Gait compensations in patients with osteoarthritis of the hip and their relationship to pain and passive hip motion

Abstract

This study related mechanisms of gait compensations to the level of pain and to limitations in passive motion in patients with osteoarthritis of the hip. Joint motion, moments, and intersegmental forces were calculated for 19 patients with unilateral osteoarthritis of the hip (12 men and seven women) and for a group of normal subjects (12 men and seven women) with a similar age distribution. The patients who had osteoarthritis walked with a decreased dynamic range of motion (17 +/- 4 degrees) of the hip and with a hesitation or reversal in the direction of the sagittal plane motion as they extended the hip. The patients with a hesitation or reversal in motion had a greater loss in the range of motion of the hip during gait (p < 0.004) and a greater passive flexion contracture (p < 0.022) than those with a smooth pattern of hip motion. This alteration in the pattern of motion was interpreted as a mechanism to increase effective extension of the hip during stance through increased anterior pelvic tilt and lumbar lordosis. The patients who had osteoarthritis of the hip walked with significantly decreased external extension, adduction, and internal and external rotation moments (p < 0.008). The decreased extension moment was significantly correlated with an increased level of pain (R = 0.78; p < 0.001). This finding suggests that decreasing muscle forces (hip flexors) may be one mechanism used to adapt to pain.

The effect of total hip arthroplasty surgical approach on gait

“…The P-L group was higher at 39.4'. A reduced range of motion has been attributed in the hip OA population to pain inhibition [8,13]. However, pain is not a factor following surgery.…”

The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint

“…1). This discontinuity of motion tends to occur at a point as the hip passes from flexion into extension during the stance phase of the gait cycle [20,37,38]. This is rarely seen in normal individuals, and even when present it tends to have a significantly smaller magnitude [38].…”

“…The reverse flexion angle (or discontinuity in motion) occurs when the smooth pattern of flexion and extension (sagittal plane movement) is disturbed by an abnormal hesitation or reversal during the flexion-extension cycle [37] (Fig. 1).…”

“…This is rarely seen in normal individuals, and even when present it tends to have a significantly smaller magnitude [38]. However, this phenomenon has been strongly linked to OA [38], and its prevalence and magnitude have been independently correlated with the radiological severity and the progression of OA regardless of pain or hip functional scores [37,38].…”

Gait analysis after total hip replacement with hip resurfacing implant or Mallory-head Exeter prosthesis: a randomised controlled trial

“…A key to analysis of function after joint replacement is the ability to identify gait adaptations specific to design features and surgical procedures, and several studies have used gait analysis to study functional outcome after THR. Impairments of gait adaptation in the hip are believed to be caused by reduced muscle strength in the gluteal muscles and reduced range of hip extension especially in the late stance phase [9,10]. Because the resurfacing surgical technique is more invasive than conventional THR, we postulated that range of motion and muscle strength would be more affected during the early phase of rehabilitation in patients receiving a resurfacing implant than in patients receiving a conventional prosthesis.…”