Joint Loading in the Sagittal Plane During Gait Is Associated With Hip Joint Abnormalities in Patients With Femoroacetabular Impingement

Abstract

Background Femoroacetabular impingement (FAI) is a morphological abnormality of the hip joint that results in functional impairments during various activities of daily living (ADL) such as walking. Purpose/Hypothesis The purpose of this study was to determine if lower extremity joint loading differed between patients with FAI and controls and to determine whether these altered biomechanical parameters were associated with intra-articular abnormalities. It was hypothesized that patients with FAI would exhibit altered lower extremity joint loading during walking when compared with healthy controls and that these altered joint loading patterns would be associated with intra-articular abnormalities. Study Design Controlled laboratory study. Methods Lower extremity kinetics was assessed during walking at a self-selected speed in 15 presurgical patients with FAI and 34 healthy controls matched for age and body mass index. All participants underwent unilateral hip magnetic resonance imaging (MRI) to assess hip joint abnormalities. Hip joint abnormalities were assessed using a semiquantitative MRI-based scoring system. Self-reported outcomes of pain and function were obtained using the Hip disability and Osteoarthritis Outcome Score (HOOS), and physical performance was measured using the 6-minute walk test (6MWT). Group differences were assessed using an independent t test and analysis of variance. In the patients with FAI, associations of joint kinetics with HOOS subscores and intra-articular abnormalities were assessed using the Pearson (r) and Spearman (ρ) correlation coefficients, respectively. Results Compared with the control group, the FAI group exhibited a significantly increased severity of acetabular (FAI: 1.87 ± 1.55; control: 0.47 ± 0.79; P < .001) and femoral (FAI: 3.27 ± 2.79; control: 1.21 ± 1.55; P = .002) cartilage abnormalities, increased levels of pain (FAI: 65.0 ± 18.8; control: 98.2 ± 3.4; P = .001), and reduced function (FAI: 67.2 ± 21.5; control: 98.9 ± 3.4; P < .001) but similar walking speeds (FAI: 1.55 ± 0.19 m/s; control: 1.63 ± 0.22 m/s; P = .20) and 6MWT performance (FAI: 628.0 ± 91.2 m; control: 667.2 ± 73.4 m; P = .13). The FAI group demonstrated increased hip flexion moment impulses (FAI: 0.14 ± 0.04 N·m·s/kg; control: 0.11 ± 0.03 N·m·s/kg; P = .03), peak ankle dorsiflexion moments (FAI: 1.64 ± 0.16 N·m/kg; control: 1.46 ± 0.31 N·m/kg; P = .04), and ankle dorsiflexion moment impulses (FAI: 0.39 ± 0.07 N·m·s/kg; control: 0.31 ± 0.07 N m s/kg; P = .01) compared with the control group. Within the FAI group, an increased hip flexion moment impulse during walking was significantly correlated with increased pain (r = −0.60, P = .03), decreased ADL (r = −0.57, P = .04), and increased severity of acetabular cartilage abnormalities (ρ = 0.82, P < .01). Conclusion Patients with FAI exhibited altered hip and ankle joint loading patterns during walking. These data suggest that patients with FAI demonstrate both local and distal joint alterations during walking and that hip joint loading is...

Lower limb biomechanics in femoroacetabular impingement syndrome: a systematic review and meta-analysis

“…There was moderate evidence of no difference in peak hip torques for flexion (−0.19, 95% CI −0.54 to 0.16; I 2 =21%, P=0.28), extension (−0.25, 95% CI −0.55 to 0.06; I 2 =0%, P=0.80), abduction (−0.04, 95% CI −0.39 to 0.31; I 2 =0%, P=0.53), adduction (−0.33, 95% CI −0.71 to 0.05; I 2 =0%, P=0.37) and internal rotation (−0.25, 95% CI −0.62 to 0.13; I 2 =0%, P=0.73) (figure 2D). Additionally, one moderate-quality29 study showed insufficient evidence that patients with FAIS had a greater peak hip flexion torque impulse (0.89, 95% CI 0.25 to 1.52) and no difference in extension torque impulse (−0.49, 95% CI −1.11 to 0.12) (table 5). …”

A Combined Treatment Approach Emphasizing Impairment-Based Manual Therapy and Exercise for Hip-Related Compensatory Injury in Elite Athletes: A Case Series

“…Once symptoms are improved, continuing an individualized program may be beneficial in further reducing this risk. 23,24,43 Additional treatment sessions including manual therapy and exercise, like those implemented in this case series, may be beneficial in the long-term management of athletes, as they continue to address any potential long-term impairments 14,22,32,36,63 and may improve outcomes. 57 For comparison, it is common practice for baseball pitchers to perform an individualized arm-care program in the presence of sportspecific morphological adaptations.…”

“…Common anatomical features such as posture and bony hip morphology may impact function 23,24,35,36 and potentially result in pathology. However, asymptomatic findings and concurrent pathoanatomical diagnoses make treating specific structures challenging.…”

“…Additionally, a focus was placed on motor control of the lumbopelvic region and lower extremity during single leg movements. 35,36,44 The exercise progression described, particularly in the sub-acute phase, is thought to be clinically significant, as advancing a training stimulus targeting the kinetic chain 62 may have greater impact on the movement system as compared to structure specific exercise. 18 In the presence of performance limiting pathology, training load should be monitored and adjusted accordingly to address risk factors while decreasing athlete decided to initially trial conservative care, and the subject was able to complete the following competitive season with an increase in playing time from the prior season.…”

“…14,23,24,35 Those with FAI have been reported to demonstrate altered lower body kinetics and force attenuation, potentially resulting in excessive impulse to the joint. 36 Motor control deficits have been linked to reports of impaired sport performance and pain. 35,37 Uneven distribution of forces across the pelvis, in part due to limited regional mobility 22 and impaired strength 31,32,33 and neuromuscular control 15,35 may result in mechanical overload and subsequent acute or chronic injury, 1,4 ultimately impacting the movement system.…”