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Lurie B, Nelson K, Pietryga J, Urness D, Daubs M, Kubiak E, Surina J. Radiographic Thigh Muscle Measurements Are a Reliable Predictor of Psoas Area and Sarcopenia. J Bone Joint Surg Am 2024; 106:950-957. [PMID: 38598605 DOI: 10.2106/jbjs.23.01177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Sarcopenia is associated with falls, fractures, postoperative complications such as periprosthetic joint infections and dislocations, and early mortality. Although cross-sectional imaging is currently used to diagnose sarcopenia, inexpensive and widely available screening tests are needed. The goal of this study was to investigate whether measurements of thigh muscles made on radiographs can predict psoas muscle area and the presence of sarcopenia as determined on computed tomography (CT) scans. METHODS A retrospective radiographic review was performed to measure thigh muscle area in the coronal and sagittal planes using the differential in soft-tissue attenuation. Psoas muscle area on CT at L3 and L4 served as the gold standard for the diagnosis of sarcopenia. The correlation between thigh muscle and psoas muscle areas was determined, and multivariable models were developed to identify predictors of psoas muscle area and sarcopenia. RESULTS Four hundred and fourteen patients (252 male, 162 female) were identified. Seventy-six (18.4%) of the patients had an L4 psoas muscle area below the sex-specific cutoff value for sarcopenia. Patients with sarcopenia on abdominal CT had significantly smaller thigh muscle measurements on all radiographic views. The mean and standard deviation of the thigh muscle measurements were determined for the entire cohort and for patients with sarcopenia, as well as for adults aged 18 to 40 years without sarcopenia to provide normative reference values. The intraclass correlation coefficients were >0.8 for all radiographic measurements. The anteroposterior-view measurement of thigh muscle width and lateral-view measurement of quadriceps height were identified as independent predictors of both psoas muscle area and sarcopenia. CONCLUSIONS Measurements of thigh muscle size made on radiographs can predict both psoas muscle area and sarcopenia. These measurements are a reliable and readily available screening tool to aid in the diagnosis and treatment of sarcopenia in the orthopaedic population. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Benjamin Lurie
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Karen Nelson
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Janel Pietryga
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Daniel Urness
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Michael Daubs
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Erik Kubiak
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Jeff Surina
- Department of Orthopaedic Surgery, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada
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Su H, Huang H, Xiang S, Gong Y, Zhou H, Chen L, Zhang Z, Tong P, Xu T. Clinical Efficacy of Intra-articular Tranexamic Acid Injection in the Management of Hemophilia with Total Hip Arthroplasty: A 24-month Retrospective Cohort Study. Orthop Surg 2024. [PMID: 38828803 DOI: 10.1111/os.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Total hip arthroplasty (THA) effectively treats end-stage hemophilic hip arthropathy. Given hemophilia's unique characteristics, perioperative bleeding remains a significant risk for patients undergoing THA. Tranexamic acid (TXA), an efficient antifibrinolytic agent, may benefit the outcomes of THA for patients with hemophilia (PWH). This study aims to explore the clinical efficacy of intra-articular injection of TXA in treating perioperative bleeding in PWH and assess its additional clinical benefits. METHODS The retrospective study comprised data of PWH who received THA from January 2015 to December 2021 in the research center. A total of 59 individuals were included in the study, divided into a TXA group (n = 31) and a non-TXA group (n = 28). We compared various parameters, including total blood loss (TBL), visible blood loss (VBL), occult blood loss (OBL), intraoperative coagulation factor VIII (FVIII) consumption, perioperative total FVIII consumption, hemoglobin (HB), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), length of hospital stay, hospitalization costs, length of surgery, total protein, activated partial thromboplastin time (APTT), D-dimer, rate of joint swelling, hip joint range of motion (ROM), visual analogue scale (VAS), and Harris hip joint function scale (HHS) between the two groups. Follow-up assessments were conducted for up to 24 months. A Student's t test was utilized for the statistical analysis. RESULTS This study demonstrated that intra-articular TXA effectively reduced TBL (1248.19 ± 439.88 mL, p < 0.001), VBL (490.32 ± 344.34 mL, p = 0.003), and OBL (757.87 ± 381.48 mL, p = 0.004) in PWH who underwent THA. TXA demonstrated effectiveness in reducing VAS scores on POD1, POD7, and POD14 and joint swelling rates on POD1, POD7, POD14, and at discharge (p < 0.05). Additionally, the TXA group achieved higher HHS ratings at all follow-up time points (p < 0.05), showing superior hip joint mobility, lower postoperative inflammation levels, reduced factor VIII consumption during surgery, and less postoperative nutritional loss. No statistically significant differences were observed between the two groups in terms of hospital stay, hospitalization costs, surgery duration, and coagulation indicators. CONCLUSION Intra-articular injection of TXA reduces perioperative bleeding in PWH undergoing THA while also improving joint mobility, post-operative rehabilitation, and quality of life. This may provide value for the future application of TXA in PWH.
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Affiliation(s)
- Hai Su
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Hua Huang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Sicheng Xiang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yichen Gong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Haojing Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Lei Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Zhongyi Zhang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Taotao Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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Stępiński P, Jegierski D, Maciąg G, Maciąg B, Adamska O, Stolarczyk A. Is There Safety Outside the "Safe Zone" in Total Hip Replacement? A Retrospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:772. [PMID: 38792955 PMCID: PMC11123271 DOI: 10.3390/medicina60050772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/24/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The safe zone in total hip replacement was introduced many years ago. Its aim was to provide guidelines for orthopedic surgeons in order to avoid complications such as instability. With the growing interest in spinopelvic alignment, some new insights suggest that the safe zone is an obsolete concept. This study aims to show that, even outside the safe zone, the effect of total hip replacement can be satisfactory. This could be used as preliminary study for an analysis of a larger group. Materials and Methods: Fifty-nine consecutive patients with end-stage osteoarthritis treated by total hip replacement were enrolled into the study and divided into two groups: inside the safe zone and outside the safe zone. A physical examination during postoperative visits was performed; the range of movement was measured using a goniometer; and the HHS and VAS were taken to measure functional outcomes and pain, respectively. An analysis of the radiological outcomes was performed. Results: There was no significant difference in regard to changes in total offset, pain, HHS and other complications. There were no signs of instability among patients during the follow-up. Conclusions: The results of this study show that the "safe zone" is a more complicated term that was previously thought. A proper soft tissue balance and spinopelvic alignment could be factors that change the "safe zone" for each patient and make it more individual.
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Affiliation(s)
- Piotr Stępiński
- Clinic for Orthopedics and Rehabilitation, Medical University of Warsaw, 04-749 Warsaw, Poland; (D.J.); (B.M.); (A.S.)
| | - Dawid Jegierski
- Clinic for Orthopedics and Rehabilitation, Medical University of Warsaw, 04-749 Warsaw, Poland; (D.J.); (B.M.); (A.S.)
| | - Grzegorz Maciąg
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (G.M.); (O.A.)
| | - Bartosz Maciąg
- Clinic for Orthopedics and Rehabilitation, Medical University of Warsaw, 04-749 Warsaw, Poland; (D.J.); (B.M.); (A.S.)
| | - Olga Adamska
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (G.M.); (O.A.)
| | - Artur Stolarczyk
- Clinic for Orthopedics and Rehabilitation, Medical University of Warsaw, 04-749 Warsaw, Poland; (D.J.); (B.M.); (A.S.)
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Cattaneo A, Ghidotti A, Catellani F, Fiorentino G, Vitali A, Regazzoni D, Rizzi C, Bombardieri E. Motion acquisition of gait characteristics one week after total hip arthroplasty: a factor analysis. Arch Orthop Trauma Surg 2024; 144:2347-2356. [PMID: 38483620 PMCID: PMC11093841 DOI: 10.1007/s00402-024-05245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/17/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Clinical gait analysis can be used to evaluate the recovery process of patients undergoing total hip arthroplasty (THA). The postoperative walking patterns of these patients can be significantly influenced by the choice of surgical approach, as each procedure alters distinct anatomical structures. The aim of this study is twofold. The first objective is to develop a gait model to describe the change in ambulation one week after THA. The secondary goal is to describe the differences associated with the surgical approach. MATERIALS AND METHODS Thirty-six patients undergoing THA with lateral (n = 9), anterior (n = 15), and posterior (n = 12) approaches were included in the study. Walking before and 7 days after surgery was recorded using a markerless motion capture system. Exploratory Factor Analysis (EFA), a data reduction technique, condensed 21 spatiotemporal gait parameters to a smaller set of dominant variables. The EFA-derived gait domains were utilized to study post-surgical gait variations and to compare the post-surgical gait among the three groups. RESULTS Four distinct gait domains were identified. The most pronounced variation one week after surgery is in the Rhythm (gait cycle time: + 32.9 % ), followed by Postural control (step width: + 27.0 % ), Phases (stance time: + 11.0 % ), and Pace (stride length: - 9.3 % ). In postsurgical walking, Phases is statistically significantly different in patients operated with the posterior approach compared to lateral (p-value = 0.017) and anterior (p-value = 0.002) approaches. Furthermore, stance time in the posterior approach group is significantly lower than in healthy individuals (p-value < 0.001). CONCLUSIONS This study identified a four-component gait model specific to THA patients. The results showed that patients after THA have longer stride time but shorter stride length, wider base of support, and longer stance time, although the posterior group had a statistically significant shorter stance time than the others. The findings of this research have the potential to simplify the reporting of gait outcomes, reduce redundancy, and inform targeted interventions in regards to specific gait domains.
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Affiliation(s)
- Andrea Cattaneo
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy.
| | - Anna Ghidotti
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy
| | | | | | - Andrea Vitali
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy
| | - Daniele Regazzoni
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy
| | - Caterina Rizzi
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy
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Çakmak MF, Bayram S, Birişik F, Ayik Ö, Şahinkaya T, Ergin ÖN, Öztürk İ. The effects of modified hardinge approach on hip muscle strength in patients with primary hip arthroplasty: a patient evaluation with isokinetic strength test and gait analyses. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1209-1218. [PMID: 38010444 DOI: 10.1007/s00590-023-03778-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Numerous factors affect abductor strength after Total hip arthroplasty (THA), including surgical technique, prosthesis type, postoperative rehabilitation program, and preoperative patient condition. We prospectively investigated the effects of the modified Hardinge approach on hip muscle strength, which was evaluated using the isokinetic test, functional results, and gait function of patients who underwent primary THA. METHODS The hip muscles strength were measured using an isokinetic dynamometer. The primary outcomes of the present study were measurement of isokinetic strength of hip abductor muscle strengths using an isokinetic evaluator and gait analyses preoperatively and at 6 months postoperatively in 27 patients. RESULTS Isokinetic muscle strength test, abductor and other hip circumference groups achieved the preoperative muscle strength at 3 months postoperatively, and the postoperative sixth month values showed a statistically significant improvement compared with the preoperative and third month values. In gait analyze, our temporospatial data showed a slight regression at postoperative 3 months but reached the same values at 6 months postoperatively. Kinematic data showed a significant regression, but the data were not compared with those in the preoperative period. CONCLUSIONS Adequate muscle strength and physiological gait pattern, similar to the preoperative status, can be achieved at 6 months postoperatively. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Mehmet Fevzi Çakmak
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey.
| | - Fevzi Birişik
- Department of Orthopaedics and Traumatology, Istanbul Research and Training Hospital University of Health Sciences, Istanbul, Turkey
| | - Ömer Ayik
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey
| | - Türker Şahinkaya
- Department of Sports Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ömer Naci Ergin
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey
| | - İrfan Öztürk
- Department of Orthopedics and Traumatology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Ritsuno Y, Morita M, Mukaino M, Otsuka K, Kanaji A, Yamada J, Saitoh E, Matsumoto M, Nakamura M, Otaka Y, Fujita N. Determinants of Gait Parameters in Patients With Severe Hip Osteoarthritis. Arch Phys Med Rehabil 2024; 105:343-351. [PMID: 37683907 DOI: 10.1016/j.apmr.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To investigate the characteristics and symptoms of patients with hip osteoarthritis that are associated with spatiotemporal gait parameters, including their variability and asymmetry. DESIGN A retrospective, cross-sectional study. SETTING University hospital. PARTICIPANTS The study analyzed the gait analysis data of 155 patients (N=155) with hip osteoarthritis who were admitted to a university hospital for total hip replacement and were able to walk on a treadmill without a handrail. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The dependent variables were gait parameters during treadmill walking. These included gait speed, stride length, cadence, coefficient of variation of stride length and stride time, swing time symmetry index, and step symmetry index. Single and multiple regression analyses were conducted using independent variables of the characteristics and symptoms of the patients, including age, sex, height, pain, leg-length discrepancy, and muscle strength of the affected and normal sides measured with a hand-held dynamometer (iliopsoas, gluteus medius, and quadriceps). RESULTS In the analysis, gait speed and stride were the dependent variables, whereas age, height, and muscle strength on the affected side were the significant independent variables (P<.05). Additionally, pain demonstrated a marginal association with gait speed (P=.053). Only the leg-length discrepancy correlated with cadence. When the coefficient of variation of the stride length was the dependent variable, age and muscle strength on the affected side were significant. For the swing time symmetry index, only the muscle strength on the affected side was significant. Furthermore, the step symmetry index only correlated with leg-length discrepancy. The muscle strength on the affected side was the only significant independent variable for the coefficient of variation of the stride time. CONCLUSIONS The results revealed that each of the frequent clinical symptoms of hip osteoarthritis, such as pain, muscle weakness, and leg-length discrepancy, can explain different aspects of gait performance.
