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Mendiolagoitia L, Rodríguez MÁ, Crespo I, del Valle M, Olmedillas H. Kinematic Gait Analysis After Primary Total Hip Replacement: A Systematic Review: Gait After Total Hip Replacement: A Systematic Review. Indian J Orthop 2020; 54:767-775. [PMID: 33133399 PMCID: PMC7573021 DOI: 10.1007/s43465-020-00101-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/28/2020] [Indexed: 02/04/2023]
Abstract
Total hip replacement (THR) is a surgical procedure indicated for patients affected by severe hip osteoarthritis. Although this technique has proved to be effective in relieving pain and restoring function, gait limitations may persist following this procedure. The objective of this systematic review was to evaluate gait kinematics after THR and compare the results with those of the pre-operative state and with healthy control individuals. PubMed/MEDLINE, Embase, Web of Science, CENTRAL and Scopus databases were searched until December 2019. Methodological quality and internal validity score of each study were assessed using the PEDro and the Newcastle-Ottawa scales. In all, ten studies met our inclusion criteria. Following THR, statistically significant improvements were seen in dynamic hip and knee range of motion of both the affected and the contralateral limb, single-limb support time symmetry, step length, stride length, walking speed and gait pattern. However, deficits were observed in all the previous parameters, as well as in hip adduction angle in comparison with healthy subjects. In conclusion, gait patterns improve after THR in comparison with the pre-operative state, although there are deficits relative to healthy individuals.
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Affiliation(s)
- Luis Mendiolagoitia
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | | | - Irene Crespo
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain ,Institute of Biomedicine, Universidad de León, León, Spain
| | - Miguel del Valle
- Department of Cellular Morphology and Biology, Universidad de Oviedo, Oviedo, Spain
| | - Hugo Olmedillas
- Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain ,Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Spain
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Meyer CAG, Corten K, Fieuws S, Deschamps K, Monari D, Wesseling M, Simon JP, Desloovere K. Biomechanical gait features associated with hip osteoarthritis: Towards a better definition of clinical hallmarks. J Orthop Res 2015; 33:1498-507. [PMID: 25982594 DOI: 10.1002/jor.22924] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 04/02/2015] [Indexed: 02/04/2023]
Abstract
Critical appraisal of the literature highlights that the discriminative power of gait-related features in patients with hip osteoarthritis (OA) has not been fully explored. We aimed to reduce the number of gait-related features and define the most discriminative ones comparing the three-dimensional gait analysis of 20 patients with hip osteoarthritis (OA) with those of 17 healthy peers. First, principal component analysis was used to reduce the high-dimensional gait data into a reduced set of interpretable variables for further analysis, including tests for group differences. These differences were indicative for the selection of the top 10 variables to be included into linear discriminant analysis models (LDA). Our findings demonstrated the successful data reduction of hip osteoarthritic-related gait features with a high discriminatory power. The combination of the top variables into LDA models clearly separated groups, with a maximum misclassification error rate of 19%, estimated by cross-validation. Decreased hip/knee extension, hip flexion and internal rotation moment were gait features with the highest discriminatory power. This study listed the most clinically relevant gait features characteristics of hip OA. Moreover, it will help clinicians and physiotherapists understand the movement pathomechanics related to hip OA useful in the management and design of rehabilitation intervention.
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Affiliation(s)
- Christophe A G Meyer
- Department of Rehabilitation Sciences, UZ Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium.,UZ Pellenberg Orthopedic Department, University Hospitals Leuven, Pellenberg, Belgium.,Laboratory for Clinical Motion Analysis (C-MAL), University Hospital Pellenberg, UZ Leuven, Belgium
| | - Kristoff Corten
- Orthopedic Association Genk, Ziekenhuis Oost-Limburg Genk, Belgium
| | - Steffen Fieuws
- I-Biostat, KU Leuven University and Universiteit Hasselt, Leuven, Belgium
| | - Kevin Deschamps
- Department of Rehabilitation Sciences, UZ Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium.,Laboratory for Clinical Motion Analysis (C-MAL), University Hospital Pellenberg, UZ Leuven, Belgium
| | - Davide Monari
- Department of Mechanical Engineering, KU Leuven, Faculty of Engineering, Leuven, Belgium
| | - Mariska Wesseling
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Jean-Pierre Simon
- UZ Pellenberg Orthopedic Department, University Hospitals Leuven, Pellenberg, Belgium.,Department of Development and Regeneration, KU Leuven, Faculty of Medicine, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, UZ Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium.,Laboratory for Clinical Motion Analysis (C-MAL), University Hospital Pellenberg, UZ Leuven, Belgium
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Lerner ZF, Board WJ, Browning RC. Effects of obesity on lower extremity muscle function during walking at two speeds. Gait Posture 2014; 39:978-84. [PMID: 24412270 PMCID: PMC3960344 DOI: 10.1016/j.gaitpost.2013.12.020] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 12/05/2013] [Accepted: 12/17/2013] [Indexed: 02/02/2023]
Abstract
