Isokinetic dynamometry and gait analysis reveal different hip joint status in patients with hip dysplasia

Sørensen, Henrik Toft; Nielsen, Dennis Brandborg; Jacobsen, Julie Sandell; Søballé, Kjeld; Mechlenburg, Inger

doi:10.1177/1120700018773401

Cited by 9 publications

(6 citation statements)

References 33 publications

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“…[15][16][17] We also found that patients with DDH experienced problems during walking, sitting, sleeping and other vital functions of everyday life. In line with our study, other studies have found that DDH is associated with gait impairments, 34 muscle strength deficits, 35 reduced function in daily living 4 and poor sleep quality. 19 36 Additionally, other studies have reported frequent traits of anxiety and depression in patients with DDH.…”

Section: Discussionsupporting

confidence: 93%

Experiences of living with developmental dysplasia of the hip in adults not eligible for surgical treatment: a qualitative study

et al. 2021

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ObjectivesAdults with developmental dysplasia of the hip face barriers in their everyday lives due to pain and physical limitations. In Denmark, some patients may not be eligible for hip-preserving surgery due to being overweight, hip osteoarthritis, age above 45 years, negative impingement test or not wishing to undergo surgery. These patients are left with no evidence-based treatment option. The patient perspective when not being eligible for surgery has not yet been investigated. This study aimed to explore the experiences of living with developmental dysplasia of the hip in adults not eligible for hip-preserving surgery.Design and participantsIn this qualitative study, we used a phenomenological–hermeneutic approach to explore the experiences of living with developmental dysplasia of the hip. We conducted semistructured interviews with 17 purposefully selected patients (median age 37 (range 19–50) years). The patients were recruited from a population of 30 patients included in a larger feasibility study evaluating a 6-month exercise and patient education intervention. We used a ricoeur-inspired method to analyse and interpret the interview data.ResultsThree themes were identified. First, developmental dysplasia of the hip is more than just a joint disease. Second, living with pain is difficult when pain has its own life. Third, limitations imposed by hip problems challenge the perception of oneself as young, active and independent. Identity, meaningfulness, control over pain and coping with pain were areas of the patients’ lives that were influenced.ConclusionLiving with developmental dysplasia of the hip had a considerable impact on the patients of this study and their everyday life in several areas. Therefore, it may be relevant to approach patients with developmental dysplasia of the hip from a biopsychosocial point of view. However, further research is required to obtain a better understanding of the experiences of living with developmental dysplasia of the hip.

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Section: Discussionsupporting

confidence: 93%

Experiences of living with developmental dysplasia of the hip in adults not eligible for surgical treatment: a qualitative study

et al. 2021

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“…Walking ability and hip abduction strength were signi cantly lesser in DDH compared to FAIS patients. Consistent with our ndings, hip abduction strength decrements are well documented for DDH 9,10,31 . Between-group differences in scores for UCLA Activity, HOS ADL, SF-12…”

