Abnormal loading of the hip and knee joints in unilateral hip osteoarthritis persists two years after total hip replacement

Abstract

A total hip replacement (THR) is a common and routine procedure to reduce pain and restore normal activity. Gait analysis can provide insights into functional characteristics and dynamic joint loading situation not identifiable by clinical examination or static radiographic measures. The present prospective longitudinal study tested whether 2 years after surgery a THR would restore dynamic loading of the knee and hip joints in the frontal plane to normal. Instrumented gait analysis was performed shortly before surgery and approximately 2 years after THR on 15 unilateral hip osteoarthritis (OA) patients. 15 asymptomatic matched individuals were recruited as healthy controls. Results showed that abnormal joint loading persisted 2 years after THR. The 2nd external knee adduction moment in terminal stance in the affected (-34%, p = 0.002, d = 1.22) and non-affected limb (-25%, p = 0.035, d = 0.81) was lower compared to controls and thus indicated a shift in the knee joint load distribution from medial to lateral. A correlation analysis revealed that a smaller hip range of motion explained 46% of 2nd knee adduction moment alterations. In contrast, the 2nd external hip adduction moment in terminal stance was postoperatively higher in the affected (+22%, p = 0.007, d = 1.04) and non-affected limb (+22%, p = 0.005, d = 1.05). Here, 51% of 2nd hip adduction moment alterations can be explained with a greater hip adduction angle. Patients with a THR may therefore be at higher risk for abnormal joint loading and thus for the development of OA in other joints of the lower extremities. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Mid-long term results of total knee arthroplasty followed by ipsilateral total hip arthroplasty versus total hip arthroplasty subsequent to ipsilateral total knee arthroplasty: A retrospective cohort study

“…Then the disease severity of ipsilateral hip gradually developed a degree where met the indication for THA. We agreed with the idea that the sequence of arthroplasties should depend on the severity of symptoms and the most symptomatic joint of hip or knee should be replaced rst [5,31].…”

“…Previous studies demonstrated that the changes in axial alignment and abnormal loading distribution after THA may result in ipsilateral knee pain and a greater disease progression of knee [3][4][5]. However, the effect of a prior THA on the outcome of a subsequent ipsilateral TKA was unclear.…”

“…Subsequently, it may increase the possibility of performing total joint arthroplasty (TJA) on ipsilateral hip and knee in the same patient. Previous studies [3][4][5] demonstrated that lateral patellar tilt increased and external knee adduction moment decreased after ipsilateral total hip arthroplasty (THA) which resulted in abnormal knee loading and ipsilateral knee pain. Yet, to our knowledge, there is no study evaluating the in uence of a prior THA on the functional results and implant survivorship of a subsequent ipsilateral total knee arthroplasty (TKA).…”

“…We then estimate distal femoral resection depend on the altered femoral mechanical axis during a subsequent TKA. Further, prior studies reported that biomechanics loads during gait on the ipsilateral or contralateral knee also was altered after unilateral THA [5,8]. Additionally, due to a prior femoral prosthesis, it is di cult to thorough insert the femoral intramedullary guide into the femoral canal in certain cases during ipsilateral TKA which has a chance of malalignment [9].…”

Knee Load Distribution in Hip Osteoarthritis Patients After Total Hip Replacement

“…Patients, who already had a unilateral total hip replacement (THR) for end-stage hip OA, have an increased risk of developing OA in other joints of their lower extremities (Shakoor et al, 2002). Stief et al (2018) showed that after THR, patients reduce the external knee adduction moment (KAM) in the second half of stance of both legs compared to healthy controls whereas Shakoor et al (2003) found a significantly higher KAM in the contralateral knee. The reduction in KAM is thought to shift the load from the medial to the lateral knee compartment (Schmidt et al, 2017).…”