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Affiliation(s)
- Yoshihiro Ritsuno
- Department of Orthopaedic Surgery, Fujita Health University School of Medicine, Aichi, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuhiro Morita
- Department of Orthopaedic Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine, Fujita Health University School of Medicine, Aichi, Japan; Department of Rehabilitation Medicine, Hokkaido University Hospital, Hokkaido, Japan.
| | - Kei Otsuka
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Arihiko Kanaji
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University Bantane Hospital, Aichi, Japan
| | - Junya Yamada
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University School of Medicine, Aichi, Japan
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Shiwa T, Kawabata Y, Ishii T, Anan M. Effect of heel lift insertion on gait function in a patient with total hip arthroplasty with patient-perceived leg length difference: a case report. J Phys Ther Sci 2024; 36:81-86. [PMID: 38304151 PMCID: PMC10830159 DOI: 10.1589/jpts.36.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/02/2023] [Indexed: 02/03/2024] Open
Abstract
[Purpose] The effect of heel lift insertion on gait in patients who have undergone total hip arthroplasty (THA) with patient-perceived leg length difference is seldom referenced in the literature. We used an AB design to investigate the alterations of gait function before and after inserting a heel lift on the non-operative side. [Participant and Methods] The participant had a patient-perceived leg length difference after THA and presented with gait disturbance. The survey phase was 10 days (phase A: normal physiotherapy for five days, and phase B: normal physiotherapy and heel lift insertion for another five days) from the 17th day following THA. The ambulatory task was conducted at a self-determined, comfortable pace and objectively assessed using an inertial sensor. [Results] The insertion of a heel lift partially improved the gait symmetry and the ratio of lumbar acceleration in three directions; it also corrected the patient-perceived leg length difference. [Conclusion] An investigation was carried out to examine the impact of a heel lift on gait in a single case of THA with patient-reported leg length difference. The application of a heel lift may enhance the relationship between the patient-perceived leg length difference, gait symmetry, and the ratio of lumbar acceleration in three dimensions.
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Affiliation(s)
- Toru Shiwa
- Graduate School of Welfare Health Science, Oita University,
Japan
- Department of Rehabilitation, Soejima Orthopedic Hospital,
Japan
| | - Yuji Kawabata
- Department of Rehabilitation Medicine, Shuto General
Hospital, JA Yamaguchi Prefectural Welfare Federation of Agricultural Cooperative,
Japan
| | - Takako Ishii
- Department of Orthopedic, Soejima Orthopedic Hospital,
Japan
| | - Masaya Anan
- Physical Therapy Course, Faculty of Welfare and Health
Science, Oita University: 700 Dannoharu, Oita-shi, Oita 870-1192, Japan
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Wang Y, Guo J, Tang H, Li X, Guo S, Tian Q. Quantification of soft tissue artifacts using CT registration and subject-specific multibody modeling. J Biomech 2024; 162:111893. [PMID: 38064998 DOI: 10.1016/j.jbiomech.2023.111893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/16/2024]
Abstract
The potential use of gait analysis for quantitative preoperative planning in total hip arthroplasty (THA) has previously been demonstrated. However, the joint kinematic data measured through this process tend to be unreliable for surgical planning due to distortions caused by soft tissue artifacts (STAs). In this study, we developed a novel motion capture framework by combining computed tomography (CT)-based postural calibration and subject-specific multibody dynamics modeling to prevent the effect of STAs in measuring hip kinematics. Three subjects with femoroacetabular impingement syndrome were recruited, and CT data for each patient were collected by attaching marker clusters near the hip. A subject-specific multibody hip joint model was developed based on reconstructed CT data. Spring-dashpot network calculations were performed to minimize the distance between the anatomical landmark and its corresponding infrared reflective marker. The STAs of the thigh was described as six degrees of freedom viscoelastic bushing elements, and their parameter values were identified via smooth orthogonal decomposition. Least squares optimization was used to modify the pelvic rotations to compensate for the rigid components of STAs. The results showed that CT-assisted motion tracking enabled the successful identification of STA influences in gait and squat positions. Furthermore, STA effects were found to alter maximal pelvis tilt and hip rotations during a squat. Compared to other techniques, such as dual fluoroscopic imaging, the adopted framework does not require additional medical imaging for patients undergoing robot-assisted THA surgery and is thus a practical way of evaluating hip joint kinematics for preoperative surgical planning.
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Affiliation(s)
- Yanbing Wang
- MOE Key Laboratory of Dynamics and Control of Flight Vehicle, School of Aerospace Engineering, Beijing Institute of Technology, Beijing, 100081, People's Republic of China
| | - Jianqiao Guo
- MOE Key Laboratory of Dynamics and Control of Flight Vehicle, School of Aerospace Engineering, Beijing Institute of Technology, Beijing, 100081, People's Republic of China.
| | - Hao Tang
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 102208, People's Republic of China
| | - Xinxin Li
- Biomechanics Laboratory, Beijing Sport University, Beijing, 100084, People's Republic of China
| | - Shaoyi Guo
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 102208, People's Republic of China
| | - Qiang Tian
- MOE Key Laboratory of Dynamics and Control of Flight Vehicle, School of Aerospace Engineering, Beijing Institute of Technology, Beijing, 100081, People's Republic of China
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Pakhan AA, Phansopkar P, Boob MA. Rehabilitation to Complement Unique Single-Stage Core Decompression and Total Hip Arthroplasty in Bilateral Avascular Necrosis: A Case Report. Cureus 2024; 16:e52914. [PMID: 38406129 PMCID: PMC10893823 DOI: 10.7759/cureus.52914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Avascular necrosis (AVN), a debilitating condition characterized by bone tissue death due to inadequate blood supply, can severely impact the hip joint, leading to pain, limited mobility, and joint dysfunction. The complex blood supply and mechanical stress on the hip make it particularly vulnerable to AVN. Early detection is challenging as AVN may remain asymptomatic initially, but as it progresses, it results in severe joint degeneration. This case report outlines the management of a 38-year-old male patient with a dermatomyositis history who presented with bilateral hip pain attributed to AVN. Radiological investigations diagnosed grade 2 AVN in the left hip and grade 3 AVN in the right hip. The patient underwent core decompression for the left hip to halt disease progression and total hip arthroplasty (THA) for the right hip to alleviate pain and restore function. A structured three-week rehabilitation program was tailored to each surgical procedure, with pre-and post-treatment assessments revealing notable improvements in pain relief, range of motion (ROM), and muscle strength. This case underscores the importance of early diagnosis, personalized surgical interventions, and comprehensive rehabilitation in managing AVN in dermatomyositis patients. Physiotherapy is vital pre- and post-operatively to enhance physical function, strength, and mobility. Rehabilitation also plays a crucial role in postoperative recovery, early mobilization, and functional restoration. The multifaceted approach employed in this case highlights the need for a comprehensive strategy when managing AVN in dermatomyositis patients, providing valuable insights for similar cases.
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Affiliation(s)
- Arjavi A Pakhan
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratik Phansopkar
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Manali A Boob
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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10
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Sara LK, Lewis CL. Rehabilitation Phases, Precautions, and Mobility Goals Following Total Hip Arthroplasty. HSS J 2023; 19:494-500. [PMID: 37937096 PMCID: PMC10626929 DOI: 10.1177/15563316231192980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 11/09/2023]
Abstract
The prevalence of total hip arthroplasty (THA) for advanced hip osteoarthritis (OA) is both increasing and shifting toward a younger average age. However, THA alone does not typically normalize function in these patients. Postoperative rehabilitation is often recommended to optimize joint motion, strength, and function. To date, there are no peer-reviewed clinical practice guidelines for postoperative rehabilitation following THA. Thus, optimal postoperative rehabilitation requires consideration of the existing literature and clinical expertise. This review article summarizes current recommendations for postoperative management of THA, including phases of rehabilitation, postoperative hip precautions, the effect of rehabilitation setting and mode of delivery on postoperative outcomes, and gait mechanics.
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Affiliation(s)
- Lauren K Sara
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Cara L Lewis
- Department of Physical Therapy, Boston University, Boston, MA, USA
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11
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Langley B, Greig M. The gait abnormality index: A summary metric for three-dimensional gait analysis. Gait Posture 2023; 105:87-91. [PMID: 37499421 DOI: 10.1016/j.gaitpost.2023.07.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND This paper proposes an easy to calculate and adaptable summary gait metric, the Gait Abnormality Index (GAI), which is capable of simultaneously including kinematic and kinetic data, overcoming a key limitation of existing metrics. RESEARCH QUESTION To determine the validity, reliability and sensitivity of the GAI. METHODS The GAI is calculated by averaging Gait Abnormality Scores, which are normalised distance metrics used to describe the deviation of pathological gait data from that of healthy controls. Validity was assessed using Pearson's correlation analysis to explore relationships between the GAI and the Gait Profile Score. Test-retest reliability of the GAI was assessed using intra-class correlation coefficients (ICC) and standard error of the measurement (SEM), and data from total hip arthroplasty patients. An independent samples t-test was used to compare GAI scores between knee osteoarthritis and total hip arthroplasty patients to explore the metrics sensitivity. RESULTS A strong positive correlation (r ≥ 0.896; p < 001) was reported between the GAI and the Gait Profile Score. Good test-retest reliability (ICC =0.830) was reported for the GAI. Knee osteoarthritis patients displayed significantly (p = .017; Hedge's g effect size = 0.98) greater GAI scores compared to total hip arthroplasty patients, with the mean difference (0.34 a.u) above the SEM (0.15 a.u). SIGNIFICANCE The GAI offers an easy to calculate summary metric for three-dimensional gait analysis, which displays good validity and reliability, and is sensitive to different pathological conditions.
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Affiliation(s)
- Ben Langley
- Sport and Physical Activity, Edge Hill University, Lancashire, UK.
| | - Matt Greig
- Sport and Physical Activity, Edge Hill University, Lancashire, UK
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Koutserimpas C, Piagkou M, Karaiskos I, Karamitros A, Raptis K, Kourelis K, Christodoulou N. Modified Anterolateral Minimally Invasive Surgery (ALMIS) for Total Hip Replacement: Anatomical Considerations, Range of Motion and Clinical Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1520. [PMID: 37763639 PMCID: PMC10533114 DOI: 10.3390/medicina59091520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: In the modified anterolateral minimally invasive surgery (ALMIS) for total hip arthroplasty (THA), the intermuscular plane between the tensor fasciae latae and the gluteus maximus (GM) is exposed, while the anterior ¼ of the GM is detached. There are scarce data regarding this surgical approach. The purpose of the present study is to thoroughly describe this approach, encompassing the anatomical background, and to present the results of a retrospective two-center study of 603 patients. Materials and Methods: The present study includes a two-center retrospective observational cohort of 603 patients undergoing the ALMIS technique with minimum 5-year follow-up. Demographics were recorded, while range of motion (ROM) of the hip joint and the Harris Hip Score (HHS) were evaluated preoperatively, at 1, 3 and 12 months postoperatively and at the final follow-up (>5 years). Surgery-related complications were also recorded. Results: The studied population's mean age was 69.4 years, while most of them were females (397; 65.8%). The mean follow-up was 6.9 years. The median HHS at the 1-month follow-up was 74, compared to the 47 preoperatively (p-value < 0.0001). At the final follow-up, median HHS was 94. At the 1-month follow-up, mean adduction was 19.9° (compared to 15.4° preoperatively; p < 0.0001), mean abduction 24.3° (18.2° preoperatively; p < 0.0001), mean flexion 107.8° (79.1° preoperatively; p < 0.0001), mean external rotation 20.1° (12.1° preoperatively; p < 0.0001) and mean internal rotation 15.3° (7.2° preoperatively; p < 0.0001). ROM further improved until the final follow-up; mean adduction reached 22°, mean abduction 27.1°, mean flexion 119.8°, mean external rotation 24.4° and mean internal rotation 19.7°. Regarding complications, 1.3% of the sample suffered anterior traumatic dislocation, in 1.8% an intraoperative femoral fracture occurred, while 1.2% suffered periprosthetic joint infection. Conclusions: The modified ALMIS technique exhibited excellent clinical outcomes at short-, mid- and long-term follow-up, by significantly improving hip ROM and the HHS. Careful utilization of this technique, after adequate training, should yield favorable outcomes, while minimal major complications should be expected.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Ilias Karaiskos
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
| | - Athanasios Karamitros
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
| | - Konstantinos Raptis
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
| | - Konstantinos Kourelis
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
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13
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Park SJ, Kim BG. Effects of exercise therapy on the balance and gait after total hip arthroplasty: a systematic review and meta-analysis. J Exerc Rehabil 2023; 19:190-197. [PMID: 37662528 PMCID: PMC10468294 DOI: 10.12965/jer.2346290.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023] Open
Abstract
The situation is such that there is a lack of research analyzing the effect of exercise therapy during the rehabilitation period of patients after total hip arthroplasty (THA). Therefore, the purpose of this systematic review and meta-analysis is to analyze the effects of exercise therapy on the balance and gait of patients after THA. The studies selected for this study were based on the PICO as follows: P (Patient)-patients after THA, I (Intervention)-exercise therapy, C (Comparison)-control and other therapy groups, O (Outcome)-balance and gait. Additional criteria for this study were study design (randomized controlled study), language (English), publication status (journal), and the year of publication were not limited. Eleven studies were included. The effects of exercise therapy on balance and gait in patients after THA were significantly different. Balance: standardized mean difference (SMD), 0.51; 95% confidence intervals (CI), 0.24-0.78; I2=22%. Gait: SMD, 0.39; 95% CI, 0.01-0.76; I2=66%. Rehabilitation specialists recommend that exercise therapy be included in rehabilitation programs to improve balance and gait in patients after THA. Further research is needed in the future, including more studies and a network meta-analysis that analyzes the effect size of each exercise therapy.
