Advertisement

Evaluation of overall gait quality in Perthes disease. Are global gait indices of value for a local musculoskeletal disorder?

      Highlights

      • This study was the first to quantify gait of Perthes patients using summary measures.
      • Gait-Deviation-, Gillette-Gait- and Hip-Flexor-Index are sensitive for pathologic gait.
      • They may serve as functional parameters for outcome examinations in Perthes disease.
      • They cannot discriminate involved and non-involved side in Perthes patients.

      Abstract

      Background

      Until now follow-up- and outcome evaluations in Perthes disease are analysing predominantly subjective results and clinical/radiological parameters. To enlarge the assessment by quantitative, functional aspects a summary measure for overall gait quality would be helpful. Therefore, the objective of this study is to evaluate whether commonly used global gait indices are sensitive to detect gait deviations during the early stages of the Perthes disease.

      Methods

      3D gait data of 70 patients scheduled for containment improving surgery with the diagnosis of Perthes were included. A group of 31 healthy children served as a control group. Based on 4 gait cycles of each subject the Gait Deviation Index, the Gillette Gait Index, the Hip Flexor Index and the Gait Deviation Index-Kinetic were calculated for the involved and non-involved side. The gait indices were compared (1) between patients and controls, (2) among patients sub-grouped by ROM/radiological classifications and (3) between the two limbs.

      Findings

      All applied gait indices besides the Gait Deviation Index-Kinetic of the patient-group are significantly different from the controls. The subgroup-analysis resulted only in significant differences between the radiological groups Herring B and C for the Gillette Gait Index. Comparing involved and non-involved side showed no significant differences.

