Are changes in radiological leg alignment and femoral parameters after total hip replacement responsible for joint loading during gait?

Abstract

BackgroundGait kinematics after total hip replacement only partly explain the differences in the joint moments in the frontal plane between hip osteoarthritis patients after hip replacement and healthy controls. The goal of this study was to determine if total hip replacement surgery affects radiological leg alignment (Hip-Knee-Shaft-Angle, femoral offset, Neck-Shaft-Angle and varus/valgus alignment) and which of these parameters can explain the joint moments, additionally to the gait kinematics.Methods22 unilateral hip osteoarthritis patients who were scheduled for total hip replacement were included in the study. Preoperatively and 1 year postoperatively all patients had biplanar radiographic examinations and 3D gait analysis.ResultsThe operated leg showed significantly (P < 0.05) more varus (1.1°) as well as a larger femoral offset (+ 8 mm) and a larger Hip-Knee-Shaft-Angle (+ 1.3°) after total hip replacement; however no significant differences in the joint moments in the frontal plane compared to healthy controls were found. The hip moment (first half of stance) and the knee moments (first and second half of stance) were mostly determined by the varus/valgus alignment (29% and respectively 36% and 35%). The combination with a kinematic parameter (knee range of motion, foot progression angle) increased the predictive value for the knee moments.ConclusionIn our patient group the joint moments after total hip replacement did not differ from healthy controls, whereas radiological leg alignment parameters changed significantly after the total hip replacement. A combination of these radiological leg parameters, especially the varus alignment, and the deviating kinematics explain the joint moments in the frontal plane during gait after total hip replacement surgery. For surgeons it is important not to create too much of a structural varus alignment by implanting the new hip joint as varus alignment can increase the knee adduction moment and the risk for osteoarthritis of the medial knee compartment.Trial registrationThis study was retrospectively registered with DRKS (German Clinical Trials Register) under the number DRKS00015053. Registered 1st of August 2018.

Knee Load Distribution in Hip Osteoarthritis Patients After Total Hip Replacement

“…Higher CF on the contralateral (non-operated) side in the second half of stance compared to the ipsilateral side confirm the results of other studies (Shakoor et al, 2003;Foucher and Wimmer, 2012;Wesseling et al, 2018), although not all studies reported significant differences between patients (ipsilateral or contralateral) and healthy controls (Wesseling et al, 2018) so that a surplus load cannot be confirmed. The present results do support studies reporting a higher risk for the development of OA in the contralateral knee joint after THR (Shakoor et al, 2002;Umeda et al, 2009;Gillam et al, 2013;Jungmann et al, 2015;Joseph et al, 2016) since patients are walking with an asymmetrical limb load. However, these studies only report more structural damage and progression of degenerative findings in the contralateral knee and do not specify the medial or lateral knee compartment.…”

“…In the present study, these data were not available as in the clinical standard only a pelvic overview X-Ray was made to check for loosening of the prosthesis. We expect that the leg alignment has only a marginal effect on the results as previous work showed that the implantation of a hip prosthesis only led to a slight increased varus alignment (1 • ) of the operated leg (van Drongelen et al, 2019).…”

Geometrical restoration during total hip arthroplasty is related to change in gait pattern - a study based on computed tomography and three-dimensional gait analysis

“…Moreover, restoring FO has a positive effect on isometric hip abductor strength [ 16 , 17 ], walking speed, and knee flexion and extension during walking 1 year after THA [ 18 ]. Restored FO has also been shown to influence knee joint moments but has no apparent impact on hip joint moments [ 19 ]. Most studies have focused on the FO in relation to gait and function.…”

Determination of Leg Alignment in Hip Osteoarthritis Patients with the EOS® System and the Effect on External Joint Moments during Gait

“…The peak external knee and hip adduction moment during the first (KAM1 and HAM1) and second (KAM2 and HAM2) half of the stance were computed for each trial (normalized to body weight and expressed in newton meters per kilogram) and averaged over the trials. As has been published previously [26], kinematic parameters during the stance phase of gait were also extracted (a) for the hip: the maximum adduction angle in the frontal plane, the maximum flexion and extension angle, and the hip RoM in the sagittal plane; (b) for the knee: the maximum flexion and extension angle, as well as the RoM in the sagittal plane (the difference between the maximum flexion in the first half and the maximum extension during the second half of the stance); (c) for the trunk: maximum sideward displacement (LTD-lateral displacement of the trunk relative to the supporting limb); (d) for the foot: mean progression angle in the transverse plane (FPA-the angle of the long axis of the foot segment relative to the direction of walking). Furthermore, the pelvic drop of the contralateral leg during the swing phase was determined.…”

“…The 3D model was made using sterEOS ® (EOS imaging, SA, Paris, France) and was then used for planning the prosthesis (hipEOS ® , EOS imaging, SA, Paris, France). From the 3D reconstruction, five clinical leg parameters, which were described in detail elsewhere [25,26], were considered to assess the leg alignment ( Figure 1).…”