Gait Alterations in Femoroacetabular Impingement Syndrome Differ by Sex

Abstract

Background Femoroacetabular impingement (FAI) syndrome may affect gait kinematics differently between males and females. Objectives To investigate whether individuals with FAI syndrome have different hip and pelvic motion during gait, at their preferred speed and a prescribed speed, compared to individuals of the same sex without pain. Methods Twenty-one participants (11 males and 10 females) with FAI syndrome and 41 participants (19 males and 22 females) without hip pain were included in this case-control laboratory study. There were no differences between the 2 groups in age, body mass index, and activity score. Kinematic data for all participants were collected while walking at a preferred speed and at 1.25 m/s. For sex and walking speed, linear regression analyses were used to examine the effect of group and the interaction of group by limb. Results At both speeds, males with FAI syndrome walked with more than 6° less peak hip extension (P≤.018), 5° greater anterior pelvic tilt (P≤.020), and 5° less posterior pelvic tilt (P≤.018) compared to males without hip pain. Females with FAI syndrome walked with 2° less hip extension (P≤.012) and at least 3° more hip adduction (P<.001) in the more painful hip than in the less painful hip at both speeds. Conclusion Males and females with FAI syndrome have different gait alterations when compared to a same-sex comparison group. In males, differences were between groups. In females with FAI syndrome, differences were between the more painful and the less painful limb. J Orthop Sports Phys Ther 2018;48(8):649-658. Epub 22 May 2018. doi:10.2519/jospt.2018.7913.

Exercise Therapy for the Management of Femoroacetabular Impingement Syndrome: Preliminary Results of Clinical Responsiveness

“…In addition, the small sample size did not allow us to use sex as a main factor in our analyses. Future larger studies should however consider sex-differences for exercise therapy effectiveness due to different clinical (33) and functional characteristics (13,34) presented by female and male patients with FAIS.…”

Editorial Commentary: Do Patients With Femoroacetabular Impingement Syndrome Already Show Hip Muscle Atrophy?

“…9,10 In addition, we suspect that sex-specific alterations in hip muscle morphology and function may exist because women and men with FAIS have shown significant differences in hip and pelvic kinematic patterns while performing functional tasks. 11 Finally, we cannot exclude that the presence of underlying morphologic bony characteristics typical of FAIS and hip instability (e.g., acetabular coverage, acetabular and femoral version, and neckshaft angle) may also affect hip muscular changes. 12,13 Early appreciation of causes of adaptive muscular alterations in FAIS and other prearthritic hip diseases might help to improve the management options and outcomes of these young and active patients.…”

Muscle activity and morphology in hip-related pain

“…Due to the limited number of women in the study (n=8), and known between sex differences in walking biomechanics, 257 only male participants were included for analysis (n=42) ( Figure 7-1 & 7-2). Participants were matched for age, height, weight, and body mass index as seen in Table 7-1.…”

“…16 Investigation of tasks that involve high loading of the hip joint, and sports specific actions could provide information relevant to the management of athletic populations most effected by hip-related pain. Differences in biomechanics between men and women, 257 highlights a need for muscle activity in women, to be investigated to allow comparison to the symptomatic population in study 5. This would identify if gender differences exist that could influence future management.…”

“…238 This study recruited both men and women, but the number of women recruited for the measurements of muscle activity was comparatively low (n=8). Variations in walking mechanics between men and women have been reported, 257 so to control for this potential confounder only male participants were included in studies involving walking trials. Consequently, the findings of this thesis are only applicable to a population of athletic men with hip-related pain.…”