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Affiliation(s)
- Se-Ju Park
- Department of Rehabilitation, Songwon University, Gwangju,
Korea
| | - Byeong-Geun Kim
- Department of Rehabilitation, Songwon University, Gwangju,
Korea
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14
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Langley B, Whelton C, Page R, Chalmers O, Cramp M, Morrison SC, Dey P, Board T. Exploring pelvis and thigh movement and coordination patterns during walking in patients after total hip arthroplasty. Gait Posture 2023; 103:196-202. [PMID: 37245333 DOI: 10.1016/j.gaitpost.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 05/18/2023] [Accepted: 05/23/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Patients after total hip arthroplasty (THA) have altered hip kinematics compared to healthy controls, specifically hip extension and range of motion are lower. Exploring pelvis-thigh coordination patterns and coordination variability may help to elucidate why differences in hip kinematics are evident in patients following THA. RESEARCH QUESTION Do sagittal plane hip, pelvis and thigh kinematics, and pelvis-thigh movement coordination and coordination variability differ between patients following THA and healthy controls during walking? METHODS Sagittal plane hip, pelvis and thigh kinematics were collected using a three-dimensional motion capture system while 10 patients who had undergone THA and 10 controls walked at a self-selected pace. A modified vector coding technique was used to quantify pelvis-thigh coordination and coordination variability patterns. Peak hip, pelvis and thigh kinematics and ranges of motion, and movement coordination and coordination variability patterns were quantified and compared between groups. RESULTS Patients after THA have significantly (p ≤ .036; g ≥ 0.995) smaller peak hip extension and range of motion, and peak thigh anterior tilt and range of motion compared to controls. Additionally, patients following THA have significantly (p ≤ .037; g ≥ 0.646) more in-phase distally and less anti-phase distally dominated pelvis-thigh movement coordination patterns compared to controls. SIGNIFICANCE The smaller peak hip extension and range of motion displayed by patients following THA is due to smaller peak anterior tilt of the thigh, which in turn limits thigh range of motion. The lower sagittal plane thigh, and in turn hip, motion used by patients after THA may be due to increases in the in-phase coordination of pelvis-thigh motion patterns, which cause the pelvis and thigh to work as a singular functional unit.
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Affiliation(s)
- Ben Langley
- Musculoskeletal Population Health Research Group, Edge Hill University, Lancashire, UK.
| | - Chris Whelton
- The Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | - Richard Page
- Musculoskeletal Population Health Research Group, Edge Hill University, Lancashire, UK
| | - Oliver Chalmers
- Musculoskeletal Population Health Research Group, Edge Hill University, Lancashire, UK
| | - Mary Cramp
- Allied Health Professions, Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Stewart C Morrison
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Paola Dey
- Musculoskeletal Population Health Research Group, Edge Hill University, Lancashire, UK
| | - Tim Board
- The Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
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15
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Maslivec A, Halewood C, Clarke S, Cobb J. Hip resurfacing arthroplasty in women: A novel ceramic device enables near normal gait function. Gait Posture 2023; 103:166-171. [PMID: 37210849 DOI: 10.1016/j.gaitpost.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Gait function improves after Total Hip Arthroplasty (THA) but is not restored to normal levels. Metal-on-metal Resurfacing Arthroplasty (MoM-HRA) is an alternative to THA and has shown to restore normal levels gait function and physical activity but has been restricted to men owing to problems of metal-ion release. Ceramic HRA (cHRA) removes the cobalt-chrome bearing surfaces, thereby eliminating these specific metal-ion concerns and aiming to be safe for females. RESEARCH QUESTION Is there a difference in gait function of female cHRA patients compared to female THA using subjective and objective measures? METHODS Fifteen unilateral cHRA and 15 unilateral THA, age and BMI matched, completed patient reported outcome measures (PROMs) (Oxford Hip Score, EQ5d and MET score) and underwent gait analysis using an instrumented treadmill pre- (2-10 weeks) and post-operatively (52-74 weeks). Maximum walking speed (MWS), Vertical GRF of the stance phase, GRF symmetry index (SI) and spatiotemporal gait measures were recorded. Patients were compared to age, gender and BMI healthy controls (CON). RESULTS There were no differences in PROMs or gait function between groups pre-operatively. Post- operatively, cHRA had a higher MET score (11.2 vs 7.1, p = 0.02) and a higher MWS (6.2 vs 6.8 km/hr, p = 0.003) compared to THA. cHRA had a similar GRF profile to CON, whereas THA had a reduced push-off force at 70-77 % of the stance phase compared to CON. At faster walking speeds of 6 km/hr walking speed, THA displayed an asymmetric GRF profile (SI<4.4 %) whereas the cHRA patients continued to display a symmetrical gait profile. cHRA was able to increase step length from pre-op levels (63 vs 66 cm, p = 0.02) and produced a larger step length compared to THA (73 vs 79 cm, p = 0.02). SIGNIFICANCE Female cHRA returned to levels of gait function and activity similar to healthy controls unlike female THA.
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Affiliation(s)
- Amy Maslivec
- Imperial College London, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK.
| | - Camilla Halewood
- Embody Orthopaedic Limited, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Susannah Clarke
- Imperial College London, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK; Embody Orthopaedic Limited, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Justin Cobb
- Imperial College London, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK; Embody Orthopaedic Limited, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
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16
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Sato EH, Stevenson KL, Blackburn BE, Peters C, Archibeck MJ, Pelt CE, Gililland JM, Anderson LA. Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00358-3. [PMID: 37068568 DOI: 10.1016/j.arth.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION Patient reported outcome measures (PROMs) are frequently used for evaluating patient satisfaction and function following total hip arthroplasty (THA). Functional measures along with chronologic modeling may help set expectations perioperatively. Our goal was to define the trajectory of recovery and function in the first year following THA. METHODS Prospective data from 1,898 patients in a multicenter study was analyzed. The PROMs included the Hip disability and Osteoarthritis Score for Joint Replacement (HOOS-JR) and EuroQol-5 dimension (EQ5D). Physical activity was recorded on a wearable technology. Data was collected pre-operatively and at one, three, six, and twelve months post-operatively. Generalized estimating equations were used to evaluate outcomes over time. RESULTS Significant improvement occurred between pre- and post-operative time points for all PROMs. The PROMs showed the greatest proportional recovery within the first month post-operatively, each improving by at least one minimal clinically important difference (MCID). Daily steps and flights of stairs took longer to reach at least one MCID (three months and one year, respectively). Gait speed and walking asymmetry returned to baseline by three months, but did not reach a MCID of improvement by one-year. CONCLUSION Patients can be counseled that the greatest proportional improvement in PROMs is within one month after THA, while function surpasses pre-operative baselines by three-months, and gait quality may not improve until after one-year. This can help set realistic expectations and target interventions toward patients deviating from the norm.
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Affiliation(s)
- Eleanor H Sato
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Brenna E Blackburn
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher Peters
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Michael J Archibeck
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Christopher E Pelt
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy M Gililland
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Lucas A Anderson
- 1Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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17
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Kaufmann M, Nüesch C, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Stoffel K, Mündermann A, Ismailidis P. Functional assessment of total hip arthroplasty using inertial measurement units: Improvement in gait kinematics and association with patient-reported outcome measures. J Orthop Res 2023; 41:759-770. [PMID: 35880355 DOI: 10.1002/jor.25421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 07/08/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023]
Abstract
Inertial measurement units (IMUs) are commonly used for gait assessment, yet their potential for quantifying improvements in gait function and patterns after total hip arthroplasty (THA) has not been fully explored. The primary aim of this study was to compare spatiotemporal parameters and sagittal plane kinematic patterns of patients with hip osteoarthritis (OA) before and after THA, and to asymptomatic controls. The secondary aim was to assess the association between dynamic hip range of motion (ROM) during walking and the Hip Osteoarthritis Outcome Scores (HOOS). Twenty-four patients with hip OA and 24 matched asymptomatic controls completed gait analyses using the RehaGait® sensor system. Patients were evaluated pre- and 1 year postoperatively, controls in a single visit. Differences in kinematic data were analyzed using statistical parametric mapping, and correlations between dynamic hip ROM and HOOS were calculated. Walking speed and stride length significantly increased (+0.08 m/s, p = 0.019; +0.06 m, p = 0.048) after THA but did not reach the level of asymptomatic controls (-0.11 m/s, p = 0.028; -0.14 m, p = 0.001). Preoperative hip and knee kinematics differed significantly from controls. After THA, they improved significantly and did not differ from controls. Dynamic hip flexion-extension ROM correlated positively with all HOOS subscores (r > 0.417; p ≤ 0.001). The change in HOOS symptoms in patients was explained by the combination of baseline HOOS symptoms and change in dynamic hip ROM (r2 = 0.748) suggesting that the additional information gained with IMU gait analysis helps to complement and objectify patient-reported outcome measures pre- and postoperatively and monitor treatment-related improvements.
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Affiliation(s)
- Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Center for Musculoskeletal Infections, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik, Birshof, Münchenstein, Switzerland
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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18
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O'Brien C, Holtzer R. Physical reserve: construct development and predictive utility. Aging Clin Exp Res 2023; 35:1055-1062. [PMID: 36848030 DOI: 10.1007/s40520-023-02371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Physical reserve (PR) refers to one's ability to maintain physical functioning despite age, illness, or injury. The measurement and predictive utility of PR, however, are not well established. AIMS We quantified PR using a residual measurement approach by extracting standardized residuals from gait speed, while accounting for demographic and clinical/disease variables, and used it to predict fall-risk. METHODS Participants (n = 510; age ≥ 70ys) were enrolled in a longitudinal study. Falls were assessed annually (in-person) and bimonthly (via structured telephone interview). RESULTS General Estimating Equations (GEE) revealed that higher baseline PR was associated with reduced odds of reporting falls over repeated assessments in the total sample, and incident falls among those without fall's history. The protective effect of PR against fall risk remained significant when adjusting for multiple demographic and medical confounders. DISCUSSION/CONCLUSION We propose a novel framework to assessing PR and demonstrate that higher PR is protective against fall-risk in older adults.
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Affiliation(s)
- Catherine O'Brien
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
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19
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Hulleck AA, Menoth Mohan D, Abdallah N, El Rich M, Khalaf K. Present and future of gait assessment in clinical practice: Towards the application of novel trends and technologies. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:901331. [PMID: 36590154 PMCID: PMC9800936 DOI: 10.3389/fmedt.2022.901331] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background Despite being available for more than three decades, quantitative gait analysis remains largely associated with research institutions and not well leveraged in clinical settings. This is mostly due to the high cost/cumbersome equipment and complex protocols and data management/analysis associated with traditional gait labs, as well as the diverse training/experience and preference of clinical teams. Observational gait and qualitative scales continue to be predominantly used in clinics despite evidence of less efficacy of quantifying gait. Research objective This study provides a scoping review of the status of clinical gait assessment, including shedding light on common gait pathologies, clinical parameters, indices, and scales. We also highlight novel state-of-the-art gait characterization and analysis approaches and the integration of commercially available wearable tools and technology and AI-driven computational platforms. Methods A comprehensive literature search was conducted within PubMed, Web of Science, Medline, and ScienceDirect for all articles published until December 2021 using a set of keywords, including normal and pathological gait, gait parameters, gait assessment, gait analysis, wearable systems, inertial measurement units, accelerometer, gyroscope, magnetometer, insole sensors, electromyography sensors. Original articles that met the selection criteria were included. Results and significance Clinical gait analysis remains highly observational and is hence subjective and largely influenced by the observer's background and experience. Quantitative Instrumented gait analysis (IGA) has the capability of providing clinicians with accurate and reliable gait data for diagnosis and monitoring but is limited in clinical applicability mainly due to logistics. Rapidly emerging smart wearable technology, multi-modality, and sensor fusion approaches, as well as AI-driven computational platforms are increasingly commanding greater attention in gait assessment. These tools promise a paradigm shift in the quantification of gait in the clinic and beyond. On the other hand, standardization of clinical protocols and ensuring their feasibility to map the complex features of human gait and represent them meaningfully remain critical challenges.
