Sex‐specific sagittal and frontal plane gait mechanics in persons post‐hip arthroscopy for femoroacetabular impingement syndrome

Abstract

Postoperative gait mechanics in persons with femoroacetabular impingement syndrome (FAIS) remain understudied as a treatment outcome despite observed, yet inconclusive, preoperative gait abnormalities. Females with FAIS demonstrate worse preoperative patient-reported hip function and altered hip mechanics when compared with males; it is unknown whether these sex differences persist postarthroscopy. The purpose of this study was to compare sex-specific gait kinematics between persons at least 1 year postarthroscopy for FAIS and healthy comparisons. General linear models with estimating equations were used to evaluate the effect of (a) limb and sex within each group, and (b) limb and group within each sex for peak sagittal and frontal plane trunk, pelvis, and hip kinematics during stance phase of gait. Analyses were covaried by gait speed. Seventeen females and eight males an average 2.5 years postarthroscopy (1.1-7.2 year) for FAIS were compared with healthy females (n = 7) and males (n = 5). Females in the FAIS group presented with an average of 4.6°more anterior pelvic tilt, and 4.8°less hip extension compared with healthy females (P ≤ .03) and 8.6°less trunk flexion, 4.8°more anterior pelvic tilt, 3.1°more pelvic drop, and 7.5°more hip flexion than males with FAIS (P ≤ .03). Males in the FAIS group presented with 2.9°less pelvic drop, and 3.2°less hip adduction than healthy males. Preoperative gait mechanics were not collected and thus changes in mechanics could not be evaluated. This study is significant to clinicians who treat patients postarthroscopy to consider sex-specific gait impairments.

Muscle and Hip Contact Forces in Asymptomatic Men With Cam Morphology During Deep Squat

“…The limitations to this study include the small sample size of our cohort, as increasing the number of participants would have resulted in higher predictive power. Limiting our cohort to male individuals with cam-type morphology only, limits our findings to this population, as differences by sex may occur (Lewis et al, 2018 ; Brown-Taylor et al, 2020 ). Second, static optimization can underestimate muscle force production during co-contractions that are modified by a joint pathology; however, this technique still produces results closest to experimental HCF (Wesseling et al, 2015 ).…”

Clinical Measures of Pelvic Tilt in Physical Therapy

“…This is further confounded by the fact that kinematic assessment of functional movements shows a precise quantifiable difference in the quantity of pelvic tilt (example: a 5 degree difference in the amount of anterior pelvic tilt between symptomatic and asymptomatic populations). 15,[23][24][25][26][27][28] This is in contrast to an absolute categorical difference (example: anterior pelvic tilt, neutral, or posterior pelvic tilt) which is how visual observation is interpreted. Further, variations in the pelvic morphology within a normal population may further confuse a simple visual or manual assessment.…”

“…At the hip joint, differences in pelvic tilt are correlated with symptomatic femoroacetabular impingement (FAI) 4,22 and non-specific groin pain 15,23 as compared to asymptomatic controls. Differences in pelvic tilt in subjects with a symptomatic hip have manifested during kinematic assessment of a variety of basic functional movements, such as walking, [24][25][26] a single leg step-down, 17,27 and squatting. 28 Significant differences of pelvic tilt during athletic activities such as cutting have also been identified in populations with a symptomatic hip condition.…”

“…4 Indeed, differences have been found in pelvic kinematics in males and females following hip arthroscopy, with increases in anterior pelvic tilt during walking evident only in females compared to healthy controls after at least 1 year post-arthroscopy. 26 Alterations in pelvic tilt have been found to influence clinical hip range of motion measurements. 5,[30][31][32] In particular, anterior pelvic tilt has been shown to reduce the available range of motion at the hip until impingement occurs, 5 and may contribute to range of motion losses that are sometimes seen in patients with symptomatic femoroacetabular impingement.…”

Sex-Based Differences in Outcomes After Hip Arthroscopic Surgery for Femoroacetabular Impingement: A Systematic Review

“…Bias was assessed based on the following 12 criteria: (1) clearly stated aim, (2) inclusion of consecutive patients, (3) prospective collection of data, (4) endpoints appropriate to the aim of the study, (5) unbiased assessment of the study endpoint, (6) follow-up period appropriate to the study aim, (7) loss to follow up <5%, and (8) prospective calculation of the study size. The following additional criteria were for comparative studies: (9) adequate control group, (10) contemporary groups, (11) baseline equivalence of groups, and (12) adequate statistical analyses.…”