Assessment of postural stability in women with hip osteoarthritis: A case-control study

Comparative assessment of a virtual performance measure with self-report and performance-based outcomes in patients with hip osteoarthritis

BACKGROUND

The purposes of this study were to examine the reliability and factorial and convergent validity of a virtual performance measure (VPM) in patients with osteoarthritis (OA) of the hip joint and to compare the known-group validity of the VPM with traditional self-report and performance-based outcomes.

METHODS

The VPM score was based on the results of 10 videos showing increasing difficulty in performing specific functional tasks. Patients were requested to choose the video that best reflected their own level of function. Clinical presentation and radiological findings were documented. Self-report measures were the lower extremity functional score (LEFS) and pain scale. The performance-based measures were the 30- second Chair Stand Test (CST) and the 40-meter fast paced walk test (40 m FPWT) test.

RESULTS

Data of 100 patients, 64 (64%) females, mean age: 67 ±10 were examined. The Cronbach's alpha coefficient that examined internal consistency of the VPM total score was 0.88. Factor analysis showed two distinct domains. Moderate correlations were observed between the VPM total score and the LEFS, pain score, and 40 m FPWT (r > 0.50). The VPM and the LEFS were able to differentiate between candidates and non-candidates for hip arthroplasty and between those with and without assistive walking devices. There was no statistically significant difference between the overall accuracy of the VPM and LEFS in the area under the curve value (0.72 vs. 0.71) with respect to candidacy for surgery.

CONCLUSIONS

This study provides substantial evidence towards the validity and reliability of the VPM outcome measure in patients with moderate to severe OA of the hip joint. Digitally based outcome measures have the potential of enhancing remote measurement of functional difficulties in specific situations.

CLINICAL TRIAL NUMBER

Not applicable.

Early Postoperative Change in Hip Rotation Angle and Factors Contributing to It for Patients Undergoing Total Hip Arthroplasty

OBJECTIVE

A possible impairment in hip proprioception after total hip arthroplasty (THA) has been an issue of concern. The aims of this study were to investigate the extent of early postoperative change in standing hip rotation angle (HRAng) in patients with osteoarthritis (OA) undergoing THA and to consider a possible mechanism behind this.

MATERIALS AND METHODS

A total of 82 hips (82 patients; 63 women and 19 men) undergoing unilateral primary THA with total capsulectomy were included. We characterized the standing HRAng and internal/external range of motion (ROM) in the prone position before THA and 2 weeks after THA. Acetabular/cup and femoral/stem anteversion, combined anteversion (CA), and leg length discrepancy were also characterized. Correlations were examined postoperatively between the HRAng and the other analyzed variables.

RESULTS

The median standing HRAng showed a significant internal shift from external to more medial position (6.3° to 1.7°) 2 weeks after THA (P<.0001). The postoperative change in standing HRAng was significantly negatively correlated with the difference between the postoperative femoral anteversion and the stem anteversion (rs=-0.429, P<.0001) and with the pre- to postoperative change in CA (rs=-0.3012, P=.0063).

CONCLUSION

This study demonstrated that the extent of the rotational shift of the distal femur toward medial direction was significantly associated with increasing stem anteversion and CA. This phenomenon can be interpreted as a compensatory mechanism for maintaining the relative positional relationship between the pelvis and the proximal femur using proprioception. Therefore, we conclude that the extracapsular/extra-articular components may be prominent determinants of joint position sense. [Orthopedics. 2024;47(3):e114-e118.].

Center of pressure and ground reaction forces in Labrador and Golden Retrievers with and without hip dysplasia at 4, 8, and 12 months of age

