Geometrical restoration during total hip arthroplasty is related to change in gait pattern - a study based on computed tomography and three-dimensional gait analysis

A-C Esbjörnsson, S Kiernan, L Mattsson, G Flivik, A-C Esbjörnsson, S Kiernan, L Mattsson, G Flivik

Abstract

Background: The effect of change in hip anatomy on change in gait pattern is not well described in current literature. Therefore, our primary aim was to describe and quantify changes in hip geometry and gait pattern 1 year after total hip arthroplasty (THA) in individuals with hip osteoarthritis. Our secondary aim was to explore the effect of postoperative change in femoral neck anteversion (FNA) and femoral offset and acetabular offset (FO/AO) quota on postoperative change in hip rotation and hip adduction moment during gait, respectively, 1 year after THA".

Methods: Sixty-five individuals with primary hip osteoarthritis, scheduled for THA, were analyzed in this prospective intervention study. Participants were evaluated pre- and 1 year postoperatively with computed tomography-scans, three-dimensional gait analysis, and patient-reported outcome measures. Multiple linear regressions were performed to evaluate the association between change in joint anatomy and change in gait pattern after THA.

Results: One year postoperatively, global offset was symmetrical between sides as a result of decreased acetabular offset and increased femoral offset on the operated side. Quality of overall gait pattern improved, and participants walked faster and with less trunk lean over the affected side. FNA and hip rotations during walking changed equally in external and internal directions after THA and change in hip rotation during walking was associated with change in FNA in the same direction. An increase in external hip adduction moments was, on the other hand, not associated with change in FO/AO quota but with a more upright walking position and increased walking speed.

Conclusions: The findings of this study suggest that geometrical restoration during THA impacts postoperative gait pattern and, in addition to known factors such as FO, height of hip rotation center, and leg length discrepancy, the FNA must also be taken into consideration.

Trial registration: Trial registration: Clinicaltrial.gov , NCT01512550 , Registered 19 January 2012 - Retrospectively registered.

Keywords: Computed tomography; Femoral neck anteversion; Femoral offset; Gait analysis; Hip joint moments; Hip osteoarthritis; Hip rotation; Total hip arthroplasty.

Conflict of interest statement

ACE and LM declare that they have no competing interests. SK and GF have both served as advisory consultants for Ortoma AB during software development.

Figures

Fig. 1
Fig. 1
Definitions of CT measurements in the frontal and transversal planes. FO, Femoral Offset; AO, Acetabular Offset; GO, Global Offset; Anteversion, Femoral Neck Anteversion. Illustrations by Sverrir Kiernan
Fig. 2
Fig. 2
Histograms describing change in CT measured femoral neck anteversion and hip rotation during walking after THA. Positive values indicate internal rotation and negative values indicate external rotation

