Three-dimensional gait analysis of adults with hip dysplasia after rotational acetabular osteotomy

Abstract

Dysplasia of the hip, the most common cause of secondary coxarthrosis, has a relatively high prevalence in Japan. Rotational acetabular osteotomy (RAO) is an interventional strategy that seeks to reduce the abnormal amount of high stress concentration in the acetabulum and thereby to prevent the development of coxarthrosis. Long-term clinical results have been reported, but functional evaluations of the gait before and after RAO are underreported. The aim of our recently initiated long-term prospective study is to assess the effect of RAO on the gait characteristics of patients using quantitative gait analysis. Thus far 22 patients (1 male, 21 females; mean age 30 years, range 15-43 years) have been enrolled, treated, and completed the preoperative and postoperative gait analyses. Hip pain during walking decreased in all patients after the RAO. The postoperative hip extension motion angle on the treated side increased significantly and correlated positively with the improvement in the Japanese Orthopaedic Association (JOA) pain score. The current study shows that coxalgia and gait function improved after RAO.

Treatment of Adolescents with a Periacetabular Osteotomy After Previous Pelvic Surgery

“…Previous reports have noted patients with hip dysplasia have increased flexion and reduced hip flexor moment [10,19,28,30]. Pedersen et al [27] initially reported this finding in a group of adult women with hip dysplasia after treatment with a PAO.…”

“…Gait analysis in adult patients with dysplasia has shown the decreased acetabular weightbearing zone and the lateralized joint center affect the joint contact pressures [1,10,24,27,28,30]. There are no studies, however, that have specifically assessed the kinematics and kinetics of the hip in adolescent and young adult patients undergoing a PAO who have been treated with a previous pelvic osteotomy.…”

Dynamic femoral head translations in dysplastic hips

“…In vivo and in vitro studies have shown hip joint forces during gait are directed superoposterior at heel strike (Bergmann et al, 2001;Endo et al, 2003; (Maeyama et al, 2008). However, these investigators did not specify the gait cycle phase in which the accelerations were observed.…”

Periacetabular osteotomy reduces the dynamic instability of dysplastic hips

“…[1][2][3][4][5][6] The major factors are mechanical stress and dynamic instability, and if these are not improved after surgery the outcome will not be good. Although many reports have shown that periacetabular osteotomy can reduce contact stress in the hip joint, 17,18,20,21 no studies have clarified whether it can also reduce instability of the hip joint during routine walking. Our results indicate that the femoral head moves in the superior, posterior and lateral directions while walking under conditions encountered in routine daily life, and that mechanical stress to the acetabulum can be expected in the posterosuperior direction in all cases.…”

“…5 Various types of periacetabular osteotomy are used in patients who are too young for total hip replacement. [13][14][15][16][17][18][19] We perform a curved periacetabular osteotomy, 16 which is a modification of the Bernese periacetabular osteotomy developed by Ganz et al 13 Although many reports have shown that periacetabular osteotomy can reduce contact stress in the hip joint, [20][21][22][23][24] none have clarified whether it can also reduce instability during walking in daily life. After our previous study 7 we hypothesised that dynamic instability of the hip joint would be reduced if the cover of the femoral head was improved by periacetabular osteotomy.…”