Canine hip dysplasia (CHD) is a common orthopedic disease. Owing to the importance of CHD in affected dogs, both clinically and for their use in breeding or work, increasing attention is being given to early diagnosis. Therefore, early clinical and radiological examination of young animals is increasingly in demand, whereas common CHD screening according to the Fédération Cynologique Internationale (FCI) is usually performed at the age of 12 months or even older in Europe. One way to objectively evaluate gait pattern is to measure the ground reaction forces (GRFs) and center of pressure (COP). In this study, we used a pressure plate to evaluate the GRF and COP parameters for 32 Labrador Retrievers and 17 Golden Retrievers at 4, 8, and 12 months of age. The dogs also underwent radiological examination of the hip joints following the FCI rules at the age of at least 12 months, which were grouped as sound (FCI grade A or B) and diseased (FCI grade C or worse). The results revealed significantly higher COP values in both breeds in the diseased limb groups at any measurement point during walking, with the most pronounced results obtained at 8 months of age. Furthermore, COP values during walking were significantly higher at 4 months than at 8 and 12 months in both the sound and diseased limb groups, indicating an increased stability of the gait pattern. Except for COP-Speed, the values of all COP parameters were higher during walking than during trotting at 4 months of age (i.e., COP-Speed was higher when trotting), indicating that the 4-beat gait in walk is more difficult to control for puppies than the 2-beat gait in trot. Overall, our results support the early evaluation of CHD in growing animals using non-invasive methods.

Relationship between postural changes, osteoarthritis and bone mineral density in postmenopausal women

OBJECTIVES

To assess the relationship between postural changes, osteoarthritis (OA) and bone mineral density (BMD) in postmenopausal women.

METHODS

A total of 127 Brazilian women, aged 45 years or older, were included in this retrospective study. Subjects were divided in two groups: study group with postural changes (SG) and control group without postural changes (CG). Possible postural changes considered were scoliosis, kyphosis and lordosis. All women underwent BMD assessment and OA was identified at the region of the hip and lumbar spine by dual energy X-ray absorptiometry (DXA) analysis.

RESULTS

SG was older (66.0 ± 7.3 years) than the CG (61.0 ± 8.6 years). In the entire sample we found thirteen women with OA and low BMD. Overall, the lumbar spine area was more affected by OA than the hip. The value of BMD T-score accounted for up to 77% of the changes observed in the SG group.

CONCLUSION

Postural changes identified in women are directly related to aging and associated with bone loss and joint degeneration. Postural changes may be the primary sign of frailty as a result of body adaptation to pain related to musculoskeletal diseases.

Effects of Hip Bracing on Gait Biomechanics, Pain and Function in Subjects With Mild to Moderate Hip Osteoarthritis

Hip Osteoarthritis (HOA) is a common joint disease with serious impact on the quality of life of the affected persons. Additionally, persons with HOA often show alterations in gait biomechanics. Developing effective conservative treatment strategies is of paramount importance, as joint replacement is only indicated for end-stage HOA. In contrast to knee osteoarthritis, little is known about the effectiveness of hip bracing for the management of HOA. Studies analysing mechanically unloading hip braces partly showed beneficial results. However, methodological limitations of these studies, such as small sample sizes or lack of control groups, limit the applicability of the results. Additionally, mechanically unloading braces might impose restrictions on motion and comfort and thus, might not be suitable for people with only mild or moderate symptoms. The aim of this study was to comprehensively quantify the effects of unilateral HOA as well as functional hip bracing on gait biomechanics, pain, proprioception and functional capacity in people with mild to moderate HOA. Hip and pelvis biomechanics during walking were analysed in 21 subjects with mild to moderate HOA under three bracing conditions: unbraced, immediately after brace application and after 1 week of brace usage. Additionally, pain, hip proprioception and functional capacity were assessed. A matched group of 21 healthy subjects was included as reference. Kinematic and kinetic data were collected using a 16-camera infrared motion capturing system and two force plates. Visual analogue scales, an angle reproduction test and a 6-min walking test were applied to measure pain, hip proprioception and functional capacity, respectively. Subjects with HOA walked slower, with reduced step length, sagittal hip range of motion and peak extension angle and had a reduced functional capacity. After 1 week of brace application step length, walking speed and functional capacity were significantly increased. Additionally, pain perception was significantly lower in the intervention period. These results encourage the application of functional hip braces in the management of mild to moderate HOA. However, as key parameters of HOA gait such as a reduced peak extension angle remained unchanged, the underlying mechanisms remain partly unclear and have to be considered in the future.

