Preoperative gait mechanics predict clinical response to total hip arthroplasty

Abstract

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.

Abnormal loading of the hip and knee joints in unilateral hip osteoarthritis persists two years after total hip replacement

“…As a consequence of this and according to a study of Foucher, the increased 2nd HAM in our patient group compared to controls after THR may be explained by the relative low preoperative function of our patients because a worse HHS is associated with higher odds of attaining a minimally clinically important improvement for the HAM . In this context, it has also been shown that THR responders have lower (worse) total HHS before surgery compared to nonresponders indicating a lower external peak HAM after surgery . In other words, patients with lower HHS are more likely to be responders and have more relative improvement in HAM.…”

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“…These criteria assess responder status based on relative change in Index (WOMAC) scores in relation to benchmarks determined by expert consensus and statistical analyses. OMERACT-OARSI criteria were chosen since they do not depend on patient characteristics of the cohort and thus reducing any potential selection bias due to the retrospective design of the study [ 23 ]. The OMERACT-OARSI criteria to assess responders after total joint replacement include improvement in pain or function of at least 50% and absolute change of at least 20 points.…”

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“…These criteria assess responder status based on relative change in Index (WOMAC) scores in relation to benchmarks determined by expert consensus and statistical analyses. OMERACT-OARSI criteria were chosen since they do not depend on patient characteristics of the cohort and thus reducing any potential selection bias due to the retrospective design of the study [ 22 ]. The OMERACT-OARSI criteria to assess responders after TKA include improvement in pain or function of at least 50% and absolute change of at least 20 points.…”