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Affiliation(s)
- Abdul Aziz Hulleck
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Dhanya Menoth Mohan
- School of Mechanical and Aerospace Engineering, Monash University, Clayton Campus, Melbourne, Australia
| | - Nada Abdallah
- Weill Cornell Medicine, New York City, NY, United States
| | - Marwan El Rich
- Mechanical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Biomedical Engineering Department, Khalifa University, Abu Dhabi, United Arab Emirates,Health Engineering Innovation Center, Khalifa University, Abu Dhabi, United Arab Emirates,Correspondence: Kinda Khalaf
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Bahadori S, Middleton RG, Wainwright TW. Using Gait Analysis to Evaluate Hip Replacement Outcomes—Its Current Use, and Proposed Future Importance: A Narrative Review. Healthcare (Basel) 2022; 10:healthcare10102018. [PMID: 36292465 PMCID: PMC9601798 DOI: 10.3390/healthcare10102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Total hip replacement (THR) is one of the most common elective orthopaedic operations. However, evidence suggests that despite postoperative pain improvements, aspects of longer-term physical performance, such as walking ability, do not reach the levels expected when compared to the general population. Walking is best assessed by using gait analysis. This review aims to explain the concept of gait analysis, its use to evaluate THR outcomes, and its proposed future importance when evaluating new technologies proposed to improve functional recovery in individuals undergoing THR surgery. Furthermore, this review discusses the advantages and challenges of gait analysis in THR patients and provides recommendations for future work.
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Affiliation(s)
- Shayan Bahadori
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset BH8 8EB, UK
| | - Robert G. Middleton
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset BH8 8EB, UK
- Orthopaedic Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth, Dorset BH7 7DW, UK
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth, Dorset BH8 8EB, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth, Dorset BH7 7DW, UK
- Correspondence:
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21
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Is simultaneous bilateral total hip arthroplasty deleterious in a biomechanical point of view? A comparative gait analysis study. BMC Musculoskelet Disord 2022; 23:903. [PMID: 36217164 PMCID: PMC9549045 DOI: 10.1186/s12891-022-05856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/22/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Uni- or bilateral hip osteoarthritis is a common disease generating pain, stiffness, and functional disabilities. Changes in the normal walking with higher energy expenditures are observed. Facing a cruel lack of biomechanical data, we decided to analyse the impact on the walking of single and simultaneous bilateral total hip arthroplasties (THA). Method We conducted a prospective monocentric study, comparing two matched groups of 15 patients able to walk with symptomatic isolated uni- (group 1) or bilateral HO (group 2) and treated respectively by unilateral THA (UTHA) or simultaneous bilateral THA (SBTHA). Surgery was performed by a single surgeon with a direct anterior approach and approved by local ethical committee. Walking was assessed by a « 3D Gait analysis motion» pre and at 6 months post operatively. Result In the UTHA group, recovery, i.e., efficiency of locomotor mechanism (p < 0.001) and pelvis sagittal balance (p = 0.031) improved, while external and total work (p = 0.010) decreased post operatively. In the SBTHA group, speed (p = 0.035), step length (p = 0.046), range of motion of knee sagittal stance (p = 0.009) and hip frontal (p = 0.031), and internal work are significatively higher (p < 0.001) post operatively. Conclusions This original study attests that THA has a positive impact on walking and energetics outcome in UTHA and SBTHA.
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Boekesteijn R, Smolders J, Busch V, Keijsers N, Geurts A, Smulders K. Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures. PeerJ 2022; 10:e14054. [PMID: 36193431 PMCID: PMC9526408 DOI: 10.7717/peerj.14054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/24/2022] [Indexed: 01/20/2023] Open
Abstract
Background Inertial sensors hold the promise to objectively measure functional recovery after total knee (TKA) and hip arthroplasty (THA), but their value in addition to patient-reported outcome measures (PROMs) has yet to be demonstrated. This study investigated recovery of gait after TKA and THA using inertial sensors, and compared results to recovery of self-reported scores of pain and function. Methods PROMs and gait parameters were assessed before and at two and fifteen months after TKA (n = 24) and THA (n = 24). Gait parameters were compared with healthy individuals (n = 27) of similar age. Gait data were collected using inertial sensors on the feet, lower back, and trunk. Participants walked for two minutes back and forth over a 6m walkway with 180° turns. PROMs were obtained using the Knee Injury and Osteoarthritis Outcome Scores and Hip Disability and Osteoarthritis Outcome Score. Results Gait parameters recovered to the level of healthy controls after both TKA and THA. Early improvements were found in gait-related trunk kinematics, while spatiotemporal gait parameters mainly improved between two and fifteen months after TKA and THA. Compared to the large and early improvements found in of PROMs, these gait parameters showed a different trajectory, with a marked discordance between the outcome of both methods at two months post-operatively. Conclusion Sensor-derived gait parameters were responsive to TKA and THA, showing different recovery trajectories for spatiotemporal gait parameters and gait-related trunk kinematics. Fifteen months after TKA and THA, there were no remaining gait differences with respect to healthy controls. Given the discordance in recovery trajectories between gait parameters and PROMs, sensor-derived gait parameters seem to carry relevant information for evaluation of physical function that is not captured by self-reported scores.
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Affiliation(s)
- Ramon Boekesteijn
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands,Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - José Smolders
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Vincent Busch
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Noël Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander Geurts
- Department of Rehabilitation, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
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Wang Y, Owen A, Franks A, Ackerman I, Fitzgerald SM, Liew S, Woods RL, Wluka AE, McNeil JJ, Cicuttini FM. Functional Outcomes Following Hip Replacement in Community-Dwelling Older Adults. J Clin Med 2022; 11:jcm11175117. [PMID: 36079051 PMCID: PMC9457152 DOI: 10.3390/jcm11175117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/16/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
Uncertainty remains regarding the benefit of hip replacement in older adults in the context of age-related decline in physical function. This study aimed to examine the effect of hip replacement on functional outcomes and identify factors associated with clinically important improvement in physical function postoperatively in community-dwelling older adults. This cohort study was performed within the ASPREE trial, with 698 participants receiving hip replacement and 677 age- and sex-matched controls without knee or hip replacement during the trial drawn from 16,703 Australian participants aged ≥70 years. Health status (physical and mental component summary [PCS and MCS]) was assessed annually using the SF-12. Participants receiving hip replacement had significantly lower pre- and post-replacement PCS scores compared with controls (p < 0.0001). There was significant improvement in PCS score following hip replacement (mean change 4.9, 95%CI 4.0−5.7) but no change in controls (0.01, 95%CI −0.7−0.7). Following hip replacement, 46.7% of participants experienced clinically important improvement in PCS score, while 15.5% experienced worsened PCS score. Participants experiencing improved postoperative PCS score had significantly lower PCS and higher MCS scores preoperatively. The degree of preoperative physical function impairment was a significant indicator of older people most likely to benefit from hip replacement surgery.
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Affiliation(s)
- Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Angus Franks
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Ilana Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Sharyn M. Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Susan Liew
- Alfred Hospital, Melbourne 3004, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Anita E. Wluka
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
| | - Flavia M. Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
- Correspondence: ; Tel.: +61-39-9030158
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24
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Usami T, Nishida K, Iguchi H, Okumura T, Sakai H, Ida R, Horiba M, Kashima S, Sahashi K, Asai H, Nagaya Y, Murakami H, Ueki Y, Kuroyanagi G. Evaluation of lower extremity gait analysis using Kinect V2 ® tracking system. SICOT J 2022; 8:27. [PMID: 35748723 PMCID: PMC9231176 DOI: 10.1051/sicotj/2022027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Microsoft Kinect V2® (Kinect) is a peripheral device of Xbox® and acquires information such as depth, posture, and skeleton definition. In this study, we investigated whether Kinect can be used for human gait analysis. Methods: Ten healthy volunteers walked 20 trials, and each walk was recorded by a Kinect and infrared- and marker-based-motion capture system. Pearson’s correlation and overall agreement with a method of meta-analysis of Pearson’s correlation coefficient were used to assess the reliability of each parameter, including gait velocity, gait cycle time, step length, hip and knee joint angle, ground contact time of foot, and max ankle velocity. Hip and knee angles in one gait cycle were calculated in Kinect and motion capture groups. Results: The coefficients of correlation for gait velocity (r = 0.92), step length (r = 0.81) were regarded as strong reliability. Gait cycle time (r = 0.65), minimum flexion angle of hip joint (r = 0.68) were regarded as moderate reliability. The maximum flexion angle of the hip joint (r = 0.43) and maximum flexion angle of the knee joint (r = 0.54) were regarded as fair reliability. Minimum flexion angle of knee joint (r = 0.23), ground contact time of foot (r = 0.23), and maximum ankle velocity (r = 0.22) were regarded as poor reliability. The method of meta-analysis revealed that participants with small hip and knee flexion angles tended to have poor correlations in maximum flexion angle of hip and knee joints. Similar trajectories of hip and knee angles were observed in Kinect and motion capture groups. Conclusions: Our results strongly suggest that Kinect could be a reliable device for evaluating gait parameters, including gait velocity, gait cycle time, step length, minimum flexion angle of the hip joint, and maximum flexion angle of the knee joint.
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Affiliation(s)
- Takuya Usami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan - Nagoya City University East Medical Center, Nagoya, Aichi 464-8547, Japan
| | - Kazuki Nishida
- Center for Advanced Medicine and Clinical Research Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Hirotaka Iguchi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Taro Okumura
- National Hospital Organization Toyohashi Medical Center, Nagoya, Aichi 440-8510, Japan
| | - Hiroaki Sakai
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Ruido Ida
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Mitsuya Horiba
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Shuuto Kashima
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Kento Sahashi
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Hayato Asai
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Yuko Nagaya
- Nagoya City University East Medical Center, Nagoya, Aichi 464-8547, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Yoshino Ueki
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
| | - Gen Kuroyanagi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan - Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
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25
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Maharaj M, Natarajan P, Fonseka RD, Khanna S, Choy WJ, Rooke K, Phan K, Mobbs RJ. The concept of recovery kinetics: an observational study of continuous post-operative monitoring in spine surgery. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:196-203. [PMID: 35875621 PMCID: PMC9263729 DOI: 10.21037/jss-22-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The spine surgeon's understanding of an individual patient's burden of disease and functional disability in daily life is shaped by patient-reported outcome measures (PROMs). Although PROMs are useful in understanding the patient's perception of their disease, the use of PROMs constitutes a "snapshot" approach of single timepoint data capture, omitting day-to-day fluctuations in functional status. We introduce the concept of kinetics when considering continuous and objective postoperative patient monitoring with wearable sensors. METHODS A prospective single-centre series was performed using patients either undergoing lumbar decompression for lumbar spinal stenosis (LSS) (n=12), or posterior lumbar fusion for degenerative spondylolisthesis (n=12). The Oswestry Disability Index (PROM) was conducted preoperatively and 12-weeks postoperatively. During this timeframe, continuous measurements of step count and distance travelled were made using a wrist-based wearable accelerometer. RESULTS Over the 12-week study period, mean daily step count for all participants improved from 4,700 to 7,700 steps per day (P=0.013), following an initial dip in total steps taken. The mean daily distance travelled improved from 3,300 to 5,300 meters per day (P=0.003). Decompression group recovered at a faster rate than the fusion group. CONCLUSIONS Although overall improvement was similar between the decompression and fusion groups, the recovery kinetics varied. The recovery kinetics approach of continuous postoperative monitoring provides additional insight to postoperative patient progress.
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Affiliation(s)
- Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
- NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, Australia
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - R. Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Sukrit Khanna
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Wen Jie Choy
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Kaitlin Rooke
- NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
- NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, Australia
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Biggs P, Holsgaard-Larsen A, Holt CA, Naili JE. Gait function improvements, using Cardiff Classifier, are related to patient-reported function and pain following hip arthroplasty. J Orthop Res 2022; 40:1182-1193. [PMID: 34330149 DOI: 10.1002/jor.25149] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/16/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
Summarizing results of three-dimensional (3D) gait analysis into a comprehensive measure of overall gait function is valuable to discern to what extent gait function is affected, and later recovered after surgery and rehabilitation. This study aimed to investigate whether preoperative gait function, quantified and summarized using the Cardiff Classifier, can predict improvements in postoperative patient-reported activities of daily living, and overall gait function 1 year after total hip arthroplasty (THA). Secondly, to explore relationships between pre-to-post surgical change in gait function versus changes in patient-reported and performance-based function. Thirty-two patients scheduled for THA and 25 nonpathological individuals were included in this prospective cohort study. Patients were evaluated before THA and 1 year postoperatively using 3D gait analysis, patient-reported outcomes, and performance-based tests. Kinematic and kinetic gait parameters, derived from 3D gait analysis, were quantified using the Cardiff Classifier. Linear regressions investigated the predictive value of preoperative gait function on postoperative outcomes of function, and univariate correlations explored relationships between pre-to-post surgical changes in outcome measures. Preoperative gait function, by means of Cardiff Classifier, explained 35% and 30% of the total variance in change in patient-reported activities of daily living, and in gait function, respectively. Moderate-to-strong correlations were found between change in gait function and change in patient-reported function and pain, while no correlations were found between change in gait function and performance-based function. Clinical significance: Preoperative gait function predicts postsurgical function to a moderate degree, while improvements in gait function after surgery are more closely related to how patients perceive function than their maximal performance of functional tests.
