Identifying clinically meaningful benchmarks for gait improvement after total hip arthroplasty

Foucher, Kharma C.

doi:10.1002/jor.22996

Cited by 34 publications

(48 citation statements)

References 53 publications

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“…However, because the preoperative range of motion was actually larger in the nonresponders, the result was that nonresponders had similar postoperative sagittal plane range of motion and lower flexion moments than nonresponders. It is important to note, however, that neither group (on average) achieved the minimum clinically important value for hip range of motion recently proposed, and that the range of motion for both groups was at the lower end of values generally reported for people after THA (30 − 40°) . Sagittal plane ROM for control subjects in the literature ranges from ∼38° to 51°) .…”

Section: Discussionmentioning

confidence: 78%

“…Function can be objectively and specifically characterized using quantitative gait analysis. Many studies have shown that gait mechanics do not fully return to normal after THA . However, work linking gait mechanics to clinical outcomes is still emerging.…”

mentioning

confidence: 99%

“…Many studies have shown that gait mechanics do not fully return to normal after THA. [19][20][21][22][23][24][25][26][27][28][29][30] However, work linking gait mechanics to clinical outcomes is still emerging. We know that higher values of walking speed, 31,32 stride length, 31 dynamic range of motion, and some external moments 33 are related to clinical improvement, but the relationship between gait mechanics and clinical response has not been investigated.…”

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confidence: 99%

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Preoperative gait mechanics predict clinical response to total hip arthroplasty

Foucher

2016

Journal Orthopaedic Research

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Some patients do not have an adequate clinical response to total hip arthroplasty (THA) for reasons that are not fully understood. Identifying modifiable factors that are associated with nonresponse could lead to new ways to identify and treat potential nonresponders. This study investigated whether any preoperative gait characteristics were associated with THA clinical response, and whether or not there were corresponding postoperative gait differences in THA nonresponders compared to responders. A secondary analysis was conducted of 124 subjects (age 61 ± 10 years; 64 female/60 male), evaluated before and 1 year after primary unilateral THA, using quantitative gait analysis and Harris Hip Scores (HHS). Responders and nonresponders were identified using the OMERACT-OARSI responder criteria, modified for use with the HHS. Pre- and postoperative dynamic sagittal plane range of motion (ROM) and 3D peak external moments were compared, for responders and nonresponders, using t-tests and logistic regression. 11.3% of subjects were nonresponders. Before surgery, the ROM was 26% higher for nonresponders than responders, but the peak external rotation moment was 30% lower (p = 0.003-0.043). Preoperative gait and HHS predicted response with a sensitivity of 71.4% and a specificity of 99.1%. There were persistent postoperative deficits in the peak external rotation moment in nonresponders compared to responders (p = 0.028). This study showed that gait analysis, where available, can augment clinical scores in predicting THA response. Moreover, it suggests that further analysis of the subtle role of transverse plane hip mechanics could lead to interventions to promote better THA response. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:366-376, 2017.

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Section: Discussionmentioning

confidence: 78%

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confidence: 99%

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confidence: 99%

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Preoperative gait mechanics predict clinical response to total hip arthroplasty

Foucher

2016

Journal Orthopaedic Research

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“…Future work in this area may lead to benchmarks for postoperative strength, such as those previously proposed for postoperative gait mechanics. 44 A somewhat surprising finding was that on average, these participants were not more fatigued than a general population of US adults. We expected, based on the OA literature, that subjects in this study would report significant levels of fatigue.…”

Section: Discussionmentioning

confidence: 93%

“…Future work in this area may lead to benchmarks for postoperative strength, such as those previously proposed for postoperative gait mechanics. 44 …”

Section: Discussionmentioning

confidence: 99%

Hip abductor strength and fatigue are associated with activity levels more than 1 year after total hip replacement

