Inter-joint coordination of kinematics and kinetics before and after total hip arthroplasty compared to asymptomatic subjects
Introduction
Hip osteoarthritis (OA) is a degenerative joint disease that leads to pain and reduced function. Total hip arthroplasty (THA) relieves pain and restores function in most patients, but leaves functional deficits in some (Judge et al., 2010, Singh and Lewallen, 2013). Gait analysis has been used to quantitatively characterize the mechanical function of the hip before and after THA. Studies consistently show that patients with OA have smaller hip ranges of motion (ROM) and external moments during normal walking compared to healthy subjects. Moreover, while gait patterns improve (Foucher and Freels, 2015, Queen et al., 2013, Rosenlund et al., 2016), gait alterations persist after THA relative to healthy controls (Agostini et al., 2014, Foucher et al., 2011, Foucher, 2016, Queen et al., 2014, Varin et al., 2013). Despite the knowledge added by biomechanical studies over the years, gait findings based on traditional measures have been consistent over time even as new surgical approaches and new implant technologies have been developed. It is possible that conventional approaches to evaluating gait mechanics have not revealed all of the information needed to develop interventions that would improve gait and clinical outcomes.
Walking is a dynamic, complex movement, requiring a substantial degree of joint coordination within the kinetic chain. A few studies have investigated joints other than the affected hip, (Beaulieu et al., 2010, Foucher and Wimmer, 2012, Horstmann et al., 2013), however even in these cases single-joint, discrete measures (e.g. peak knee adduction moment) are reported. More comprehensive measures of dynamic movement may reveal systematic gait differences not revealed using traditional measures. For example, an analysis of joint kinematic coordination in subjects with acetabular cartilage defects revealed abnormalities that suggested motor control deficits, which in turn may be relevant for OA progression (Samaan et al., 2015).
In this study, we evaluated two methods of characterizing inter-joint coordination during walking. The first technique is a cyclogram, an angle-angle diagram of the cyclical kinematics of a coordinated system (Goswami, 1998). Cyclograms are generated by simultaneously plotting one joint variable against another joint variable. For example, a hip-knee angle cyclogram graphically shows the relationship between the angles of both joints throughout the entire gait cycle (Fig. 1). The resulting plot can provide measures of the coordinated pattern. Cyclograms have been used to detect differences in locomotion patterns during various distances, over various inclines, and among individuals with various injury diagnoses (Decker et al., 2007, Goswami, 1998, Mah et al., 1999). The second technique, support moment (MS), was developed to study total kinetics of the coordinated system (Winter, 1980). The overall moment (i.e. sum of the moments) produced about the hip, knee, and ankle results in the MS (Fig. 2). Muscle extensor moments are responsible for vertical support as well as propelling the center of gravity forward during the stance phase of walking. The MS has been used to identify abnormalities in knee OA during walking (Zeni and Higginson, 2011) and in sit-to-stand activities in femoroacetabular impingement (Samaan et al., 2017), but to our knowledge has not previously been evaluated in the setting of THA.
The purpose of this study was to explore changes in inter-joint coordination before and one year after THA surgery using both a kinematic and kinetic measure: a hip-knee angle cyclogram and the MS. The rationale is that we know that normal gait function is not completely restored after THA. We therefore postulate that inter-joint coordination is compromised before and possibly after surgery. This information could provide new approaches to ultimately optimize rehabilitation. We hypothesized that in patients undergoing THA, inter-joint coordination measures (i) are worse than control subjects before surgery, (ii) improve from preoperative to postoperative, but (iii) remain worse compared to control subjects after surgery.