The Evaluation of Postural Stability and Fall Risk in Patients with Primary Hip Osteoarthritis

BACKGROUND

The hip is a significant weight-bearing joint and hip osteoarthritis (HOA) is one of the common musculoskeletal disorders. HOA may affect postural stability and fall risk by disrupting joint biomechanics.

METHODS

Fourty patients with unilateral primary HOA and a control group consisting of 41 healthy subjects were included in the study. HOA was radiographically graded by Kellgren Lawrence (KL) HOA classification. There were 26 patients with mild HOA (KL grade ≤ 2) and 14 patients with moderate-severe HOA (KL grade ≥ 3). The falls efficacy scale-international was used to assess fear of falling. Postural stability and the fall risk were evaluated by using the Biodex Stability System.

RESULTS

The postural stability and the fall risk indices were statistically significantly higher in the study group. Also, there was a positive correlation between the number of falls in the last 1 year, weight, and body mass index; and these correlations were statistically significant (r 0.686, p 0.003; r 0.477, p 0.002; r 0.444, p 0.004). There was no statistically significant difference in fall risk by the HOA was mild or moderate-severe.

CONCLUSIONS

Determining the deterioration in postural stability and the fall risk in patients with both mild and moderate-severe HOA may be a stimulus for early initiation of postural stability exercises in HOA.

Relationship between single-leg stance test with light touch and hip muscle strength in healthy young adults

[Purpose] This study investigated the relationship between the single-leg stance test with light touch and hip rotator muscle strength. [Participants and Methods] Thirty-one healthy young adults participated in the study. A single leg stance test with light touch was performed to evaluate the participants’ static balance ability. The duration that an individual could successfully perform the single leg stance test with light touch in the eyes open was measured. The participants were instructed to slightly touch their right index fingertip on the digital scale. The hip muscle strength of the internal rotators and external rotators were measured by the isometric peak torque. The internal/external rotator strength ratio was calculated by dividing the strength of the internal rotator by that of the external rotator. [Results] The hip external rotator muscle strength was higher in males than in females. Moreover, there was a significant correlation between the single-leg stance test with light touch and hip external rotator muscle strength in males and between the single leg stance test with light touch and hip internal rotator muscle strength in females. Furthermore, a significant positive correlation was found between the single leg stance test with light touch and hip internal rotator/external rotator ratio in males. [Conclusion] We concluded that the single leg stance test with light touch is a useful tool to evaluate static hip muscle strength.

Is Thumb Proprioception Decreased in Patients With Trapeziometacarpal Joint Osteoarthritis?

Proprioception is thought to be essential for normal joint homeostasis, and its decreased function has been associated with an increased risk of joint diseases. However, only a few studies have been performed on the association between proprioceptive function in the trapeziometacarpal joint (TMCJ) and osteoarthritis. The purpose of this study was to compare TMCJ proprioceptive function in elderly women with radiographic TMCJ osteoarthritis relative to age-matched control women without osteoarthritis. We enrolled 19 women (mean age, 66 years) with symptomatic, radiographic Eaton and Littler grade 2, 3, and 4 TMCJ osteoarthritis and 19 age-matched control women without osteoarthritis. We evaluated thumb proprioception by using a joint-position reproduction test and compared the reposition error (RE) between the groups. We carried out a multivariate analysis for factors potentially associated with increased RE, such as age, body mass index, hand dominance, the presence of diabetes, pain level, and the presence of osteoarthritis. Also, a logistic regression analysis was performed for factors associated with the occurrence of TMCJ osteoarthritis. Patients with TMCJ osteoarthritis had greater RE than did the control patients in the joint-position reproduction test at 20°, 30°, and 40° of thumb palmar abduction. The multivariate analysis indicated that increased RE was associated with the presence of osteoarthritis, but not with the other factors assessed. The occurrence of TMCJ osteoarthritis was associated with increased RE at 20°, 30°, and 40° of thumb palmar abduction. This study showed that decreased proprioceptive function was associated with the presence of osteoarthritis in the TMCJ, although the causality remains unknown. Further studies on the role of proprioception in the pathogenesis of TMCJ osteoarthritis and the potential role of its training for disease prevention or treatment are required.