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Affiliation(s)
- Paul Biggs
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK
| | - Anders Holsgaard-Larsen
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Cathy A Holt
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, UK
| | - Josefine E Naili
- Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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27
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Walha R, Gaudreault N, Dagenais P, Boissy P. Spatiotemporal parameters and gait variability in people with psoriatic arthritis (PsA): a cross-sectional study. J Foot Ankle Res 2022; 15:19. [PMID: 35246222 PMCID: PMC8895502 DOI: 10.1186/s13047-022-00521-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Foot involvement is a major manifestation of psoriatic arthritis (PsA) and can lead to severe levels of foot pain and disability and impaired functional mobility and quality of life. Gait spatiotemporal parameters (STPs) and gait variability, used as a clinical index of gait stability, have been associated with several adverse health outcomes, including risk of falling, functional decline, and mortality in a wide range of populations. Previous studies showed some alterations in STPs in people with PsA. However, gait variability and the relationships between STPs, gait variability and self-reported foot pain and disability have never been studied in these populations. Body-worn inertial measurement units (IMUs) are gaining interest in measuring gait parameters in clinical settings. Objectives To assess STPs and gait variability in people with PsA using IMUs, to explore their relationship with self-reported foot pain and function and to investigate the feasibility of using IMUs to discriminate patient groups based on gait speed-critical values. Methods Twenty-one participants with PsA (age: 53.9 ± 8.9 yrs.; median disease duration: 6 yrs) and 21 age- and sex-matched healthy participants (age 54.23 ± 9.3 yrs) were recruited. All the participants performed three 10-m walk test trials at their comfortable speed. STPs and gait variability were recorded and calculated using six body-worn IMUs and Mobility Lab software (APDM®). Foot pain and disability were assessed in participants with PsA using the foot function index (FFI). Results Cadence, gait speed, stride length, and swing phase were significantly lower, while double support was significantly higher, in the PsA group (p < 0.006). Strong correlations between STPs and the FFI total score were demonstrated (|r| > 0.57, p < 0.006). Gait variability was significantly increased in the PsA group, but it was not correlated with foot pain or function (p < 0.006). Using the IMUs, three subgroups of participants with PsA with clinically meaningful differences in self-reported foot pain and disability were discriminated. Conclusion STPs were significantly altered in participants with PsA, which could be associated with self-reported foot pain and disability. Future studies are required to confirm the increased gait variability highlighted in this study and its potential underlying causes. Using IMUs has been useful to objectively assess foot function in people with PsA. Trial registration ClinicalTrials.gov, NCT05075343, Retrospectively registered on 29 September 2021.
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Affiliation(s)
- Roua Walha
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nathaly Gaudreault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pierre Dagenais
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick Boissy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. .,Research Center on Aging, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada.
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Shema-Shiratzky S, Beer Y, Mor A, Elbaz A. Smartphone-based inertial sensors technology - Validation of a new application to measure spatiotemporal gait metrics. Gait Posture 2022; 93:102-106. [PMID: 35121485 DOI: 10.1016/j.gaitpost.2022.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Smartphones are increasingly recognized as the future technology for clinical gait assessment. RESEARCH QUESTION To determine the concurrent validity of gait parameters obtained using the smartphone technology and application in a group of patients with musculoskeletal pathologies. METHODS Patients with knee, lower back, hip, or ankle pain were included in the study (n = 72). Spatiotemporal outcomes were derived from the walkway and the smartphone simultaneously. Pearson's correlations and limits of agreement (LoA) determined the association between the two methods. RESULTS Cadence and gait cycle time showed excellent correlation and agreement between the smartphone and the walkway (cadence: r = 0.997, LoA=1.4%, gait cycle time: r = 0.996, LoA = 1.6%). Gait speed, double-limb support and left and right step length demonstrated strong correlations and moderate agreement between methods (gait speed: r = 0.914, LoA=15.4%, left step length: r = 0.842, LoA = 17.0%, right step length: r = 0.800, LoA=16.4%). The left and right measures of single-limb support and stance percent showed a consistent 4% bias across instruments, yielding moderate correlation and very good agreement between the smartphone and the walkway (r = 0.532, LoA = 9% and r = 0.460, LoA=9.8% for left and right single-limb support; r = 0.463, LoA = 5.1% and r = 0.533, LoA = 4.4% for left and right stance). SIGNIFICANCE The examined application appears to be a valid tool for gait analysis, providing clinically significant metrics for the assessment of patients with musculoskeletal pathologies. However, additional studies should examine the technology amongst patients with severe gait abnormalities.
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Affiliation(s)
| | - Yiftah Beer
- Department of Orthopaedic Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
| | - Amit Mor
- AposTherapy Research Group, Herzliya, Israel.
| | - Avi Elbaz
- AposTherapy Research Group, Herzliya, Israel.
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Martines GA, Tamanini JTN, Mota GMDS, Barreto ET, Santos JLF, Sartori MGF, Girão MJBC, Castro RDA. Urinary incontinence, overactive bladder, and quality of life in women submitted to total hip replacement. Neurourol Urodyn 2022; 41:830-840. [PMID: 35114028 DOI: 10.1002/nau.24888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Hip osteoarthritis (OA) compromises functioning. Total hip replacement (THR) is the indicated treatment and may improve urinary incontinence (UI) and symptoms of overactive bladder (OAB). OBJECTIVES Assess UI, OAB symptoms, and quality of life (QoL) impact in preoperative and postoperative periods of women submitted to THR and investigate associated factors. METHODS A prospective cohort was conducted with 183 women submitted to THR. The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), International Consultation on Incontinence Questionnaire-Overactive Bladder (ICIQ-OAB) and SF-12 questionnaires were administered pre- and 3 and 6 months after surgery. RESULTS Significant improvements were found in UI and QoL 3- and 6-month postoperatively in the overall sample and in the subgroup with preoperative UI. The multivariate regression revealed that the preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI 6-month postoperatively. The factors the best predicted the occurrence of UI 6-month following THR were the preoperative ICIQ-OAB scores and preoperative UI. Each unit of increase in the ICIQ-OAB increases the chances of UI by 26.9% and preoperative UI increases the chances of postoperative UI by 18.7-fold. A weak but significant negative correlation was found between the ICIQ-SF score and the SF-12 score. CONCLUSION Significant improvements in UI, OAB and QoL were found at 3- and 6-month postoperatively. Preoperative ICIQ-SF and ICIQ-OAB final scores were the best predictors of UI at 6 months after surgery. We found significant association between urinary symptoms and THR, but this association is partially explained by current literature.
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Affiliation(s)
- Guilherme Augusto Martines
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, SP, Brazil
| | | | | | - Eduardo Tavares Barreto
- Department of Orthopedics, Evangelical Hospital of Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Jair Lício Ferreira Santos
- Department of Social Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | | | - Rodrigo de Aquino Castro
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, SP, Brazil
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Ikutomo H, Nagai K, Tagomori K, Miura N, Okamura K, Okuno T, Nakagawa N, Masuhara K. Incidences and circumstances of falls among women following total hip arthroplasty on long-term follow-up. J Orthop Sci 2022; 28:577-582. [PMID: 35063335 DOI: 10.1016/j.jos.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/29/2021] [Accepted: 12/27/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND Patients who undergo total hip arthroplasty have an increased risk of falls during the first postoperative year. However, it is unclear whether patients after total hip arthroplasty will continue to be at high risk of falls more than 1 year postoperatively. To better understand whether the risk of falls changes after a 1-year period, we investigated the incidences and circumstances of falls in women patients for 5 years after total hip arthroplasty. METHODS This longitudinal prospective cohort study analyzed 65 women with severe hip osteoarthritis who underwent total hip arthroplasty. The incidences and circumstances of falls before total hip arthroplasty and at 1, 2, and 5 years postoperatively were investigated. We assessed the Harris Hip Score and evaluated hip pain and ambulatory ability using a self-administered questionnaire. RESULTS The incidences of at least one fall were 30.8%, 26.2%, 23.1%, and 30.8% before and 1, 2, and 5 years after surgery, respectively. Among the circumstances of falls from pre-surgery to 5 years post-surgery, there was a significant difference in the direction of falls; however, there were no significant differences in the location, time, cause, and type of injury. Most falls occurred indoors by tripping or loss of balance during the daytime. Among the participants who had falls almost half sustained injuries, and approximately 10% of falls resulted in fractures each year. Although self-reported hip pain, ambulation, and the Harris Hip Score significantly improved in women after total hip arthroplasty compared to pre-surgery, there was no significant difference in the incidences of falls from 1 to 5 years post-surgery. CONCLUSION Women who underwent total hip arthroplasty continued to have an increased risk of falls and fall-induced injuries for 5 years postoperatively. Preventive measures against falling to reduce fall-induced injuries in the long term are required for women after total hip arthroplasty.
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Affiliation(s)
- Hisashi Ikutomo
- Department of Rehabilitation, Masuhara Clinic 3-4-2, Tenmabashi, Kita-ku, Osaka City, Osaka, 530-0042, Japan.
| | - Koutatsu Nagai
- Department of Rehabilitation, Graduate School of Health Science, Hyogo University of Health Sciences. 1-3-6, Minatojima, Chuo-ku, Kobe City, Hyogo, 650-8530, Japan
| | - Keiichi Tagomori
- Department of Rehabilitation, Masuhara Clinic 3-4-2, Tenmabashi, Kita-ku, Osaka City, Osaka, 530-0042, Japan
| | - Namika Miura
- Department of Rehabilitation, Masuhara Clinic 3-4-2, Tenmabashi, Kita-ku, Osaka City, Osaka, 530-0042, Japan
| | - Kenichi Okamura
- Department of Rehabilitation, Masuhara Clinic 3-4-2, Tenmabashi, Kita-ku, Osaka City, Osaka, 530-0042, Japan
| | - Takato Okuno
- Department of Rehabilitation, Masuhara Clinic 3-4-2, Tenmabashi, Kita-ku, Osaka City, Osaka, 530-0042, Japan
| | - Norikazu Nakagawa
- Department of Rehabilitation, Masuhara Clinic 3-4-2, Tenmabashi, Kita-ku, Osaka City, Osaka, 530-0042, Japan
| | - Kensaku Masuhara
- Department of Orthopaedics, Masuhara Clinic 3-4-2, Tenmabashi, Kita-ku, Osaka City, Osaka, 530-0042, Japan
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Kinoshita K, Kimura K, Miyamoto S, Takata Y, Kodama Y, Ieiri A, Ishida K, Inoue M, Abe S, Mikami T, Kanno T. Relationship between Perceived Leg Length Discrepancy at One Month and Preoperative Hip Abductor Muscle Elasticity in Patients after Total Hip Arthroplasty. Phys Ther Res 2022; 24:232-239. [PMID: 35036257 DOI: 10.1298/ptr.e10102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Preoperative factors related to perceived leg length discrepancy (PLLD) after total hip arthroplasty (THA) are not well studied. This study aimed to examine the preoperative factors, including hip abductor modulus, related to PLLD one month after THA. METHODS The study included 73 patients diagnosed with osteoarthritis secondary to developmental dysplasia of the hip and a posterior approach to surgery. Multiple logistic regression analysis was performed using the presence or absence of PLLD as the dependent variable and preoperative hip abductor's modulus of elasticity, pain, hip abduction range of motion, hip abductor muscle strength and pelvic obliquity as the independent variable. Additionally, receiver operating characteristic curves were used for the extracted variables for calculating the cutoffs, sensitivity, specificity and area under the curve (AUC) to determine the presence or absence of PLLD. The significance level was set at p<0.05. RESULTS The hip abductor modulus (odds ratio=1.13; 95% confidence interval=1.06-1.21; p<0.001) was selected as a preoperative factor. The cutoff value to determine the presence or absence of a PLLD was 16.32 kPa. The sensitivity and specificity were 81.8% and 72.5%, respectively, and the AUC was 0.8137. CONCLUSION The hip abductor muscle elastic modulus affected PLLD one month after THA. If the preoperative hip abductor elastic modulus is higher than the cutoff value, it may affect the appearance of PLLD at one month postoperatively.
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Affiliation(s)
| | - Kazushi Kimura
- Graduate School of Rehabilitation Science, Hokkaido Bunkyo University, Japan
| | - Shigenori Miyamoto
- Graduate School of Rehabilitation Science, Hokkaido Bunkyo University, Japan
| | - Yuichi Takata
- Graduate School of Rehabilitation Science, Hokkaido Bunkyo University, Japan
| | - Yuji Kodama
- Department of Rehabilitation, Wajokai Eniwa Hospital, Japan
| | - Akira Ieiri
- Department of Rehabilitation, Wajokai Eniwa Hospital, Japan
| | | | - Masahiro Inoue
- Department of Orthopedic Surgery, Wajokai Eniwa Hospital, Japan
| | - Satomi Abe
- Department of Orthopedic Surgery, Wajokai Eniwa Hospital, Japan
| | - Takashi Mikami
- Department of Orthopedic Surgery, Wajokai Eniwa Hospital, Japan
| | - Taiki Kanno
- Department of Orthopedic Surgery, Wajokai Eniwa Hospital, Japan
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Kurihara Y, Ohsugi H, Matsuda T, Tosaka T, Endo Y, Tsuneizumi Y, Tsukeoka T. Early postoperative relationship between patient-reported outcome measures and gait biomechanical factors after total hip arthroplasty. Gait Posture 2022; 91:14-18. [PMID: 34628217 DOI: 10.1016/j.gaitpost.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) have recently been considered as indicating clinical outcomes after total hip arthroplasty (THA). Although various factors are reportedly associated with post-THA and PROMs, the relationship with gait parameters, which are objective assessment factors after THA, remains unclear. RESEARCH QUESTION What is the relationship between PROMs and gait biomechanical factors four weeks after THA? METHODS Forty-five patients (six men and 39 women) who underwent THA were included. Three-dimensional gait analysis was performed four weeks post-THA; joint angle, internal moment, and power of the lower extremity at the first and second peaks of the vertical component of the floor reaction force were assessed for the operated side. PROMs were evaluated using the Japanese Orthopedic Association Hip Disease Evaluation Questionnaire (JHEQ). The relationship between the JHEQ score and extracted gait parameters was analyzed using gender and gait speed as control factors. RESULTS For the JHEQ sub-domain, movement was positively correlated with the internal knee extension moment values at the first peak (r = 0.347). There was no significant correlation between JHEQ and the internal hip abduction moment value at the first peak. Mental status was negatively correlated with the hip flexion angle value at the second peak (r = -0.373), and positively correlated with the hip flexion moment value (r = 0.348). Total JHEQ scores and mental status were negatively correlated with the power of hip flexion value at the second peaks, respectively (r = -0.316, -0.444). SIGNIFICANCE The results of this study may provide recovery guidelines to be used as an index for gait assessment in the early post-THA period. Further studies are needed to verify whether gait parameters can improve PROMs in the early post-THA period.