Walking is a recommended form of physical activity for obese adults, yet the effects of obesity and walking speed on the biomechanics of walking are not well understood. The purpose of this study was to examine joint kinematics, muscle force requirements and individual muscle contributions to the walking ground reaction forces (GRFs) at two speeds (1.25 ms(-1) and 1.50 ms(-1)) in obese and nonobese adults. Vasti (VAS), gluteus medius (GMED), gastrocnemius (GAST), and soleus (SOL) forces and their contributions to the GRFs were estimated using three-dimensional musculoskeletal models scaled to the anthropometrics of nine obese (35.0 (3.78 kg m(-2))); body mass index mean (SD)) and 10 nonobese (22.1 (1.02 kg m(-2))) subjects. The obese individuals walked with a straighter knee in early stance at the faster speed and greater pelvic obliquity during single limb support at both speeds. Absolute force requirements were generally greater in obese vs. nonobese adults, the main exception being VAS, which was similar between groups. At both speeds, lean mass (LM) normalized force output for GMED was greater in the obese group. Obese individuals appear to adopt a gait pattern that reduces VAS force output, especially at speeds greater than their preferred walking velocity. Greater relative GMED force requirements in obese individuals may contribute to altered kinematics and increased risk of musculoskeletal injury/pathology. Our results suggest that obese individuals may have relative weakness of the VAS and hip abductor muscles, specifically GMED, which may act to increase their risk of musculoskeletal injury/pathology during walking, and therefore may benefit from targeted muscle strengthening.
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Affiliation(s)
- Zachary F. Lerner
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Wayne J. Board
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Raymond C. Browning
- School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA,Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
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Kubota M, Uchida K, Kokubo Y, Shimada S, Matsuo H, Yayama T, Miyazaki T, Takeura N, Yoshida A, Baba H. Changes in gait pattern and hip muscle strength after open reduction and internal fixation of acetabular fracture. Arch Phys Med Rehabil 2012; 93:2015-21. [PMID: 22475054 DOI: 10.1016/j.apmr.2012.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To characterize changes in the gait pattern at 3 and 12 months after surgery for acetabular fracture, to assess the relationship between various gait parameters and hip muscle strength, and to determine the factors associated with gait disorders that correlate with gait parameters measured at 12 months after surgery. DESIGN Prospective cohort study. SETTING University hospital. PARTICIPANTS Patients (N=19) with acetabular fractures were treated by open reduction and internal fixation (ORIF) and examined at 3 and 12 months postoperatively. The study also included a similar number of sex- and age-matched control subjects. INTERVENTIONS Postoperative rehabilitation program. MAIN OUTCOME MEASURES Spatiotemporal, kinematic, and kinetic variables of gait and strength of hip flexor, adductor, and abductor muscles at 3 and 12 months after ORIF. RESULTS Walking velocity at 3 months after ORIF was slower in the patients than in the control subjects; however, walking velocity at 12 months was similar in the 2 groups. Although most of the kinematic and kinetic variables showed recovery to control levels at 3 and 12 months after ORIF, recovery was incomplete for pelvic forward tilt and hip abduction moment even at 12 months after ORIF. The greatest loss of muscle strength was noted in the hip abductors, where the average deficit was 35.4% at 3 months and 24.6% at 12 months. There was a significant relationship between hip abductor muscle strength and hip abduction moment at 3 months (R(2)=.63); however, this relationship diminished at 12 months (R(2)=.14). The presence of associated injuries correlated with lack of recovery of the peak hip abduction moment. CONCLUSIONS Pelvic forward tilt and peak hip abduction moment showed incomplete recovery at 12 months after ORIF with subsequent conventional and home exercise rehabilitation programs. Our results suggest that improvement of hip abductor muscle strength in the early postoperative period could improve the peak hip abduction moment.
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Affiliation(s)
- Masafumi Kubota
- Gait Analysis Laboratory, Division of Physical Therapy and Rehabilitation, Fukui University Hospital, Fukui, Japan
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Queen RM, Watters TS, Abbey AN, Sabesan VJ, Vail TP, Bolognesi MP. Gait symmetry: a comparison of hip resurfacing and jumbo head total hip arthroplasty patients. J Arthroplasty 2011; 26:680-5. [PMID: 20884168 DOI: 10.1016/j.arth.2010.07.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 07/30/2010] [Indexed: 02/01/2023] Open
Abstract
Proponents of large femoral head total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) have touted the potential for restoration of more normal hip kinematics. This study examined 20 patients (10 THA and 10 HRA patients) approximately 18 months after surgery. Subjects were evaluated at a self-selected pace, while bilateral spatial-temporal gait variables, hip flexion/extension kinematics, and ground reaction forces were collected. For both groups, swing time was increased on the surgical side, whereas peak hip flexion, peak extension, and flexion at heel strike were decreased. Peak hip extension and peak vertical ground reaction forces were decreased in THA subjects compared with HRA subjects. After a large-diameter THA or HRA, subjects do not display symmetric gait approximately 18 months postoperatively. Total hip arthroplasty subjects demonstrated restricted hip extension and reduced limb loading when compared with HRA subjects.
