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Dynamic hip joint stiffness in individuals with total hip arthroplasty: Relationships between hip impairments and dynamics of the other joints

      Abstract

      Background

      Little is known about hip joint stiffness during walking (dynamic joint stiffness) and the effect of hip impairments on biomechanical alterations of other joints in patients with total hip arthroplasty.

      Methods

      Twenty-four patients (mean age 61.7 years) who underwent unilateral (n=12) or bilateral total hip arthroplasty (n=12) and healthy subjects (n=12) were recruited. In addition to kinematic and kinetic variables, dynamic hip joint stiffness which was calculated as an angular coefficient of linear regression of the plot of the hip flexion moment vs. hip extension angle during the late stance of gait, was measured. Group differences were compared using one-way ANOVA and Tukey's post-hoc test, and relationships between primary hip impairments and secondary gait impairments were found using partial correlation coefficients adjusted for gait speed and stride length.

      Findings

      Dynamic hip joint stiffness was 47% higher on the side with the more pronounced limp in patients with bilateral arthroplasty than in healthy controls. In the same patients, increased dynamic hip joint stiffness was significantly associated especially with increased ankle plantarflexion moment on the ipsilateral side. In patients with unilateral arthroplasty, decreased hip power was significantly related to increased ankle plantarflexor power, only on the non-operated side.

      Interpretation

      We found that dynamic hip joint stiffness was an important factor in assessing relationships between hip impairments and dynamics in other joints, especially in patients with bilateral total hip arthroplasty. The effects of altering hip joint stiffness on gait biomechanics need to be explored.