References

    1. Abramson SB, Attur M. Developments in the scientific understanding of osteoarthritis. Arthritis Res Ther. 2009;11(3):227. doi: 10.1186/ar2655.
    1. Glyn-Jones S, Palmer AJ, Agricola R, Price AJ, Vincent TL, Weinans H, Carr AJ. Osteoarthritis. Osteoarthritis Lancet. 2015;386(9991):376–387. doi: 10.1016/S0140-6736(14)60802-3.
    1. Loureiro A, Mills PM, Barrett RS. Muscle weakness in hip osteoarthritis: a systematic review. Arthritis Care Res. 2013;65(3):340–352. doi: 10.1002/acr.21806.
    1. Leigh RJ, Osis ST, Ferber R. Kinematic gait patterns and their relationship to pain in mild-to-moderate hip osteoarthritis. Clin Biomech (Bristol, Avon) 2016;34:12–17. doi: 10.1016/j.clinbiomech.2015.12.010.
    1. Watelain E, Dujardin F, Babier F, Dubois D, Allard P. Pelvic and lower limb compensatory actions of subjects in an early stage of hip osteoarthritis. Arch Phys Med Rehabil. 2001;82(12):1705–1711. doi: 10.1053/apmr.2001.26812.
    1. Ewen AM, Stewart S, St Clair Gibson A, Kashyap SN, Caplan N. Post-operative gait analysis in total hip replacement patients-a review of current literature and meta-analysis. Gait Posture. 2012;36(1):1–6. doi: 10.1016/j.gaitpost.2011.12.024.
    1. Kiyama T, Naito M, Shinoda T, Maeyama A. Hip abductor strengths after total hip arthroplasty via the lateral and posterolateral approaches. J Arthroplast. 2010;25(1):76–80. doi: 10.1016/j.arth.2008.11.001.
    1. Bahl JS, Nelson MJ, Taylor M, Solomon LB, Arnold JB, Thewlis D. Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil. 2018;26(7):847–863. doi: 10.1016/j.joca.2018.02.897.
    1. Esbjornsson AC, Naili JE. Functional movement compensations persist in individuals with hip osteoarthritis performing the five times sit-to-stand test 1 year after total hip arthroplasty. J Orthop Surg Res. 2020;15(1):151. doi: 10.1186/s13018-020-01663-0.
    1. Stief F, Schmidt A, van Drongelen S, Lenarz K, Froemel D, Tarhan T, Lutz F, Meurer A. Abnormal loading of the hip and knee joints in unilateral hip osteoarthritis persists two years after total hip replacement. J Orthop Res. 2018;36(8):2167–2177. doi: 10.1002/jor.23886.
    1. Clement ND, Patrick-Patel RS, MacDonald D, Breusch SJ. Total hip replacement: increasing femoral offset improves functional outcome. Arch Orthop Trauma Surg. 2016;136(9):1317–1323. doi: 10.1007/s00402-016-2527-4.
    1. Bhaskar D, Rajpura A, Board T. Current concepts in Acetabular positioning in Total hip Arthroplasty. Indian J Orthop. 2017;51(4):386–396. doi: 10.4103/ortho.IJOrtho_144_17.
    1. De Fine M, Romagnoli M, Toscano A, Bondi A, Nanni M, Zaffagnini S. Is there a role for femoral offset restoration during total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res. 2017;103(3):349–355. doi: 10.1016/j.otsr.2016.12.013.
    1. Forde B, Engeln K, Bedair H, Bene N, Talmo C, Nandi S. Restoring femoral offset is the most important technical factor in preventing total hip arthroplasty dislocation. J Orthop. 2018;15(1):131–133. doi: 10.1016/j.jor.2018.01.026.
    1. Ogawa T, Takao M, Hamada H, Sakai T, Sugano N. Soft tissue tension is four times lower in the unstable primary total hip arthroplasty. Int Orthop. 2018;42(9):2059–2065. doi: 10.1007/s00264-018-3908-9.
    1. Mahmood SS, Mukka SS, Crnalic S, Wretenberg P, Sayed-Noor AS. Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength. A prospective cohort study of 222 patients. Acta Orthop. 2016;87(1):36–41. doi: 10.3109/17453674.2015.1091955.
    1. McGrory BJ, Morrey BF, Cahalan TD, An KN, Cabanela ME. Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty. J Bone Joint Surg Br. 1995;77(6):865–869. doi: 10.1302/0301-620X.77B6.7593096.
    1. Sariali E, Klouche S, Mouttet A, Pascal-Moussellard H. The effect of femoral offset modification on gait after total hip arthroplasty. Acta Orthop. 2014;85(2):123–127. doi: 10.3109/17453674.2014.889980.
    1. van Drongelen S, Kaldowski H, Tarhan T, Assi A, Meurer A, Stief F. Are changes in radiological leg alignment and femoral parameters after total hip replacement responsible for joint loading during gait? BMC Musculoskelet Disord. 2019;20(1):526. doi: 10.1186/s12891-019-2832-5.
    1. Malik A, Maheshwari A, Dorr LD. Impingement with total hip replacement. J Bone Joint Surg Am. 2007;89(8):1832–1842. doi: 10.2106/JBJS.F.01313.