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Affiliation(s)
- Robin M Queen
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA
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Mont MA, Seyler TM, Ragland PS, Starr R, Erhart J, Bhave A. Gait analysis of patients with resurfacing hip arthroplasty compared with hip osteoarthritis and standard total hip arthroplasty. J Arthroplasty 2007; 22:100-8. [PMID: 17197316 DOI: 10.1016/j.arth.2006.03.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2005] [Accepted: 03/27/2006] [Indexed: 02/01/2023] Open
Abstract
Patients with standard total hip arthroplasties may have reduced hip abduction and extension moments when compared with normal nonosteoarthritic hips. In comparison, patients after resurfacing total hip arthroplasty appear to have a near-normal gait. The authors evaluated temporal-spatial parameters, hip kinematics, and kinetics in hip resurfacing patients compared with patients with unilateral osteoarthritic hips and unilateral standard total hip arthroplasties. Patients with resurfacing walked faster (average 1.26 m/s) and were comparable with normals. There were no significant differences in hip abductor and extensor moments of patients with resurfacing compared with patients in the standard hip arthroplasty group. This study showed more normal hip kinematics and functionality in resurfacing hip arthroplasty, which may be due to the large femoral head.
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Affiliation(s)
- Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA
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Viceconti M, Davinelli M, Taddei F, Cappello A. Automatic generation of accurate subject-specific bone finite element models to be used in clinical studies. J Biomech 2004; 37:1597-605. [PMID: 15336935 DOI: 10.1016/j.jbiomech.2003.12.030] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2003] [Indexed: 11/18/2022]
Abstract
Most of the finite element models of bones used in orthopaedic biomechanics research are based on generic anatomies. However, in many cases it would be useful to generate from CT data a separate finite element model for each subject of a study group. In a recent study a hexahedral mesh generator based on a grid projection algorithm was found very effective in terms of accuracy and automation. However, so far the use of this method has been documented only on data collected in vitro and only for long bones. The present study was aimed at verifying if this method represents a procedure for the generation of finite element models of human bones from data collected in vivo, robust, accurate, automatic and general enough to be used in clinical studies. Robustness, automation and numerical accuracy of the proposed method were assessed on five femoral CT data sets of patients affected by various pathologies. The generality of the method was verified by processing a femur, an ileum, a phalanx, a proximal femur reconstruction, and the micro-CT of a small sample of spongy bone. The method was found robust enough to cope with the variability of the five femurs, producing meshes with a numerical accuracy and a computational weight comparable to those found in vitro. Even when the method was used to process the other bones the levels of mesh conditioning remained within acceptable limits. Thus, it may be concluded that the method presents a generality sufficient to cope with almost any orthopaedic application.
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Affiliation(s)
- Marco Viceconti
- Laboratorio di Tecnologia Medica, Istituti Ortopedici Rizzoli, via di Barbiano 1/10, Bologna 40136, Italy.
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Petrofsky JS. Microprocessor-based gait analysis system to retrain Trendelenburg gait. Med Biol Eng Comput 2001; 39:140-3. [PMID: 11214266 DOI: 10.1007/bf02345278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A microprocessor-based gait analysis system is described that uses two electromyogram (EMG) amplifiers, two foot switches and an audio feedback device to allow the retraining of one type of improper gait, where the hip abductors (gluteus medius muscles) are weak on one side of the body, causing the opposite hip to drop during the swing phase of gait (Trendelenburg gait). As the abnormality is strictly on one side of the body in most people, the circuitry is minimised, as gait can be analysed by only comparing muscle activity in the affected gluteus medius muscle with that in the unaffected gluteus medius muscle, through the EMG. Two foot contact switches are used to help assess timing of the step cycle. If gait is different on the two sides of the body, an audio cue directs the patient to correct the abnormality by increasing activity on the affected side. The device is tested on five patients. Trendelenburg gait is reduced by an average of 29 degrees through the use of the device. The average stride length at the beginning of the study is 0.32 +/- 0.3 m. By the end of the study, the stride length is increased to 0.45 +/- 0.2 m for the entire group of five subjects. The speed of gait has increased from 1.6 +/- 0.4 kmh(-1) to 3.1 +/- 0.5km h(-1).
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Affiliation(s)
- J S Petrofsky
- Department of Physical Therapy, Loma Linda University, School of Allied Health, California, USA.
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