      Keywords

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      References

        • Beaulieu M.L.
        • Lamontagne M.
        • Beaulé P.E.
        Lower limb biomechanics during gait do not return to normal following total hip arthroplasty.
        Gait Posture. 2010; 32: 269-273
        • Berman A.T.
        • Quinn R.H.
        • Zarro V.J.
        Quantitative gait analysis in unilateral and bilateral total hip replacements.
        Arch. Phys. Med. Rehabil. 1991; 72: 190-194
        • Bessette B.J.
        • Fassier F.
        • Tanzer M.
        • Brooks C.E.
        Total hip arthroplasty in patients younger than 21 years: a minimum 10-year follow-up.
        Can. J. Surg. 2003; 46: 257-262
        • Butler R.J.
        • Crowell III, H.P.
        • Davis I.M.
        Lower extremity stiffness: implications for performance and injury.
        Clin. Biomech. 2003; 18: 511-517
        • Childs J.D.
        • Sparto P.J.
        • Fitzgerald G.K.
        • Bizzini M.
        • Irrgang J.J.
        Alteration in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis.
        Clin. Biomech. 2004; 19: 44-49
        • Davis R.B.
        • DeLuca P.A.
        Gait characterization via dynamic joint stiffness.
        Gait Posture. 1996; 4: 224-231
        • Dixon S.J.
        • Hinman R.S.
        • Creaby M.W.
        • Kemp G.
        • Crossley K.M.
        Knee joint stiffness during walking in knee osteoarthritis.
        Arthritis Care Res. 2010; 62: 38-44
        • Eng J.J.
        • Winter D.A.
        Kinetic analysis of the lower limbs during walking: what information can be gained from a three-dimensional model?.
        J. Biomech. 1995; 28: 753-758
        • Farley C.T.
        • Houdijk H.H.P.
        • Strien C.V.
        • Louie M.
        Mechanism of leg stiffness adjustment for hopping on surfaces of different stiffnesses.
        J. Appl. Physiol. 1998; 85: 1044-1055
        • Foucher K.C.
        • Hurwitz D.E.
        • Wimmer M.A.
        Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients.
        J. Biomech. 2007; 40: 3432-3437
        • Frigo C.
        • Crenna P.
        • Jensen L.M.
        Moment-angle relationship at lower limb joints during human walking at different velocities.
        J. Electromyogr. Kinesiol. 1996; 6: 177-190
        • Galli M.
        • Rigoldi C.
        • Brunner R.
        • Virji-Babul N.
        • Giorgio A.
        Joint stiffness and gait pattern evaluation in children with Down syndrome.
        Gait Posture. 2008; 28: 502-506
        • Gurney B.
        Leg length discrepancy.
        Gait Posture. 2002; 15: 195-206
        • Hamill J.
        • Moses M.
        • Seay J.
        Lower extremity joint stiffness in runners with low back pain.
        Res. Sports Med. 2009; 17: 260-273
        • Kilgus D.J.
        • Dorey F.J.
        • Finerman G.A.
        • Amstutz H.C.
        Patient activity, sports participation, and impact loading on the durability of cemented total hip replacements.
        Clin. Orthop. Relat. Res. 1991; 269: 25-31
        • Kleemann R.U.
        • Heller M.O.
        • Stoeckle U.
        • Taylor W.R.
        • Duda G.N.
        THA loading arising from increased femoral anteversion and offset may lead to critical cement stresses.
        J. Orthop. Res. 2003; 21: 767-774
        • Lelas J.L.
        • Merriman G.J.
        • Riley P.O.
        • Kerrigan D.C.
        Predicting peak kinematic and kinetic parameters from gait speed.
        Gait Posture. 2003; 17: 106-112
        • Loizeau J.
        • Allard P.
        • Duhaime M.
        • Landjerit B.
        Bilateral gait patterns in subjects fitted with a total hip prosthesis.
        Arch. Phys. Med. Rehabil. 1995; 76: 552-557
        • Madsen M.S.
        • Ritter M.A.
        • Morris H.H.
        • Meding J.B.
        • Berend M.E.
        • Faris P.M.
        • et al.
        The effect of total hip arthroplasty surgical approach on gait.
        J. Orthop. Res. 2004; 22: 44-50
        • McGibbon C.A.
        Toward a better understanding of gait changes with age and disablement: neuromuscular adaptation.
        Exerc. Sport Sci. Rev. 2003; 31: 102-108
        • Miki H.
        • Sugano N.
        • Hagio K.
        • Nishii T.
        • Kawakami H.
        • Kakimoto A.
        • et al.
        Recovery of walking speed and symmetrical movement of the pelvis and lower extremity joints after unilateral THA.
        J. Biomech. 2004; 37: 443-455
        • Nantel J.
        • Termoz N.
        • Vendittoli P.A.
        • Lavigne M.
        • Prince F.
        Gait pattern after total hip arthroplasty and surface replacement arthroplasty.
        Arch. Phys. Med. Rehabil. 2009; 90: 463-469
        • Neptune R.R.
        • Kautz S.A.
        • Zajac F.E.
        Contributions of the individual ankle plantar flexors to support, forward progression and swing initiation during walking.
        J. Biomech. 2001; 34: 1387-1398
        • Perron M.
        • Malouin F.
        • Moffet H.
        • McFadyen B.J.
        Three-dimensional gait analysis in women with a total hip arthroplasty.
        Clin. Biomech. 2000; 15: 504-515
        • Rasch A.
        • Byström A.H.
        • Dalén N.
        • Martinez-Carranza M.
        • Berg H.E.
        Persisting muscle atrophy two years after replacement of the hip.
        J. Bone Joint Surg. Br. 2009; 91-B: 583-588
        • Sadeghi H.
        • Sadeghi S.
        • Prince F.
        • Allard P.
        • Labelle H.
        • Vaughan C.L.
        Functional roles of ankle and hip sagittal muscles moments in able-bodied gait.
        Clin. Biomech. 2001; 16: 688-695
        • Schmitt L.C.
        • Rudolph K.S.
        Muscle stabilization strategies in people with medial knee osteoarthritis: the effect of instability.
        J. Orthop. Res. 2008; 26: 1180-1185
        • Tanaka R.
        • Shigematsu M.
        • Motooka T.
        • Mawatari M.
        • Hotokebuchi T.
        Factors influencing the improvement of gait ability after total hip arthroplasty.
        J. Arthroplasty. 2009; 29: 1-4
        • Umeda N.
        • Miki H.
        • Nishii T.
        • Yoshikawa H.
        • Sugano N.
        Progression of osteoarthritis of the knee after unilateral total hip arthroplasty: minimum 10-year follow-up study.
        Arch. Orthop. Trauma. Surg. 2009; 129: 149-154
        • Wykman A.
        • Olsson E.
        Walking ability after total hip replacement. A comparison of gait analysis in unilateral and bilateral cases.
        J. Bone Joint Surg. Br. 1992; 74-B: 53-56
        • Zeni Jr., J.A.
        • Higginson J.S.
        Dynamic knee joint stiffness in subjects with a progressive increase in severity of knee osteoarthritis.
        Clin. Biomech. 2009; 24: 366-371