Preoperative factors associated with postoperative gait kinematics and kinetics after total hip arthroplasty

2016

Self Cite

Some patients do not have an adequate clinical response to total hip arthroplasty (THA) for reasons that are not fully understood. Identifying modifiable factors that are associated with nonresponse could lead to new ways to identify and treat potential nonresponders. This study investigated whether any preoperative gait characteristics were associated with THA clinical response, and whether or not there were corresponding postoperative gait differences in THA nonresponders compared to responders. A secondary analysis was conducted of 124 subjects (age 61 ± 10 years; 64 female/60 male), evaluated before and 1 year after primary unilateral THA, using quantitative gait analysis and Harris Hip Scores (HHS). Responders and nonresponders were identified using the OMERACT-OARSI responder criteria, modified for use with the HHS. Pre- and postoperative dynamic sagittal plane range of motion (ROM) and 3D peak external moments were compared, for responders and nonresponders, using t-tests and logistic regression. 11.3% of subjects were nonresponders. Before surgery, the ROM was 26% higher for nonresponders than responders, but the peak external rotation moment was 30% lower (p = 0.003-0.043). Preoperative gait and HHS predicted response with a sensitivity of 71.4% and a specificity of 99.1%. There were persistent postoperative deficits in the peak external rotation moment in nonresponders compared to responders (p = 0.028). This study showed that gait analysis, where available, can augment clinical scores in predicting THA response. Moreover, it suggests that further analysis of the subtle role of transverse plane hip mechanics could lead to interventions to promote better THA response. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:366-376, 2017.

Section: Discussionsupporting

confidence: 83%

“…Function can be objectively and specifically characterized using quantitative gait analysis. Many studies have shown that gait mechanics do not fully return to normal after THA . However, work linking gait mechanics to clinical outcomes is still emerging.…”

mentioning

confidence: 99%

Preoperative gait mechanics predict clinical response to total hip arthroplasty

2016

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“…Unfortunately, between 14 and 22% of patients report limitations in walking function and other physical activities, or do not have clinically meaningful functional improvement . Abnormal gait mechanics may be a barrier to full restoration of physical function . In recent reviews, the most consistently reported spatiotemporal, kinematic, and kinetic gait deficits, are, respectively, reduced walking speed, reduced dynamic hip range of motion in the sagittal plane and reduced dynamic abductor function compared to control subjects.…”

mentioning

confidence: 99%

“…A barrier in the goal of improving gait mechanics after THA is that we do not yet have a definition of what constitutes an “acceptable” or “good” gait outcome. A tacit assumption is that normal walking mechanics is the goal, but this goal may be unattainable for many patients because of the significant impairment present before surgery . Normal walking mechanics may also not necessarily be desirable, because high values of certain gait parameters may increase potentially damaging joint forces .…”

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confidence: 99%

Identifying clinically meaningful benchmarks for gait improvement after total hip arthroplasty

2015

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There are no established benchmarks for gait mechanics after total hip arthroplasty (THA). This study sought to identify minimum clinically important postoperative (MCIP) or minimum clinically important improvement (MCII) values for self-selected walking speed, sagittal plane dynamic hip range of motion (HROM) (peak flexion-peak extension) and peak hip adduction moments measured during quantitative gait analysis. Preoperative and 1-year postoperative data collected during quantitative gait analysis, along with Harris Hip Scores (HHS), for 145 subjects were collected from a motion analysis data repository. The MCIP (or MCII) was defined as the 75th percentile mark on a plot of the cumulative percent of subjects with HHS ! 80 versus the postoperative value (or change) in the respective variable. 95% confidence intervals (CI) were calculated. Logistic regression was used to test the association of age, sex, BMI, and preoperative HHS with benchmarks. The MCIP of speed was 1.

“…The activity avoidance model may therefore still be applicable after surgery, however, both in light of studies that show that muscle weakness persists after THR, 31-34 and that preoperative dynamic abductor dysfunction is highly predictive of postoperative abductor impairment. 21 …”

Section: Introductionmentioning

confidence: 99%

Hip abductor strength and fatigue are associated with activity levels more than 1 year after total hip replacement

Cinnamon

Ryan

et al. 2017

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Despite improvements in pain and function, people who undergo total hip arthroplasty (THR) may not always return to desired levels of physical activity (PA). The factors associated with low activity levels are not fully understood. Abductor weakness and fatigue have both been proposed as factors that limit activity in older adults or people with hip osteoarthritis, but have not been investigated after THR. We hypothesized that abductor weakness and fatigue are associated with lower activity levels in people who have undergone a THR and that fatigue mediates the association between abductor strength and activity. We evaluated 16 subjects (24 ± 10 months post-THR; age 56.8 ± 8.4 yrs; BMI 31 ± 7 kg/m ). Fatigue was assessed using the PROMIS fatigue short-form 7a. Peak isometric hip abductor torque was assessed using a dynamometer with subjects in a sidelying position. We assessed activity level using the UCLA activity score. We used Pearson correlations to explore the associations among the variables. Next we used a three-step linear regression procedure to test whether or not fatigue acted as a mediator between abductor torque and UCLA activity scores. Higher abductor torque was associated with less fatigue (R = 0.275; p = 0.037) and with higher UCLA scores (R = 0.488, p = 0.003). Higher fatigue was associated with lower UCLA scores (R = 0. 307, p = 0.017), however there was no evidence of mediation. This suggests that addressing both abductor strength and fatigue may increase physical activity. Statement of Clinical Significance: Fatigue and abductor weakness should be evaluated in sedentary THR patients presenting for long-term follow-up. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1519-1525, 2018.