Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients

Foucher, Kharma C.; Hurwitz, Debra E.; Wimmer, Markus A.

doi:10.1016/j.jbiomech.2007.05.020

Cited by 165 publications

(184 citation statements)

References 22 publications

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“…Weight-bearing exercises may provide more functional benefit because this type of exercise often activates a greater number of muscle group [38]. Muscle strength recovery and gait adaption was not complete one year after total hip arthroplasty in patients with unilateral osteoarthritis or osteonecrotic hips [39,40]. Another study demonstrated a slow morphological recovery in cross-sectional area (CSA) and radiological density (RD) of hip muscles compared to the healthy limb two years after THA in patients with osteoarthritis [41].…”

Section: Discussionmentioning

confidence: 99%

Changes of gluteus medius muscle in the adult patients with unilateral developmental dysplasia of the hip

Liu

Wen

Tong

et al. 2012

BMC Musculoskelet Disord

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BackgroundThe gluteus medius muscle is essential for gait and hip stability. Changes that occur in the gluteus medius muscles in patients with developmental dysplasia of the hip (DDH) are not well understood. A better understanding of DDH related changes will have positive repercussions toward hip soft tissue reconstruction.Methods19 adult patients with unilateral DDH scheduled for total hip arthroplasty were assessed for: cross-sectional area (CSA), radiological density (RD) and the length of gluteus medius using computed tomograhpy(CT) (scanned before THA). Hip abductor moment arm and gluteus medius activation angle were also measured via hip anteroposterior radiographs.ResultsBoth CSA and RD of gluteus medius muscle were significantly reduced (p < 0.05) in the affected hip compared to the control. In the affected hip, the length of the gluteus medius muscle was reduced by 8-11 % (p < 0.05) while the gluteus medius activation angle was significantly increased (p < 0.05) and the hip abductor moment arm was decreased (p < 0.05).ConclusionsThe gluteus medius showed substantial loss of CSA, RD as well as decreased length in patients with DDH in the affected hip. These changes should be considered in both hip reconstruction and postoperative rehabilitation training in patients with DDH.

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Section: Discussionmentioning

confidence: 99%

Changes of gluteus medius muscle in the adult patients with unilateral developmental dysplasia of the hip

Liu

Wen

Tong

et al. 2012

BMC Musculoskelet Disord

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“…20 Postoperative gait and radiographic data were used. Twenty-eight subjects (18 males/ 10 females, age 64 AE 7 years, height 1.72 AE 0.11 m, weight 850 AE 155 N) were evaluated 1 year (14 AE 3 months) after primary unilateral THR for a diagnosis of primary hip osteoarthritis.…”

Section: Methods Subjectsmentioning

confidence: 99%

“…[20][21][22][23] Joint positions linked to high forces or adverse THR outcome include superior or lateral hip joint center, a small abductor moment arm, and a small offset. Theoretically, the main effect of each of these positions is to decrease the moment generating capacity of the abductors, such that they must produce a higher force to generate the same moment, thereby increasing overall implant loads.…”

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confidence: 99%

Relative importance of gait vs. joint positioning on hip contact forces after total hip replacement

Foucher

Hurwitz

Wimmer

2009

Journal Orthopaedic Research

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Implant loosening is a common indication for total hip replacement (THR) revision. High contact forces and implant twisting moments are thought to be associated with implant loosening. Relationships between joint positioning and hip forces, or outcomes, have been investigated through in vivo and in vitro modalities. Relationships between hip forces and gait are less understood, despite repeated findings that gait following a THR does not fully return to normal. We tested the hypothesis that gait parameters would be better predictors of implant force (peak contact forces and peak twisting moment during walking) than joint positioning parameters. Subjects underwent gait analysis, hip force modeling, and measurement of clinical radiographs 1 year after successful THR surgery. Gait parameters were consistently more influential in determining hip forces. Alone, gait explained as much as 67% of the variation in force, compared to a maximum of 33% by joint geometry. Combinations of gait and joint positioning parameters together explained up to 86% of the variation in hip force parameters. Results suggest that gait may provide a valuable postoperatively modifiable target to improve hip loads and potentially reduce the risk for implant loosening. ß

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“…Postoperative gait characteristics after THA have been the subject of a number of previous studies, many of which have demonstrated persistent postoperative biomechanical abnormalities at the operative hip [16][17][18]. However, there are few studies that directly compare the effect of the surgical approach on postoperative gait characteristics after THA.…”

Section: Introductionmentioning

confidence: 99%

Total Hip Arthroplasty Surgical Approach Does Not Alter Postoperative Gait Mechanics One Year After Surgery

Queen

Appleton

Butler

et al. 2013

PM&R

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Objective: To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery. Design: This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment 1 year after total hip arthroplasty (THA). Temporospatial, kinetic, and kinematic data as well as functional outcomes were collected. Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries. Setting: A controlled laboratory study. Participants: This study examined 35 patients with primary, unilateral THA. The THA surgical approaches that were used in these patients included 12 direct lateral, 18 posterior, and 11 anterolateral. All the patients were assessed 1 year after THA. Patients were excluded from the study if they had contralateral hip pain or pathology, or any prior lower extremity total joint replacements. Main Outcome Measurements: Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected. In addition, a series of physical performance measures were collected. Results: No main effects for the physical performance measures or biomechanical variables were observed among the approach groups. Significant limb-to-limb asymmetries were observed among all the patients, with decreased sagittal plane range of motion, peak extension, and peak vertical ground reaction forces on the operative side. Conclusion:The results of this study indicated that no significant differences existed among the different surgical approach groups for any study variable. However, 1 year after THA, the patients demonstrated asymmetric gait patterns regardless of surgical approach, which indicated the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry after THA.

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Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients

Cited by 165 publications

References 22 publications

Changes of gluteus medius muscle in the adult patients with unilateral developmental dysplasia of the hip

Changes of gluteus medius muscle in the adult patients with unilateral developmental dysplasia of the hip

Relative importance of gait vs. joint positioning on hip contact forces after total hip replacement

Total Hip Arthroplasty Surgical Approach Does Not Alter Postoperative Gait Mechanics One Year After Surgery

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