      Interpretation

      The evaluated gait indices are sensitive to identify a pathologic gait pattern in Perthes disease, so they can be used as a functional outcome parameter evaluating treatment concepts. Nevertheless, these are not applicable to identify the pathologic side indicating that a local hip problem leads to global gait deviations.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Catterall A.
        The natural history of Perthes' disease.
        J. Bone Joint Surg. (Br.). 1971; 53: 37-53
        • Church C.
        • Ge J.
        • Hager S.
        • Haumont T.
        • Lennon N.
        • Niiler T.
        • Hulbert R.
        • Miller F.
        Flexed-knee gait in children with cerebral palsy: a long-term follow-up study.
        Bone Joint J. 2018; 100-B: 549-556
        • Cimolin V.
        • Galli M.
        Summary measures for clinical gait analysis: a literature review.
        Gait Posture. 2014; 39: 1005-1010
        • Cohen J.
        Statistical Power Analysis for the Behavioural Sciences.
        2nd ed. L. Erlbaum Associates, Hillsdale, N.J1988
        • Galloway A.M.
        • van-Hille T.
        • Perry D.C.
        • Holton C.
        • Mason L.
        • Richards S.
        • Siddle H.J.
        • Comer C.
        A systematic review of the non-surgical treatment of Perthes’ disease.
        Bone Jt Open. 2020; 2: 720-730
        • Guzik A.
        • Drużbicki M.
        Application of the Gait Deviation Index in the analysis of post-stroke hemiparetic gait.
        J. Biomech. 2020; 23109575https://doi.org/10.1016/j.jbiomech.2019.109575
        • Herring J.A.
        • Neustadt J.B.
        • Williams J.J.
        • Early J.S.
        • Browne R.H.
        The lateral pillar classification of Legg-Calvé-Perthes disease.
        J. Pediatr. Orthop. 1992; 12: 143-150
        • Peck J.B.
        • Greenhill D.A.
        • Morris W.Z.
        • Do D.-H.
        • McGuire M.F.
        • Kim H.K.W.P.
        Prolonged non-weightbearing treatment decreases femoral head deformity compared to symptomatic treatment in the initial stage of Legg-Calvé-Perthes disease.
        J. Pediatr. Orthop. B. 2021; 20 (Online ahead of print.)https://doi.org/10.1097/BPB.0000000000000873
        • Putz C.
        • Blessing A.K.
        • Erhard S.
        • Fiethen K.
        • Geisbüsch A.
        • Niklasch M.
        • Döderlein L.
        • Wolf S.I.
        • Dreher T.
        Long-term results of multilevel surgery in adults with cerebral palsy.
        Int. Orthop. 2019; 43: 255-260
        • Rich M.M.
        • Schoenecker P.L.
        Management of Legg-Calvé-Perthes disease using an A-frame orthosis and hip range of motion: a 25-year experience.
        J. Pediatr. Orthop. 2013; 33: 112-119
        • Rozumalski A.
        • Schwartz M.H.
        The GDI-kinetic: a new index for quantifying kinetic deviations from normal gait.
        Gait Posture. 2011; 33: 730-732
        • Schulitz K.P.
        • Dustmann H.O.
        Morbus Perthes.
        2nd ed. Springer, Berlin, Heidelberg1998
        • Schutte L.M.
        • Narayanan U.
        • Stout J.L.
        • Selber P.
        • Gage J.R.
        • Schwartz M.H.
        An index for quantifying deviations from normal gait.
        Gait Posture. 2000; 11: 25-31
        • Schwartz M.
        The reliability of the normalcy index for quantifying gait pathology.
        Gait Posture. 2003; 18: S119
        • Schwartz M.H.
        • Rozumalski A.
        The gait deviation index: a new comprehensive index of gait pathology.
        Gait Posture. 2008; 28: 351-357
        • Schwartz M.H.
        • Novacheck T.F.
        • Trost J.
        A tool for quantifying hip flexor function during gait.
        Gait Posture. 2000; 12: 122-127
        • Souza M.A.
        • Cezarani A.
        • Lizzi E.A.D.A.
        • Davoli G.B.Q.
        • Mattiello S.M.
        • Jones R.
        • Mattiello-Sverzut A.C.
        The use of the gait profile score and gait variable score in individuals with Duchenne Muscular Dystrophy.
        J. Biomech. 2020; 2109485https://doi.org/10.1016/j.jbiomech.2019.109485
        • Stief F.
        • Schmidt A.
        • Adolf S.
        • Kremer L.
        • Brkic M.
        • Meurer A.
        Development of gait performance and dynamic hip and knee joint loading after containment improving surgery in patients with Legg-Calvé-Perthes disease.
        Gait Posture. 2016; 47: 51-56
        • Svehlík M.
        • Kraus T.
        • Steinwender G.
        • Zwick E.B.
        • Linhart W.E.
        Pathological gait in children with Legg-Calvé-Perthes disease and proposal for gait modification to decrease the hip joint loading.
        Int. Orthop. 2012; 36: 1235-1241
        • Tönnis D.
        Die angeborene Hüftdysplasie und Hüftluxation in Kindes- und Erwachsenenalter.
        Springer Verlag, 1984
        • Waldenström H.
        Coxa plana.
        Osteochondritis deformans coxae. Zentralblatt Chir. 1920; 47: 539
        • Westhoff B.
        • Petermann A.
        • Hirsch M.A.
        • Willers R.
        • Krauspe R.
        Computerized gait analysis in Legg calve Perthes disease - analysis of the frontal plane.
        Gait Posture. 2006; 24: 196-202
        • Westhoff B.
        • Zilkens C.
        • Reith A.
        • Jelinek E.
        • Martiny F.
        • Willers R.
        • Krauspe R.
        Correlation of functional outcome and X-ray findings after Perthes disease.
        Int. Orthop. 2011; 35: 1833-1837
        • Westhoff B.
        • Martiny F.
        • Reith A.
        • Willers R.
        • Krauspe R.
        Computerized gait analysis in Legg-Calvé-Perthes disease - analysis of the sagittal plane.
        Gait Posture. 2012; 35: 541-546