Patients with Symptomatic Hip Osteoarthritis Have Altered Kinematics during Stair Ambulation

Abstract

Background Osteoarthritis (OA) is a degenerative joint disease. Understanding contributing factors to slowing or stopping disease progression is crucial. There has been no research describing lower extremity kinematics of the hip, knee, and ankle during stair ambulation in individuals with hip OA. Objective To explore the differences in lower extremity kinematics between participants with clinical and morphological findings of hip OA and controls. Design A cross‐sectional study. Setting Clinical research laboratory. Participants Participants with radiographic and symptomatic signs of hip OA (n = 42) and healthy controls (n = 30) were enrolled. Interventions Participants underwent hip magnetic resonance imaging (MRI). The Scoring Hip Osteoarthritis with MRI (SHOMRI) method was used to assess cartilage abnormalities. Self‐reported measures of hip pain and function were obtained using the Hip Disability and Osteoarthritis Outcome Score (HOOS). Participants were assigned into a symptomatic hip osteoarthritis group (HOA) with SHOMRI>0 and HOOS≤80, and a control group (CG) with SHOMRI = 0 and HOOS>90. Patients underwent 3D motion analysis during stair ascent/descent at self‐selected speed. Main Outcome Measures The primary outcome measurements were peak hip, knee, and ankle kinematics. General Estimation Equations were used to compare kinematics between groups (P ≤ .05). Results The HOA group ascended stairs with a more internally rotated hip (CG = 1.77 ± 6.3; HOA = 4.97 ± 4.2; P = .02), more abducted hip (CG = ‐5 ± 2.7, HOA = ‐3.5 ± 3; P = .02), and a more externally rotated knee (CG = ‐8.02 ± 3; HOA = ‐10.63 ± 6.3; P = .02) and ankle (CG = ‐11.8 ± 6.1; HOA = ‐16.3 ± 5.6; P = .01). Similarly, HOA participants descended stairs with a more extended knee (CG = ‐15.5 ± 4.9; HOA = ‐12 ± 4.9; P = .01), and more externally rotated knee (CG = ‐10.1 ± 4.4; HOA = ‐13.1 ± 6.6; P = .04) and ankle (CG = ‐13.5 ± 5.3; HOA = ‐17.9 ± 5.5; P = .002). Conclusion Participants with hip OA‐related morphology and symptoms ambulate stairs utilizing abnormal lower extremity mechanics.

Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

“…There is a general understanding that the rotational alignment of the whole lower limb plays a critical role in the onset of hip pathologies ( Eckhoff, 1994 ; Keshmiri et al, 2016 ). Additionally, several kinematic compensatory strategies can be adopted at the hip ( Bruderer-Hofstetter et al, 2015 ; Alexander et al, 2019 ), as a consequence of either pain avoidance ( Leigh et al, 2016 ; Popovic et al, 2020 ) or lever arm dysfunction, particularly of the hip abductors ( Arnold et al, 1997 ; van der Krogt et al, 2012 ; Boyer et al, 2016 ). Moreover, modeling excessive femoral antetorsion was shown to alter magnitude and orientation of predicted joint contact forces in pediatric pathological populations ( Bosmans et al, 2014 ; Passmore et al, 2018 ), as well as in typically developing children ( Kainz et al, 2020 ).…”

Effects of hip osteoarthritis on lower body joint kinematics during locomotion tasks: a systematic review and meta-analysis

“…Peak external rotation was significantly reduced during stance phase (56) but not during swing phase (44). Transverse hip ROM was significantly reduced (44).…”

“…Results not included in the meta-analysis showed no differences in peak hip extension during the gait cycle (44) or during the stance phase (56). Peak flexion was significantly reduced in the swing phase (44).…”

“…Hip peak abduction was significantly reduced during swing (44) and stance phase (56). Hip frontal ROM was significantly reduced (44).…”

Assessing the impact of a long-term physiotherapy program on hip function in patients with osteoarthritis: the role of patient-reported and assessor-observed outcome measures

“…We believe that actual structural progression may have been the factor, in our study, preventing objective functional improvement, which manifests in the outcome of specific PBTs. It has been repeatedly reported that increased severity of morphological signs in subjects with HOA is associated with an increased load on the joint resulting in abnormal kinetics during walking or stair ambulation [28][29][30][31][32].…”