Section snippets
Methods
We queried an institutional review board-approved data repository of participants of a motion analysis laboratory study to identify subjects for this retrospective cohort study. Original subjects participated in studies of pre- and postoperative THA gait biomechanics. There were no restrictions on age, functional ability, operated-hip pain level or disease severity for any of the original studies. However, all original studies excluded patients with pain or prior joint replacements in the
Results
Total cyclogram area (Table 2) was 572.2 ± 307.8 deg2 in the pre-THA subjects compared to 1292.1 ± 301.4 deg2 in control subjects (55% lower in pre-THA subjects, p < 0.001) (Fig. 3). Cyclogram area increased by 70% from pre- to post-THA to 973.3 ± 309.7 deg2 (p < 0.001), but remained 20% lower than controls (p < 0.001). When we analyzed stance-phase separately (Table 2), we found stance-phase area was 43% lower at pre-THA compared to control values (p < 0.001). Stance-phase area increased by
Discussion
The purpose of our study was to explore changes in inter-joint coordination during walking before and one year after THA using a kinematic and kinetic measure: a hip-knee angle cyclogram and MS impulse. We hypothesized that inter-joint coordination would be abnormal before THA and would not return to normal following THA, based, in part, on previous findings regarding individual joints. Our hypothesis was partially supported. Total cyclogram area was reduced compared to control values before
Acknowledgements
Data were originally collected at Rush University Medical Center. Data acquisition was funded by a grant from the Rush Research Mentoring Program Young Investigators Fund. The sponsor had no involvement in the study design, conduct, or manuscript preparation. Kris Dapiton, B.S. and Kristin Tayag, B.S. participated in data analysis for the present study.
Conflict of interest statement
There are no financial or personal relationships that have influenced this work.
References (38)
- et al.
Gait parameters and muscle activation patterns at 3, 6 and 12 months after total hip arthroplasty
J. Arthroplasty
(2014) - et al.
Lower limb biomechanics during gait do not return to normal following total hip arthroplasty
Gait Posture
(2010) - et al.
Variability in inter-joint coordination during walking of elderly adults and its association with clinical balance measures
Clin. Biomech. (Bristol, Avon)
(2013) - et al.
Altered inter-joint coordination during walking in patients with total hip arthroplasty
Gait Posture
(2010) - et al.
An alternative approach to normalization and evaluation for gait patterns: procrustes analysis applied to the cyclograms of sprinters and middle-distance runners
J. Biomech.
(2007) Gait abnormalities before and after total hip arthroplasty differ in men and women
J. Biomech.
(2016)- et al.
Preoperative factors associated with postoperative gait kinematics and kinetics after total hip arthroplasty
Osteoarthr. Cartilage/OARS, Osteoarthr. Res. Soc.
(2015) - et al.
Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients
J. Biomech.
(2007) - et al.
Contralateral hip and knee gait biomechanics are unchanged by total hip replacement for unilateral hip osteoarthritis
Gait Posture
(2012) - et al.
Time course and extent of functional recovery during the first postoperative year after minimally invasive total hip arthroplasty with two different surgical approaches–a randomized controlled trial
J. Biomech.
(2011)
A new gait parameterization technique by means of cyclogram moments: application to human slope walking
Gait and Posture
Changes in gait patterns and muscle activity following total hip arthroplasty: a six-month follow-up
Clin. Biomech. (Bristol, Avon)
Hip motion and moments during gait relate directly to proximal femoral bone mineral density in patients with hip osteoarthritis
J. Biomech.
Kinematic gait patterns and their relationship to pain in mild-to-moderate hip osteoarthritis
Clin. Biomech.
Walking with increased ankle pushoff decreases hip muscle moments
J. Biomech.
Effect of increased pushoff during gait on hip joint forces
J. Biomech.
Quantitative kinematics of gait patterns during the recovery period after stroke
J. Stroke Cerebrovas. Dis.: Off. J. Nat. Stroke Assoc.
Total hip arthroplasty surgical approach does not alter postoperative gait mechanics one year after surgery
PM R: J. Injury Funct. Rehab.
Does surgical approach during total hip arthroplasty alter gait recovery during the first year following surgery?
J. Arthroplasty
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