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Affiliation(s)
- Yasushi Kurihara
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture, 283-8555, Japan.
| | - Hironori Ohsugi
- Department of Physical Therapy, Faculty of Social Work Studies, Josai International University, 1 Gumyo, Togane-City, Chiba-Prefecture, 283-8555, Japan
| | - Tadamitsu Matsuda
- Department of Physical Therapy, Faculty of Health Sciences, Juntendo University, 2-1-1 Hongou Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomonari Tosaka
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Yuki Endo
- Department of Physical Therapy for Adults, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Yoshikazu Tsuneizumi
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
| | - Tadashi Tsukeoka
- Department of Orthopedic Surgery, Chiba Rehabilitation Center, 1-45-2 Hondacho Midori-ku, Chiba-City, Chiba-Prefecture, 266-0005, Japan
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Labanca L, Ciardulli F, Bonsanto F, Sommella N, Di Martino A, Benedetti MG. Balance and proprioception impairment, assessment tools, and rehabilitation training in patients with total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2021; 22:1055. [PMID: 34930190 PMCID: PMC8690357 DOI: 10.1186/s12891-021-04919-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Osteoarthritis and subsequent total hip arthroplasty (THA) lead to damages to hip joint mechanoceptors, which in turns lead to impairments in proprioception. One of the abilities mainly affected by an altered joint proprioception is balance. The aim of this work was to investigate the balance and proprioception impairments, current assessment tools, and rehabilitation training after THA. METHODS A systematic literature revision was conducted on PubMed, Web of Science and Cochrane databases. Articles reporting balance and proprioception impairments, current assessment tools, or rehabilitation interventions were included. Methodological quality was assessed using the Downs and Black checklist. A total of 41 articles were included, 33 discussing balance and proprioception assessment, and 8 dealing with training. Data related to type of surgical approach, type and timing of assessment protocols, assessment instrumentation, and type, volume and duration of the rehabilitation training were extracted from each study. RESULTS Thirty-one studies were of high quality, 2 of moderate quality and 8 of low-quality. Literature review showed an improvement in balance following THA in comparison with the pre-operative performance, although balance abnormalities persist up to 5 years after surgery, with THA patients showing an increased risk for falls. Balance training is effective in all the rehabilitation phases if specifically structured for balance enhancement and consistent in training volume. It remains unclear which assessments are more appropriate for the different rehabilitation phases, and if differences exist between the different surgical procedures used for THA. Only two studies assessed proprioception. CONCLUSION Balance and proprioception show impairments up to 5 years after THA, increasing the risk of falls. However, patients with THA may benefit of an adequate balance training. Further research is needed to investigate the gaps in balance and proprioception assessment and training following THA surgery.
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Affiliation(s)
- Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy. .,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Francesca Ciardulli
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabio Bonsanto
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Nadia Sommella
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Di Martino
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,I Orthopaedic Clinic, IRCSS- Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Negrini F, de Sire A, Lazzarini SG, Pennestrì F, Sorce S, Arienti C, Vitale JA. Reliability of activity monitors for physical activity assessment in patients with musculoskeletal disorders: A systematic review. J Back Musculoskelet Rehabil 2021; 34:915-923. [PMID: 33935067 DOI: 10.3233/bmr-200348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Activity monitors have been introduced in the last years to objectively measure physical activity to help physicians in the management of musculoskeletal patients. OBJECTIVE This systematic review aimed at describing the assessment of physical activity by commercially available portable activity monitors in patients with musculoskeletal disorders. METHODS PubMed, Embase, PEDro, Web of Science, Scopus and CENTRAL databases were systematically searched from inception to June 11th, 2020. We considered as eligible observational studies with: musculoskeletal patients; physical activity measured by wearable sensors based on inertial measurement units; comparisons performed with other tools; outcomes consisting of number of steps/day, activity/inactivity time, or activity counts/day. RESULTS Out of 595 records, after removing duplicates, title/abstract and full text screening, 10 articles were included. We noticed a wide heterogeneity in the wearable devices, that resulted to be 10 different types. Patients included suffered from rheumatoid arthritis, osteoarthritis, juvenile idiopathic arthritis, polymyalgia rheumatica, and fibromyalgia. Only 3 studies compared portable activity trackers with objective measurement tools. CONCLUSIONS Taken together, this systematic review showed that activity monitors might be considered as useful to assess physical activity in patients with musculoskeletal disorders, albeit, to date, the high device heterogeneity and the different algorithms still prevent their standardization.
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Affiliation(s)
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Castioni D, Galasso O, Iannò B, Mercurio M, Gasparini G. Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study. BMC Musculoskelet Disord 2021; 22:932. [PMID: 34749687 PMCID: PMC8576907 DOI: 10.1186/s12891-021-04679-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND One of the most controversial aspects for maximizing outcomes after total hip arthroplasty (THA) remains the surgical approach to the hip joint. The posterior (PA) and lateral approaches (LA) are the two most commonly performed approaches used worldwide, but sparse data are available for their comparison in terms of health-related quality-of-life (HRQoL). The aim of this study was to assess the role of the PA and LA in the HRQoL and hip functionality of patients who underwent primary and elective THA for osteoarthritis, after a minimum 2-year follow-up. METHODS One hundred twenty-eight patients (140 THAs: 68 with PA and 72 with LA) were evaluated in a matched cohort study. Data gathered included the body mass index, the American Society of Anesthesiologists score, surgery time, serum creatine phosphokinase (CpK) levels, estimated intraoperative blood loss and intra- or postoperative complications. Preoperatively and at the last follow-up, the activities of daily living, and the instrumental activities of daily living (IADL) scales, the Western Ontario and Mac Master University (WOMAC) Questionnaire, the Harris Hip Score (HHS) and the Visual Analogue Scale (VAS) were used to assess HRQoL and functionality. The Short Form-36 Health Survey (SF-36) Questionnaire was administered at the last follow-up. RESULTS Postoperatively, CpK was higher in the LA group compared to the PA (695 ± 648 vs. 447 ± 326 UI/L, p < 0.001). At a mean follow-up of 47 ± 22 months for the LA group and 42 ± 29 months for the PA group, IADL, VAS, HHS and WOMAC scores significantly improved for both groups (all p < 0.001), but PA reported better VAS, residual pain and WOMAC scores (p = 0.002, p = 0.004 and p = 0.018, respectively). The PA group demonstrated a significant higher mental SF-36 subscale values than the LA group (49 ± 13 vs. 42 ± 19, p = 0.001). The LA group showed a higher number of Trendelenburg signs (p = 0.029). On the contrary, the PA group showed a higher number of leg lengthening (p = 0.020); however, most of these cases was less than the clinically significant value of 10 mm (p = 0.738). CONCLUSIONS Patients who underwent THA performed with the PA reported greater improvement in HRQoL with lower residual pain, postoperative muscle damage and Trendelenburg signs than those who underwent the LA.
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Affiliation(s)
- Davide Castioni
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, V.le Europa, (loc. Germaneto), 88100 Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, V.le Europa, (loc. Germaneto), 88100 Catanzaro, Italy
| | - Bruno Iannò
- Department of Surgery, Division of Orthopedics and Trauma Surgery, “G. Jazzolino” Hospital, Piazza Fleming, 89900 Vibo Valentia, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, V.le Europa, (loc. Germaneto), 88100 Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, V.le Europa, (loc. Germaneto), 88100 Catanzaro, Italy
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Estes BT, Enomoto M, Moutos FT, Carson MA, Toth JM, Eggert P, Stallrich J, Willard VP, Veis DJ, Little D, Guilak F, Lascelles BDX. Biological resurfacing in a canine model of hip osteoarthritis. SCIENCE ADVANCES 2021; 7:eabi5918. [PMID: 34524840 PMCID: PMC8443182 DOI: 10.1126/sciadv.abi5918] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/22/2021] [Indexed: 05/31/2023]
Abstract
Articular cartilage has unique load-bearing properties but has minimal capacity for intrinsic repair. Here, we used three-dimensional weaving, additive manufacturing, and autologous mesenchymal stem cells to create a tissue-engineered, bicomponent implant to restore hip function in a canine hip osteoarthritis model. This resorbable implant was specifically designed to function mechanically from the time of repair and to biologically integrate with native tissues for long-term restoration. A massive osteochondral lesion was created in the hip of skeletally mature hounds and repaired with the implant or left empty (control). Longitudinal outcome measures over 6 months demonstrated that the implant dogs returned to normal preoperative values of pain and function. Anatomical structure and functional biomechanical properties were also restored in the implanted dogs. Control animals never returned to normal and exhibited structurally deficient repair. This study provides clinically relevant evidence that the bicomponent implant may be a potential therapy for moderate hip osteoarthritis.
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Affiliation(s)
| | - Masataka Enomoto
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | | | - Megan A. Carson
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | | | - Peter Eggert
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jonathan Stallrich
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | | | - Deborah J. Veis
- Division of Bone and Mineral Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Shriners Hospitals for Children—St. Louis, St. Louis, MO, USA
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
| | - Dianne Little
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, USA
| | - Farshid Guilak
- Cytex Therapeutics Inc., Durham, NC, USA
- Shriners Hospitals for Children—St. Louis, St. Louis, MO, USA
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
- Center of Regenerative Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - B. Duncan X. Lascelles
- Translational Research in Pain Program, Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
- Comparative Pain Research and Education Center, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
- Thurston Arthritis Center, UNC School of Medicine, Chapel Hill, NC, USA
- Center for Translational Pain Research, Department of Anesthesiology, Duke University, Durham, NC, USA
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Which functional tasks present the largest deficits for patients with total hip arthroplasty before and six months after surgery? A study of the timed up-and-go test phases. PLoS One 2021; 16:e0255037. [PMID: 34506498 PMCID: PMC8432811 DOI: 10.1371/journal.pone.0255037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/08/2021] [Indexed: 01/23/2023] Open
Abstract
Six to eight months after total hip arthroplasty, patients only attain 80% of the functional level of control groups. Understanding which functional tasks are most affected could help reduce this deficit by guiding rehabilitation towards them. The timed up-and-go test bundles multiple tasks together in one test and is a good indicator of a patient's overall level of function. Previously, biomechanical analysis of its phases was used to identify specific functional deficits in pathological populations. To the best of our knowledge, this analysis has never been performed in patients who have undergone total hip arthroplasty. Seventy-one total hip arthroplasty patients performed an instrumented timed up-and-go test in a gait laboratory before and six months after surgery; fifty-two controls performed it only once. Biomechanical features were selected to analyse the test's four phases (sit-to-stand, walking, turning, turn-to-sit) and mean differences between groups were evaluated for each phase. On average, six months after surgery, patients' overall test time rose to 80% of the mean of the control group. The walking phase was revealed as the main deficiency before and after surgery (-41 ± 47% and -22 ± 32% slower, respectively). High standard deviations indicated that variability between patients was high. On average, patients showed improved results in every phase of the timed up-and-go test six months after surgery, but residual deficits in function differed between those phases. This simple test could be appropriate for quantifying patient-specific deficits in function and hence guiding and monitoring post-operative rehabilitation in clinical settings.
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Nüesch C, Ismailidis P, Koch D, Pagenstert G, Ilchmann T, Eckardt A, Stoffel K, Egloff C, Mündermann A. Assessing Site Specificity of Osteoarthritic Gait Kinematics with Wearable Sensors and Their Association with Patient Reported Outcome Measures (PROMs): Knee versus Hip Osteoarthritis. SENSORS 2021; 21:s21165363. [PMID: 34450828 PMCID: PMC8398113 DOI: 10.3390/s21165363] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022]
Abstract
There is a great need for quantitative outcomes reflecting the functional status in patients with knee or hip osteoarthritis (OA) to advance the development and investigation of interventions for OA. The purpose of this study was to determine if gait kinematics specific to the disease—i.e., knee versus hip OA—can be identified using wearable sensors and statistical parametric mapping (SPM) and whether disease-related gait deviations are associated with patient reported outcome measures. 113 participants (N = 29 unilateral knee OA; N = 30 unilateral hip OA; N = 54 age-matched asymptomatic persons) completed gait analysis with wearable sensors and the Knee/Hip Osteoarthritis Outcome Score (KOOS/HOOS). Data were analyzed using SPM. Knee and hip kinematics differed between patients with knee OA and patients with hip OA (up to 14°, p < 0.001 for knee and 8°, p = 0.003 for hip kinematics), and differences from controls were more pronounced in the affected than unaffected leg of patients. The observed deviations in ankle, knee and hip kinematic trajectories from controls were associated with KOOS/HOOS in both groups. Capturing gait kinematics using wearables has a large potential for application as outcome in clinical trials and for monitoring treatment success in patients with knee or hip OA and in large cohorts representing a major advancement in research on musculoskeletal diseases.
