31 (18-47) min.d(-1). Fifty-two percent accumulated 30 min.d(-1) of at least moderate-intensity physical activity. Only 1% achieved those 30 min from three or more bouts of at least 10 min. Average intensity, moderate and vigorous physical activity was lower with higher age or body mass index (BMI). Men spent more time than women in moderate and vigorous physical activity, but there was no gender difference in average intensity. The variation in inactivity could not be explained by gender, age, or BMI.
Objectively obtained estimates of physical activity yielded lower values and a different activity pattern compared with those obtained by commonly used self-reports. This highlights the need to better understand the nature and measurement issues of health-enhancing physical activity of adults.
Patients undergoing total hip arthroplasty (THA) exhibit changes in the alignment of lower extremities following the procedure, and these changes may exert effects on other joints over the long-term. Therefore, we investigated the course of knee osteoarthritis in patients undergoing long-term follow up after THA, in addition to the relationship between the course of knee osteoarthritis and alignment of lower extremities.
We retrospectively performed radiographic evaluation of the course of knee osteoarthritis (OA) after THA. Thirty patients undergoing successful unilateral THA were followed for a minimum of 10 years.
Eleven (33%) subjects showed progression of medial tibiofemoral OA on the non-THA side, while only three (10%) showed progression on the THA side, and this difference was significant (P = 0.033). In addition, the mechanical axes on the THA side passed through more lateral regions of the tibial plateau than those on the non-THA side (P = 0.044).
Medial tibiofemoral OA on the THA side was less likely to deteriorate than on the non-THA side. The reduced vulnerability to OA progression on the THA side may be due to the lower offset and resultant lateral shift in mechanical axes.
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Gait analysis: normal and pathological function
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Perry J, Burnfield J (2010) Gait analysis: normal and pathological function. J Sports Sci Med 9:353