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

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.

Functional assessment of total hip arthroplasty using inertial measurement units: Improvement in gait kinematics and association with patient‐reported outcome measures

“…We found no significant difference in cadence postoperatively compared to controls suggesting that the slower walking speed is caused entirely by the shorter stride length. Previous studies, including four systematic reviews, 9,25–27 reported similar consistent results for walking speed and stride length 28–31 . Only one study in a rather small cohort ( N = 12 per group) found a faster walking speed in patients after THA compared to controls 32 .…”

“…Previous studies, including four systematic reviews, 9,25-27 reported similar consistent results for walking speed and stride length. [28][29][30][31] Only one study in a rather small cohort (N= 12 per group) found a faster walking speed in patients after THA compared to controls. 32 The reports on cadence are more heterogeneous.…”

The association of postoperative global femoral offset with total hip arthroplasty outcomes

“…Cassidy et al reported a significantly low score in the postoperative WOMAC physical function test in a decreased femoral offset group 2 . Conversely, Esbjörnsson et al reported that pain and quality of life were improved, and Bonnin et al reported that the stress of the abductor muscles decreased when the acetabular component was placed slightly medially and the FO was enlarged 3 , 4 . Most of these reported outcomes are based on plain radiographs, which do not show the effects of hip internal and external rotation on FO 5 .…”

Gait biomechanics after proximal femoral nailing of intertrochanteric fractures

“…Specifically, external hip adduction moments, reflective of internal abduction moments including torques generated by the hip abductor muscles, 24 are of particular interest. With recent studies highlighting the effects of changes in hip geometry on postoperative gait patterns in total hip arthroplasty patients, 25 there is a need to explore whether femoral nailing after ITF influences gait biomechanics. This paper aimed to: (1) identify changes in gait biomechanics after femoral nailing of ITFs between 6 weeks, and 6 months postoperatively; (2) identify differences in gait biomechanics between ITF patients and elderly controls; and (3) to investigate whether FOS and lateral lag screw protrusion (LSP) was correlated with contralateral pelvic drop, maximum external hip adduction moment, step length and gait speed from gait analysis.…”