Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis

Bahl, Jasvir S.; Nelson, Maximillian J.; Taylor, Mark; Solomon, Lucian B.; Arnold, John B.; Thewlis, Dominic

doi:10.1016/j.joca.2018.02.897

Cited by 91 publications

(76 citation statements)

References 82 publications

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“…Abductor de ciency has been reported after THA [2,20]. Previous studies demonstrated that when the hip abductor is weak, the pelvis drops to the sound side, leading to gait instability [3,7]. In this study, we found that the abductor muscle lengths of the THA side were longer than the contralateral non-implanted side during the support phase (Figure. 2), implying less abductor muscle contraction in the THA side.…”

Section: Discussionsupporting

confidence: 49%

Adverse Effects of Total Hip Arthroplasty on The Hip Abductor and Adductor Muscle Lengths and Moment Arms During Gait

Zheng

Hsu

et al. 2020

Preprint

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Background: Precise evaluation the hip abductor and adductor muscles function in total hip arthroplasty (THA) patients during gait could help prevent postoperative complications and optimize the rehabilitation training program. The purpose of this study was to elucidate the effects of THA on the hip abductor and adductor muscle lengths and moment arms of in vivo patients during gait.Methods: Ten unilateral THA patients received CT scan and dual fluoroscopic imaging for the hip kinematics during gait. The hip abductor and adductor muscle insertions were digitized on the 3D hip model for the determination of their dynamic lines of action and moment arms. Changes in the hip abductor and adductor muscle lengths and moment arms of THA patients between the implanted and non-implanted sides were quantified during gait.Results: The adductor longus, adductor brevis, and pectineus of the implanted hips had significantly (P<0.05) less elongation than that of the non-implanted side during the stance phase. The gluteus medius, gluteus minimus, and piriformis moment arms of the implanted side were significantly shorter. The piriformis muscle moment arm was significantly larger. In the double support phase, the adductor magnus and adductor longus moment arms of the implanted sides were significantly decreased. Conclusions: Results suggested that the adverse effects of THA on hip stability. Development of a rehabilitation program considering the effects of THA is essential. Accurate surgical techniques may reduce the impact of THA on the peripheral muscles.

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Section: Discussionsupporting

confidence: 49%

Adverse Effects of Total Hip Arthroplasty on The Hip Abductor and Adductor Muscle Lengths and Moment Arms During Gait

Zheng

Hsu

et al. 2020

Preprint

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“…Variables of interest were gait speed, hip flexion‐extension range of motion, peak hip extension angle, and peak hip adduction angle. Variables were selected based on previous evidence demonstrating improvement of these variables following THA, 2 and their relationship to atypical hip reaction force profiles 12 …”

Section: Methodsmentioning

confidence: 99%

“…Primary THA is a well‐established and successful orthopedic procedure for reducing pain and improving self‐reported physical function in individuals with end‐stage hip osteoarthritis (OA) 1 . However, previous studies have identified that patients display a reduced level of gait function compared to age‐matched healthy individuals, even up to 1 year postsurgery 2‐4 . Recently, the magnitude of hip joint forces during gait have been used to further understand patient recovery following THA, where it is reported that the magnitude of hip joint loading remains reduced compared to healthy individuals 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Lower functioning patients demonstrate atypical hip joint loading before and following total hip arthroplasty for osteoarthritis