Section: Discussionsupporting

confidence: 92%

Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip

Nunley

Mulligan

Chhabra

et al. 2023

Preprint

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Background Patient-reported outcomes are commonly used to assess patient symptoms and track post-operative improvements. The effect that specific hip pathology has on the relationship between perceived and objectively measured symptoms remains unclear. The purpose of this study was (1) to evaluate differences of function and pain in FAIS and DDH patients, (2) to assess the correlation between perceived and true functional ability, and (3) to determine the influence of pain on measures of function. Methods This prospective cross-sectional study included 73 pre-operative patients with femoroacetabular impingement syndrome (FAIS) and developmental dysplasia of the hip (DDH), who were diagnosed based on clinical history, physical examination, and radiographic findings. Objectively measured function (6-minute walk test [6MWT], single leg hop test [SLHT], Biodex sway test [BST], hip abduction strength test [HABST], and STAR excursion balance reach tests [STAR] in multiple directions), patient-reported function (UCLA Activity scale, Hip Outcome Score [HOS] activities of daily living [ADL] and Sport subscales, Short Form 12 [SF-12] Physical Activity subscale, and the Hip Disability and Osteoarthritis Outcome Score [HOOS] ADL and Sport), and patient-reported pain data (HOOS Pain, visual analogue scale (VAS), and a pain location scale with eight bilateral body locations) were collected during pre-surgical clinic visits. Patient demographics were compared using independent two-sample t-tests. Between-group comparisons of patient scores were performed using Wilcoxon Rank-Sum tests. Within-group relationships between pairs of outcome variable were analyzed using Spearman’s rank correlation coefficients. The level of significance for all statistical tests was set at α = 0.05 (two-tailed). Results 6MWT was moderately-to-strongly correlated with nearly all patient-reported measures of function (FAIS: r = 0.34–0.62, DDH: r = 0.27–0.56). In FAIS patients, only HOOS Pain was significantly correlated with an objective measure of function, which was 6MWT (r=-0.53). However, in DDH patients, patient-reported pain scores were moderately correlated with a number of objective measures of function (r=-0.32–0.48). Conclusion FAIS patients reported significantly higher function and lower pain compared to DDH patients. No single patient-reported measure of function was broadly significantly correlated with objective measures of function in either patient group. Functional performance in patients with DDH appears to be influenced by self-perceived pain.

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“…While fatty infiltration can increase in pathological conditions, the presence of abnormal fatty content in patients with DDH is not known. Mechanical muscle function, such as the ability to generate torque may be compromised in patients with DDH due to decreased muscle moment arms, 21 or other factors, but few studies of function have included patients with DDH before osteoarthritis or compared them to healthy controls 7,22 . Ultimately, alterations to muscle geometry and function, and how they relate to skeletal deformities have not been clearly presented in a single group of patients with DDH.…”

Section: Introductionmentioning

confidence: 99%

The biomechanical disadvantage of dysplastic hips

Harris

Shepherd

Song

et al. 2021

Journal Orthopaedic Research

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Developmental dysplasia of the hip (DDH) is strongly associated with an increased risk for hip osteoarthritis. Skeletal deformities undeniably contribute to detrimental biomechanical loading in dysplastic hips, but cannot explain all types of damage and symptoms that patients with DDH experience. Characterizing the geometry and function of the muscles spanning the hip is a logical next step in our progression of knowledge about DDH pathomechanics. In this study, we compared skeletal geometry, muscle volumes, intramuscular fatty infiltration, moment arms, and isometric strength in patients with DDH (N = 20) to healthy controls (N = 15). Femoral coverage was significantly less in patients (p < 0.001, Cohen's d effect size = 2.2), femoral neck-shaft angles were larger (p = 0.001, d = 1.3), and hip joint centers (HJCs) were more lateral (p = 0.001, d = 1.3). These skeletal abnormalities were associated with smaller abductor muscle moment arms in patients with DDH (e.g., gluteus medius [GMED]: p = 0.001, d = 1.2). Patients with DDH also had larger GMED volumes (p = 0.02, d = 0.83), but no differences in fatty infiltration, compared to controls. Isometric strength of the hip abductors, extensors, and flexors was lower in patients, but not significantly different from controls. The abnormal skeletal geometry, lateralized HJC, and reduced muscle moment arms represent a chronic biomechanical disadvantage under which patients with DDH operate. This phenomenon causes increased demand on the abductor muscles and results in high medially and superiorly directed joint reaction forces, which can explain reports of superomedial femoral cartilage damage in patients. The abnormal muscle geometry and function, in context with abnormal skeletal structure, are likely strong, but underappreciated, contributors to damaging loads in DDH.

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Isokinetic dynamometry and gait analysis reveal different hip joint status in patients with hip dysplasia

Cited by 9 publications

References 33 publications

Experiences of living with developmental dysplasia of the hip in adults not eligible for surgical treatment: a qualitative study

Experiences of living with developmental dysplasia of the hip in adults not eligible for surgical treatment: a qualitative study

Relationships between self-perceived and clinical expression of pain and function differ based on the underlying pathology of the human hip

The biomechanical disadvantage of dysplastic hips

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