Foucher

Cinnamon

Ryan

et al. 2017

Journal Orthopaedic Research

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Despite improvements in pain and function, people who undergo total hip arthroplasty (THR) may not always return to desired levels of physical activity (PA). The factors associated with low activity levels are not fully understood. Abductor weakness and fatigue have both been proposed as factors that limit activity in older adults or people with hip osteoarthritis, but have not been investigated after THR. We hypothesized that abductor weakness and fatigue are associated with lower activity levels in people who have undergone a THR and that fatigue mediates the association between abductor strength and activity. We evaluated 16 subjects (24 ± 10 months post-THR; age 56.8 ± 8.4 yrs; BMI 31 ± 7 kg/m ). Fatigue was assessed using the PROMIS fatigue short-form 7a. Peak isometric hip abductor torque was assessed using a dynamometer with subjects in a sidelying position. We assessed activity level using the UCLA activity score. We used Pearson correlations to explore the associations among the variables. Next we used a three-step linear regression procedure to test whether or not fatigue acted as a mediator between abductor torque and UCLA activity scores. Higher abductor torque was associated with less fatigue (R = 0.275; p = 0.037) and with higher UCLA scores (R = 0.488, p = 0.003). Higher fatigue was associated with lower UCLA scores (R = 0. 307, p = 0.017), however there was no evidence of mediation. This suggests that addressing both abductor strength and fatigue may increase physical activity. Statement of Clinical Significance: Fatigue and abductor weakness should be evaluated in sedentary THR patients presenting for long-term follow-up. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1519-1525, 2018.

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Effect of Denosumab on Femoral Periprosthetic BMD and Early Femoral Stem Subsidence in Postmenopausal Women Undergoing Cementless Total Hip Arthroplasty

et al. 2019

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Antiresorptive denosumab is known to improve the quality and strength of cortical bone in the proximal femurs of osteoporotic women, but its efficacy in preventing periprosthetic bone loss and reducing femoral stem migration has not been studied in women undergoing cementless total hip arthroplasty. We conducted a single‐center, randomized, double‐blinded, placebo‐controlled trial of 65 postmenopausal women with primary hip osteoarthritis and Dorr type A or B proximal femur anatomy. The patients randomly received subcutaneous injections of denosumab 60 mg or placebo once every 6 months for 12 months, starting 1 month before surgery. The primary endpoint was the change in bone mineral density (BMD) of the proximal femur (Gruen zone 7) at week 48, and the secondary endpoint was stem subsidence measured by radiostereometric analysis (RSA) at week 48. Exploratory endpoints included changes in BMDs of the contralateral hip, lumbar spine and distal radius, serum levels of bone turnover markers, walking speed, walking activity, patient‐reported outcome measures, and radiographic assessment of stem osseointegration. The participants underwent vertebral‐fracture assessment in an extension safety study at 3 years. Denosumab significantly decreased bone loss in the medial femoral neck (zone 7) and increased periprosthetic BMD in the greater trochanteric region (zone 1) and lesser trochanteric region (zone 6). Denosumab did not reduce temporary femoral stem migration. The migration occurred mainly during the settling period (0 to 12 weeks) after implantation of the prosthesis. All of the stems osseointegrated, as evaluated by RSA and radiographs. There were no intergroup differences in functional recovery. Discontinuation of denosumab did not lead to any adverse events. In conclusion, denosumab increased periprosthetic BMD in the clinically relevant regions of the proximal femur, but the treatment response was not associated with any reduction of initial stem migration. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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Identifying clinically meaningful benchmarks for gait improvement after total hip arthroplasty

Cited by 34 publications

References 53 publications

Preoperative gait mechanics predict clinical response to total hip arthroplasty

Preoperative gait mechanics predict clinical response to total hip arthroplasty

Hip abductor strength and fatigue are associated with activity levels more than 1 year after total hip replacement

Effect of Denosumab on Femoral Periprosthetic BMD and Early Femoral Stem Subsidence in Postmenopausal Women Undergoing Cementless Total Hip Arthroplasty

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