Bahl

Arnold

Taylor

et al. 2020

Journal Orthopaedic Research

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Previous studies have established that up to 1 year post total hip arthroplasty (THA), patients do not recover normal function and the magnitude of hip joint loading remains reduced compared to healthy individuals. However, the temporal nature of the loading profile has not been considered to identify individuals who are at a greater risk of poor functional outcomes following THA. This study aimed to determine changes to the profile and magnitude of the resultant hip joint reaction force before and up to 6 months post‐primary THA, and factors associated with atypical loading profiles. Hip joint loading was computed using a personalized lower‐limb musculoskeletal model in 43 participants awaiting primary THA for osteoarthritis (mean age: SD = 65, 14 years; body mass index: SD = 30, 5 kg/m2) before and up to 6 months after THA. Atypical, single‐peak loading profiles were observed for 11 patients before surgery, where four showed a single peak at 6 months. Patients displaying a single‐peak profile walked slower (mean difference: −0.4 m/s) compared to individuals displaying double‐peak profile (P = <.001) and had significantly reduced sagittal plane hip range of motion during gait (mean difference −9.6°, P = <.001). Self‐reported pain, function, and stiffness did not differentiate between patients with a single or double‐peak loading profile. Individuals with a single‐peak force profile did not meet the minimal clinically important hip range of motion during gait and would be classified as low‐functioning THA patients. Clinical Relevance: The temporal nature of the force profile may help to identify individuals who are at the greatest risk of poor functional outcomes after THA.

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“…Within the currently available techniques, stereophotogrammetry [16] and radiography [30] have potential regarding these in vivo analyses for both ROM and StL interaction analyses. The ROM at the replaced hip in extreme motion exercises has been analyzed to a limited extent [31,32], as well as for StL impingement [6,33], where there is a lack of studies on patients with large diameter heads. Whereas standard GA [34] can be easily adapted for more demanding motor activities, accurate 3D StL interactions can only be addressed using 3D videofluoroscopy analysis (VA).…”

Section: Introductionmentioning

confidence: 99%

Cup-To-Neck Contact and Range of Motion after Total Hip Arthroplasty with Large Head Diameters: An Original Three-Dimensional Combined Gait and Videofluoroscopy Analysis

et al. 2020

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After a total hip arthroplasty, a limited range of motion and lower-limb disability continue to be observed, with these being mainly associated with the implant design and the head-to-neck ratio. Larger diameters of the head bearings were assumed to provide better stability, a larger range of motion, and smaller risks of dislocation and stem-to-liner impingement. However, these claims have never been demonstrated in real patients. The specific aim of this study was to assess, via multi-instrumental analysis, whether the range of motion of a replaced hip is limited by the stem-to-liner contact in patients with large femoral head diameters. Twenty-three patients with a total hip arthroplasty were evaluated at their one-year follow-ups using clinical and instrumental examinations. A combined three-dimensional gait analysis of the full body and videofluoroscopy analysis of the replaced hip were performed during the execution of standard, i.e., daily living, and more demanding motor tasks. The latter were meant to reach the extreme range of motion at the replaced hip site, thus revealing possible stem-to-liner contact. An original technique based on imaging and computer-aided design (CAD) models of the prosthesis components was developed to calculate the stem-to-liner distance. Excellent clinical scores were observed in the study. The gait analysis showed that the range of motion of the replaced hip in the sagittal plane, averaged over all patients, ranged from 28° to 78° in standard activities. In more demanding tasks, single peaks were as high as 110°, 39°, and 60° in the sagittal, frontal, and transverse anatomical planes, respectively. In all motor tasks, the stem-to-liner distances ranged from 8.7 to 13.0 mm on average, with one outlier minimum distance being 2.2 mm. This study shows that, even in demanding motor tasks and with an extreme range of motion, the hip joint replaced with large femoral head diameters did not experience impingement between the prosthesis components.

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Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis

Abstract: Following THA for OA, early improvements were demonstrated for spatiotemporal and kinematic gait patterns compared to the pre-operative levels. Deficits were still observed in THA patients compared to healthy individuals at 12 months.

Cited by 91 publications

References 82 publications

Adverse Effects of Total Hip Arthroplasty on The Hip Abductor and Adductor Muscle Lengths and Moment Arms During Gait

Adverse Effects of Total Hip Arthroplasty on The Hip Abductor and Adductor Muscle Lengths and Moment Arms During Gait

Lower functioning patients demonstrate atypical hip joint loading before and following total hip arthroplasty for osteoarthritis

Cup-To-Neck Contact and Range of Motion after Total Hip Arthroplasty with Large Head Diameters: An Original Three-Dimensional Combined Gait and Videofluoroscopy Analysis

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