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Affiliation(s)
- Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - David Koch
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department for Sport, Movement and Health, University of Basel, 4052 Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Clarahof Clinic of Orthopaedic Surgery, 4058 Basel, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik Birshof, 4142 Münchenstein, Switzerland; (T.I.); (A.E.)
| | - Karl Stoffel
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Christian Egloff
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland; (C.N.); (P.I.); (D.K.); (K.S.); (C.E.)
- Department of Spine Surgery, University Hospital Basel, 4031 Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Correspondence:
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Instrumental Validity of the Motion Detection Accuracy of a Smartphone-Based Training Game. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168410. [PMID: 34444160 PMCID: PMC8394475 DOI: 10.3390/ijerph18168410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022]
Abstract
Demographic changes associated with an expanding and aging population will lead to an increasing number of orthopedic surgeries, such as joint replacements. To support patients’ home exercise programs after total hip replacement and completing subsequent inpatient rehabilitation, a low-cost, smartphone-based augmented reality training game (TG) was developed. To evaluate its motion detection accuracy, data from 30 healthy participants were recorded while using the TG. A 3D motion analysis system served as reference. The TG showed differences of 18.03 mm to 24.98 mm along the anatomical axes. Surveying the main movement direction of the implemented exercises (squats, step-ups, side-steps), differences between 10.13 mm to 24.59 mm were measured. In summary, the accuracy of the TG’s motion detection is sufficient for use in exergames and to quantify progress in patients’ performance. Considering the findings of this study, the presented exer-game approach has potential as a low-cost, easily accessible support for patients in their home exercise program.
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Trunk movement compensation identified by inertial measurement units is associated with deficits in physical performance, muscle strength and functional capacity in people with hip osteoarthritis. Clin Biomech (Bristol, Avon) 2021; 88:105436. [PMID: 34364100 PMCID: PMC8691225 DOI: 10.1016/j.clinbiomech.2021.105436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trunk movement compensation characterized as ipsilateral trunk lean and posterior rotation with respect to pelvis during stance phase of walking is common in people with hip osteoarthritis and a biomarker of deficits in physical function in older adults. However, the relationship between trunk movement compensation on deficits in physical performance, muscle strength and functional capacity is unknown. METHODS A cross-sectional study design was used. Two inertial measurement units were used to assess trunk movement compensation during the six-minute-walk-test. Knee extension, knee flexion and hip abduction strength were measured using hand-held dynamometer. Multivariate regression models, controlling for self-reported hip pain, were used to regress trunk movement compensation onto six-minute-walk-test and muscle strength measures. Pairwise t-tests were used to evaluate the difference trunk movement compensation has on functional capacity by comparing the first and last minute of the six-minute-walk-test. FINDINGS Thirty-five participants (63.3 ± 7.4 years, 57% male, 28.6 ± 4.5 kg/m2) were enrolled. Greater trunk movement compensation was related to poorer six-minute-walk-test (p = 0.03; r = -0.46). Greater hip abduction weakness was related to increased trunk movement compensation in both the sagittal (p = 0.05; r = -0.44) and frontal (p = 0.04; r = -0.38) planes. Participants demonstrated greater frontal plane trunk movement compensation during the last minute compared to the first minute of the six-minute-walk-test (p < 0.01). INTERPRETATION Trunk movement compensation, identified by inertial measure units, is a clinically relevant measure and has a moderate-to-strong relationship on deficits in physical performance, muscle strength and functional capacity. Inertial measurement units can be used as a practical means of measuring movement quality in the clinical setting.
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Yuan X, Zhang Y, Cai C, Liu C, Xie J, Yi C. Circular RNA circZNF652 is overexpressed in osteoarthritis and positively regulates LPS-induced apoptosis of chondrocytes by upregulating PTEN. Autoimmunity 2021; 54:415-421. [PMID: 34263675 DOI: 10.1080/08916934.2021.1951716] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Circular RNA circZNF652 promotes LPS-induced inflammation, contributing to the development of osteoarthritis (OA), indicating the potential involvement of circZNF652 in OA. This study was carried to explore the involvement of circZNF652 in OA. RT-qPCR was performed to analyse the expression of circZNF652 and PTEN mRNA in synovial fluid samples from 60 OA patients and 60 healthy controls. Correlations between circZNF652 and PTEN mRNA were analysed by Pearson's correlation coefficient. Overexpression and siRNA silencing of circZNF652 were achieved in chondrocytes, followed by performing RT-qPCR and Western blot to analyse the expression of PTEN. The role of circZNF652 and PTEN in regulating the apoptosis of chondrocytes induced by LPS was analysed by cell apoptosis assay. We found that circZNF652 was overexpressed in OA and positively correlated with PTEN, MMP13, and NF-KB mRNA. In chondrocytes, circZNF652 overexpression increased the expression of PTEN, MMP13, and NF-KB; circZNF652 siRNA silencing decreased the expression of PTEN, MMP13, and NF-KB. Moreover, circZNF652 and PTEN positively regulated the apoptosis of chondrocytes induced by LPS. PTEN overexpression reversed the inhibitory effects of circZNF652 siRNA silencing on cell apoptosis. Therefore, circZNF652 is overexpressed in OA and positively regulates LPS-induced apoptosis of chondrocytes by upregulating PTEN.
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Affiliation(s)
- Xuefeng Yuan
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P. R. China
| | - Yingchi Zhang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P. R. China
| | - Cong Cai
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P. R. China
| | - Chaoxu Liu
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P. R. China
| | - Jie Xie
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P. R. China
| | - Chengla Yi
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan City, Hubei Province, P. R. China
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Bahl JS, Millar SC, Fraysse F, Arnold JB, Taylor M, Callary S, Solomon LB, Thewlis D. Changes in 24-Hour Physical Activity Patterns and Walking Gait Biomechanics After Primary Total Hip Arthroplasty: A 2-Year Follow-up Study. J Bone Joint Surg Am 2021; 103:1166-1174. [PMID: 34043603 DOI: 10.2106/jbjs.20.01679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite marked improvements in self-reported pain, perceived functional ability, and gait function following primary total hip arthroplasty (THA), it remains unclear whether these improvements translate into improved physical activity and sleep behaviors. The aim of this study was to determine the change in 24-hour activity profile (waking activities and sleep) and laboratory-based gait function from preoperatively to 2 years following the THA. METHODS Fifty-one patients undergoing primary THA at a single public hospital were recruited. All THAs were performed using a posterior surgical approach with the same prosthesis type. A wrist-worn accelerometer was used to capture 24-hour activity profiles preoperatively and at 1 and 2 years postoperatively. Three-dimensional gait analysis was performed to determine changes in temporospatial and kinematic parameters of the hip and pelvis. RESULTS Patients showed improvements in all temporospatial and kinematic parameters with time. Preoperatively, patients were sedentary or asleep for a mean time (and standard deviation) of 19.5 ± 2.2 hours per day. This remained unchanged up to 2 years postoperatively (19.6 ± 1.3 hours per day). Sleep efficiency remained suboptimal (<85%) at all time points and was worse at 2 years (77% ± 10%) compared with preoperatively (84% ± 5%). More than one-quarter of the sample were sedentary for >11 hours per day at 1 year (32%) and 2 years (41%), which was greater than the preoperative percentage (21%). Patients accumulated their activity performing light activities; however, patients performed less light activity at 2 years compared with preoperative levels. No significant differences (p = 0.935) were observed for moderate or vigorous activity across time. CONCLUSIONS Together with improvements in self-reported pain and perceived physical function, patients had significantly improved gait function postoperatively. However, despite the opportunity for patients to be more physically active postoperatively, patients were more sedentary, slept worse, and performed less physical activity at 2 years compared with preoperative levels. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jasvir S Bahl
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Alliance for Research in Exercise, Nutrition and Activity (ARENA) (J.S.B., S.C.M., F.F., and J.B.A.) and Innovation, Implementation and Clinical Translation in Health (IIMPACT) (J.B.A.), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Stuart C Millar
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Alliance for Research in Exercise, Nutrition and Activity (ARENA) (J.S.B., S.C.M., F.F., and J.B.A.) and Innovation, Implementation and Clinical Translation in Health (IIMPACT) (J.B.A.), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - François Fraysse
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) (J.S.B., S.C.M., F.F., and J.B.A.) and Innovation, Implementation and Clinical Translation in Health (IIMPACT) (J.B.A.), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - John B Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) (J.S.B., S.C.M., F.F., and J.B.A.) and Innovation, Implementation and Clinical Translation in Health (IIMPACT) (J.B.A.), Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Mark Taylor
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Stuart Callary
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
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43
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Röhner E, Mayfarth A, Sternitzke C, Layher F, Scheidig A, Groß HM, Matziolis G, Böhle S, Sander K. Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis. J Clin Med 2021; 10:jcm10112416. [PMID: 34072524 PMCID: PMC8198188 DOI: 10.3390/jcm10112416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of this study was to determine if patients following total hip arthroplasty (THA) could benefit from gait training on crutches conducted by a mobile robot in a clinical setting. METHOD This clinical trial was conducted with 30 patients following total hip arthroplasty. Fifteen patients received the conventional physiotherapy program in the clinic (including 5 min of gait training supported by a physiotherapist). The intervention group of 15 patients passed the same standard physiotherapy program, but the 5-min gait training supported by a physiotherapist was replaced by 2 × 5 min of gait training conducted by the robot. Length of stay of the patients was set to five days. Biomechanical gait parameters of the patients were assessed pre-surgery and upon patient discharge. RESULTS While before surgery no significant difference in gait parameters was existent, patients from the intervention group showed a significant higher absolute walking speed (0.83 vs. 0.65 m/s, p = 0.029), higher relative walking speed (0.2 vs. 0.16 m/s, p = 0.043) or shorter relative cycle time (3.35 vs. 3.68 s, p = 0.041) than the patients from the control group. CONCLUSION The significant higher walking speed of patients indicates that such robot-based gait training on crutches may shorten length of stay (LOS) in acute clinics. However, the number of patients involved was rather small, thus calling for further studies.
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Affiliation(s)
- Eric Röhner
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
- Correspondence: ; Tel.: +49-36691-8-1254; Fax: +49-36691-8-1807
| | - Anke Mayfarth
- Tediro GmbH, Ehrenbergstr. 11, 98693 Ilmenau, Germany; (A.M.); (C.S.)
| | | | - Frank Layher
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Andrea Scheidig
- TU Ilmenau, Neuroinformatics and Cognitive Robotics Lab, PF 100565, 98684 Ilmenau, Germany; (A.S.); (H.-M.G.)
| | - Horst-Michael Groß
- TU Ilmenau, Neuroinformatics and Cognitive Robotics Lab, PF 100565, 98684 Ilmenau, Germany; (A.S.); (H.-M.G.)
| | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Sabrina Böhle
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
| | - Klaus Sander
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, 07607 Eisenberg, Germany; (F.L.); (G.M.); (S.B.); (K.S.)
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Zuo J, Xu M, Zhao X, Shen X, Gao Z, Xiao J. Effects of the depth of the acetabular component during simulated acetabulum reaming in total hip arthroplasty. Sci Rep 2021; 11:9836. [PMID: 33972628 PMCID: PMC8110577 DOI: 10.1038/s41598-021-89292-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/21/2021] [Indexed: 12/05/2022] Open
Abstract
We aimed to evaluate whether there are differences in the rotation center, cup coverage, and biomechanical effects between conventional and anatomical technique. Computed tomography scans of 26 normal hips were used to simulate implantation of acetabular component. The hip rotation center and acetabular component coverage rate were calculated. Moreover, a finite element model of the hip joint was generated to simulate and evaluate the acetabular cup insertion. Micromotion and the peak stress distribution were used to quantify the biomechanical properties. The medial and superior shifts of the rotation center were 5.2 ± 1.8 mm and 1.6 ± 0.7 mm for the conventional reaming technique and 1.1 ± 1.5 mm and 0.8 ± 0.5 mm for anatomical technique, respectively. The acetabular component coverage rates for conventional reaming technique and anatomical technique were 86.8 ± 4% and 70.0 ± 7%, respectively. The micromotion of the cup with conventional reaming technique was greater than that with anatomical technique. The peak stress concentration was highest in the superior portion with conventional reaming technique, whereas with anatomical technique, there was no stress concentration. Paradoxically although the acetabular component coverage rate is larger with conventional reaming technique, anatomical technique provides less micromotion and stress concentration for initial cup stability. Thus, anatomical technique may be more suitable for acetabulum reaming during primary total hip arthroplasty.
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Affiliation(s)
- Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Avenue, Changchun, Jilin, China
| | - Meng Xu
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Changchun, Jilin, China
| | - Xin Zhao
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Changchun, Jilin, China
| | - Xianyue Shen
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Changchun, Jilin, China
| | - Zhongli Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Avenue, Changchun, Jilin, China
| | - Jianlin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Avenue, Changchun, Jilin, China.
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45
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Reh J, Schmitz G, Hwang TH, Effenberg AO. Acoustic Feedback in Gait Rehabilitation-Pre-Post Effects in Patients With Unilateral Hip Arthroplasty. Front Sports Act Living 2021; 3:654546. [PMID: 34027404 PMCID: PMC8138186 DOI: 10.3389/fspor.2021.654546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
It is known that patients after unilateral hip arthroplasty still suffer from a deficient gait pattern compared to healthy individuals one year after surgery. Through the method of gait sonification, it may be possible to achieve a more efficient training and a more physiological gait pattern. Increased loads on the musculoskeletal system could thus be reduced and rehabilitation times shortened. In a previous investigation with this patient group, we found immediate gait pattern changes during training with dual mode acoustic feedback [real-time feedback (RTF) and instructive model sequences (IMS)]. To determine whether an effect persists without the immediate use of acoustic feedback, we analyze data from four times of testing. Following unilateral hip arthroplasty 22 patients participated in an intervention of ten gait training sessions of 20 min each. During gait training the sonification group (SG) (n = 11) received an acoustic feedback consisting of RTF and IMS compared to a control group (CG) (n = 11). Pre-test, intermediate test, post-test, and re-test were conducted using an inertial sensor-based motion analysis system. We found significant effects (α = 0.05) regarding step length and range of motion (RoM) of the hip joint. Step length of the affected leg increased in the SG from intermediate test to post-test but decreased in the CG [intermediate test: (SG) 0.63 m ± 0.12 m, (CG) 0.63 m ± 0.09 m; post-test: (SG) 0.66 m ± 0.11 m, (CG) 0.60 m ± 0.09 m]. However, from the post-test to the re-test a reverse development was observed [re-test: (SG) 0.63 m ± 0.10 m, (CG) 0.65 m ± 0.09 m]. Also, from post-test to re-test a decrease in the RoM of the unaffected hip for the SG but an increase for the CG could be observed [post-test: (SG) 44.10° ± 7.86°, (CG) 37.05° ± 7.21°; re-test: (SG) 41.73° ± 7.38°, (CG) 40.85° ± 9.28°]. Regarding further parameters, significant interactions in step duration as well as increases in stride length, gait speed, cadence, and a decrease in ground contact time from pre-test to re-test were observed for both groups. Clinical Trial Registration: https://www.drks.de/drks_web/, identifier DRKS00022570.
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Affiliation(s)
- Julia Reh
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
| | - Gerd Schmitz
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
| | - Tong-Hun Hwang
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
| | - Alfred O Effenberg
- Institute of Sports Science, Leibniz University Hannover, Hannover, Germany
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46
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Esbjörnsson AC, Kiernan S, Mattsson L, Flivik G. Geometrical restoration during total hip arthroplasty is related to change in gait pattern - a study based on computed tomography and three-dimensional gait analysis. BMC Musculoskelet Disord 2021; 22:369. [PMID: 33879123 PMCID: PMC8058981 DOI: 10.1186/s12891-021-04226-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background The effect of change in hip anatomy on change in gait pattern is not well described in current literature. Therefore, our primary aim was to describe and quantify changes in hip geometry and gait pattern 1 year after total hip arthroplasty (THA) in individuals with hip osteoarthritis. Our secondary aim was to explore the effect of postoperative change in femoral neck anteversion (FNA) and femoral offset and acetabular offset (FO/AO) quota on postoperative change in hip rotation and hip adduction moment during gait, respectively, 1 year after THA”. Methods Sixty-five individuals with primary hip osteoarthritis, scheduled for THA, were analyzed in this prospective intervention study. Participants were evaluated pre- and 1 year postoperatively with computed tomography-scans, three-dimensional gait analysis, and patient-reported outcome measures. Multiple linear regressions were performed to evaluate the association between change in joint anatomy and change in gait pattern after THA. Results One year postoperatively, global offset was symmetrical between sides as a result of decreased acetabular offset and increased femoral offset on the operated side. Quality of overall gait pattern improved, and participants walked faster and with less trunk lean over the affected side. FNA and hip rotations during walking changed equally in external and internal directions after THA and change in hip rotation during walking was associated with change in FNA in the same direction. An increase in external hip adduction moments was, on the other hand, not associated with change in FO/AO quota but with a more upright walking position and increased walking speed. Conclusions The findings of this study suggest that geometrical restoration during THA impacts postoperative gait pattern and, in addition to known factors such as FO, height of hip rotation center, and leg length discrepancy, the FNA must also be taken into consideration. Trial registration Trial registration: Clinicaltrial.gov, NCT01512550, Registered 19 January 2012 - Retrospectively registered.
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Affiliation(s)
- A-C Esbjörnsson
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden.
| | - S Kiernan
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden
| | - L Mattsson
- Prophysics SOL, Jungmansvägen 3, 24335, Höör, Sweden
| | - G Flivik
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden
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47
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Porta M, Pau M, Leban B, Deidda M, Sorrentino M, Arippa F, Marongiu G. Lower Limb Kinematics in Individuals with Hip Osteoarthritis during Gait: A Focus on Adaptative Strategies and Interlimb Symmetry. Bioengineering (Basel) 2021; 8:bioengineering8040047. [PMID: 33924515 PMCID: PMC8069064 DOI: 10.3390/bioengineering8040047] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/02/2021] [Accepted: 04/11/2021] [Indexed: 01/01/2023] Open
Abstract
Among the functional limitations associated with hip osteoarthritis (OA), the alteration of gait capabilities represents one of the most invalidating as it may seriously compromise the quality of life of the affected individual. The use of quantitative techniques for human movement analysis has been found valuable in providing accurate and objective measures of kinematics and kinetics of gait in individuals with hip OA, but few studies have reported in-depth analyses of lower limb joint kinematics during gait and, in particular, there is a scarcity of data on interlimb symmetry. Such aspects were investigated in the present study which tested 11 individuals with hip OA (mean age 68.3 years) and 11 healthy controls age- and sex-matched, using 3D computerized gait analysis to perform point-by-point comparisons of the joint angle trends of hip, knee, and ankle. Angle-angle diagrams (cyclograms) were also built to compute several parameters (i.e., cyclogram area and orientation and Trend Symmetry) from which to assess the degree of interlimb symmetry. The results show that individuals with hip OA exhibit peculiar gait patterns characterized by severe modifications of the physiologic trend at hip level even in the unaffected limb (especially during the stance phase), as well as minor (although significant) alterations at knee and ankle level. The symmetry analysis also revealed that the effect of the disease in terms of interlimb coordination is present at knee joint as well as hip, while the ankle joint appears relatively preserved from specific negative effects from this point of view. The availability of data on such kinematic adaptations may be useful in supporting the design of specific rehabilitative strategies during both preoperative and postoperative periods.
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Affiliation(s)
- Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Michela Deidda
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Marco Sorrentino
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, 09123 Cagliari, Italy; (Micaela Porta); (Massimiliano Pau); (B.L.); (M.D.); (M.S.); (F.A.)
| | - Giuseppe Marongiu
- Orthopaedic and Trauma Clinic, Department of Surgical Sciences, University of Cagliari, 09042 Monserrato, Italy
- Correspondence: or ; Tel.: +39-070-6094368
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Hu X, Zheng N, Chen Y, Dai K, Dimitriou D, Li H, Tsai TY. Optimizing the Femoral Offset for Restoring Physiological Hip Muscle Function in Patients With Total Hip Arthroplasty. Front Bioeng Biotechnol 2021; 9:645019. [PMID: 33869155 PMCID: PMC8045972 DOI: 10.3389/fbioe.2021.645019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/19/2021] [Indexed: 12/27/2022] Open
Abstract
Objective Femoral offset (FO) restoration is significantly correlated with functional recovery following total hip arthroplasty (THA). Accurately assessing the effects of FO changes on hip muscles following THA would help improve function and optimize functional outcomes. The present study aimed to (1) identify the impact of FO side difference on the hip muscle moment arms following unilateral THA during gait and (2) propose the optimal FO for a physiological hip muscle function. Methods In vivo hip kinematics from eighteen unilateral THA patients during gait were measured with a dual-fluoroscopic imaging system. The moment arms of thirteen hip muscles were calculated using CT-based 3D musculoskeletal models with the hip muscles’ lines of actions. The correlation coefficient (R) between FO and hip muscle moment arm changes compared with the non-implanted hip was calculated. We considered that the FO reconstruction was satisfactory when the abductor moment arms increased, while the extensor, adductor, and flexor moment arms decreased less than 5%. Results A decreased FO following THA was significantly correlated with a decrease of the abductor and external rotator moment arms during the whole gait (R > 0.5) and a decrease of extensor moment arms during the stance phase (R > 0.4). An increased FO following THA was significantly associated with shorter flexor moment arms throughout the gait (R < −0.5) and shorter adductor moment arms in the stance phase (R < −0.4). An increase in FO of 2.3–2.9 mm resulted in increased abductor moment arms while maintaining the maximum decrease of the hip muscles at less than 5.0%. Conclusion An increase of 2–3 mm in FO could improve the abductor and external rotator function following a THA. Accurate surgical planning with optimal FO reconstruction is essential to restoring normal hip muscle function in THA patients.
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Affiliation(s)
- Xiangjun Hu
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunsu Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kerong Dai
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopaedics, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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49
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Malus J, Skypala J, Silvernail JF, Uchytil J, Hamill J, Barot T, Jandacka D. Marker Placement Reliability and Objectivity for Biomechanical Cohort Study: Healthy Aging in Industrial Environment (HAIE-Program 4). SENSORS (BASEL, SWITZERLAND) 2021; 21:1830. [PMID: 33807948 PMCID: PMC7961569 DOI: 10.3390/s21051830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/27/2022]
Abstract
In large cohort studies, due to the time-consuming nature of the measurement of movement biomechanics, more than one evaluator needs to be involved. This may increase the potential occurrence of error due to inaccurate positioning of markers to the anatomical locations. The purpose of this study was to determine the reliability and objectivity of lower limb segments length by multiple evaluators in a large cohort study concerning healthy aging in an industrial environment. A total of eight evaluators performed marker placements on five participants on three different days. Evaluators placed markers bilaterally on specific anatomical locations of the pelvis, thigh, shank and foot. On the right foot, markers were placed in anatomical locations to define a multi-segmental foot model. The position of the marker at the anatomical locations was recorded by a motion capture system. The reliability and objectivity of lower limb segment lengths was determined by the intraclass correlation coefficient of a two-way random model and of the two-way mixed model, respectively. For all evaluators for all segments, the average reliability and objectivity was greater than 0.8, except for the metatarsus segment (0.683). Based on these results, we can conclude that multiple evaluators can be engaged in a large cohort study in the placement of anatomical markers.
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Affiliation(s)
- Jan Malus
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200 Ostrava, Czech Republic; (J.S.); (J.F.S.); (J.U.); (J.H.); (D.J.)
| | - Jiri Skypala
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200 Ostrava, Czech Republic; (J.S.); (J.F.S.); (J.U.); (J.H.); (D.J.)
| | - Julia Freedman Silvernail
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200 Ostrava, Czech Republic; (J.S.); (J.F.S.); (J.U.); (J.H.); (D.J.)
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA
| | - Jaroslav Uchytil
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200 Ostrava, Czech Republic; (J.S.); (J.F.S.); (J.U.); (J.H.); (D.J.)
| | - Joseph Hamill
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200 Ostrava, Czech Republic; (J.S.); (J.F.S.); (J.U.); (J.H.); (D.J.)
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA
| | - Tomas Barot
- Department of Mathematics with Didactics, University of Ostrava, 70900 Ostrava, Czech Republic;
| | - Daniel Jandacka
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200 Ostrava, Czech Republic; (J.S.); (J.F.S.); (J.U.); (J.H.); (D.J.)
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Effects of Hip Abductor Strengthening on Musculoskeletal Loading in Hip Dysplasia Patients after Total Hip Replacement. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11052123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hip dysplasia patients after total hip replacement show worse functional performance compared to primary osteoarthritis patients, and unfortunately there is no research on muscle and joint loads that would help understand rehabilitation effects, motor dysfunctions and failure events. We tested the hypothesis that a higher functional improvement in hip dysplasia patients who received hip abductor strengthening after hip replacement, would result in different gait function and musculoskeletal loads during walking compared to patients who performed standard rehabilitation only. In vivo gait analysis and musculoskeletal modeling were used to analyze the differences in gait parameters and hip and muscle forces during walking between the two groups of patients. We found that, in a functional scenario of very mild abnormalities, the patients who performed muscle strengthening expressed a more physiological force pattern and a generally greater force in the operated limb, although statistically significant in limited portions of the gait cycle, and likely related to a higher gait speed. We conclude that in a low-demand task, the abductor strengthening program does not have a marked effect on hip loads, and further studies on hip dysplasia patients would help clarify the effect of muscle strengthening on loads.
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