    1. Weber M, Weber T, Woerner M, Craiovan B, Worlicek M, Winkler S, Grifka J, Renkawitz T. The impact of standard combined anteversion definitions on gait and clinical outcome within one year after total hip arthroplasty. Int Orthop. 2015;39(12):2323–2333. doi: 10.1007/s00264-015-2777-8.
    1. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75(2):228–232. doi: 10.1302/0301-620X.75B2.8444942.
    1. Muller M, Abdel MP, Wassilew GI, Duda G, Perka C. Do post-operative changes of neck-shaft angle and femoral component anteversion have an effect on clinical outcome following uncemented total hip arthroplasty? Bone Joint J. 2015;97-B(12):1615–1622. doi: 10.1302/0301-620X.97B12.34654.
    1. Geijer M, Rundgren G, Weber L, Flivik G. Effective dose in low-dose CT compared with radiography for templating of total hip arthroplasty. Acta Radiol. 2017;58(10):1276–1282. doi: 10.1177/0284185117693462.
    1. Geijer M, Kiernan S, Sundberg M, Flivik G. Pre- and postoperative offset and femoral neck version measurements and validation using 3D computed tomography in total hip arthroplasty. Acta Radiol Open. 2020;9(10):2058460120964911. doi: 10.1177/2058460120964911.
    1. Davis RB, Ounpuu S, Tyberski SD, Gage JR. A gait analysis data collection and reduction technique. Hum Mov Sci. 1991;10(5):575–587. doi: 10.1016/0167-9457(91)90046-Z.
    1. Schwartz MH, Rozumalski A. The gait deviation index: a new comprehensive index of gait pathology. Gait Posture. 2008;28(3):351–357. doi: 10.1016/j.gaitpost.2008.05.001.
    1. Nilsdotter AK, Lohmander LS, Klassbo M, Roos EM. Hip disability and osteoarthritis outcome score (HOOS)--validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003;4(1):10. doi: 10.1186/1471-2474-4-10.
    1. Brooks RG, Jendteg S, Lindgren B, Persson U, Bjork S. EuroQol: health-related quality of life measurement. Results of the Swedish questionnaire exercise. Health Policy. 1991;18(1):37–48. doi: 10.1016/0168-8510(91)90142-K.
    1. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494–502. doi: 10.1136/ard.16.4.494.
    1. Naili JE, Hedstrom M, Brostrom EW. Changes of and interrelationships between performance-based function and gait and patient-reported function 1 year after total hip arthroplasty. J Orthop Traumatol. 2019;20(1):14. doi: 10.1186/s10195-019-0521-7.
    1. Petis S, Howard J, Lanting B, Jones I, Birmingham T, Vasarhelyi E. Comparing the anterior, posterior and lateral approach: gait analysis in total hip arthroplasty. Can J Surg J Can Chirurgie. 2017;60(6):3217.
    1. Sato H, Maezawa K, Gomi M, Kajihara H, Hayashi A, Maruyama Y, Nozawa M, Kaneko K. Effect of femoral offset and limb length discrepancy on hip joint muscle strength and gait trajectory after total hip arthroplasty. Gait Posture. 2020;77:276–282. doi: 10.1016/j.gaitpost.2020.02.008.
    1. Terrier A, Levrero Florencio F, Rudiger HA. Benefit of cup medialization in total hip arthroplasty is associated with femoral anatomy. Clin Orthop Relat Res. 2014;472(10):3159–3165. doi: 10.1007/s11999-014-3787-3.
    1. Charles MN, Bourne RB, Davey JR, Greenwald AS, Morrey BF, Rorabeck CH. Soft-tissue balancing of the hip: the role of femoral offset restoration. Instr Course Lect. 2005;54:131–141.
    1. McGinley JL, Baker R, Wolfe R, Morris ME. The reliability of three-dimensional kinematic gait measurements: a systematic review. Gait Posture. 2009;29(3):360–369. doi: 10.1016/j.gaitpost.2008.09.003.
    1. Zugner R, Tranberg R, Lisovskaja V, Shareghi B, Karrholm J. Validation of gait analysis with dynamic radiostereometric analysis (RSA) in patients operated with total hip arthroplasty. J Orthop Res. 2017;35(7):1515–1522. doi: 10.1002/jor.23415.
    1. Mao C, Liang Y, Ding C, Guo L, Wang Y, Zeng Q, Wang G. The consistency between measurements of the femoral neck anteversion angle in DDH on three-dimensional CT and MRI. Acta Radiol. 2016;57(6):716–720. doi: 10.1177/0284185115603244.
    1. Sariali E, Mouttet A, Pasquier G, Durante E. Three-dimensional hip anatomy in osteoarthritis. Analysis of the femoral offset. J Arthroplast. 2009;24(6):990–997. doi: 10.1016/j.arth.2008.04.031.
    1. Bolink S, Lenguerrand E, Brunton LR, Hinds N, Wylde V, Heyligers IC, et al. The association of leg length and offset reconstruction after total hip arthroplasty with clinical outcomes. Clin Biomech (Bristol, Avon) 2019;68:89–95. doi: 10.1016/j.clinbiomech.2019.05.015.
    1. Traina F, De Fine M, Biondi F, Tassinari E, Galvani A, Toni A. The influence of the Centre of rotation on implant survival using a modular stem hip prosthesis. Int Orthop. 2009;33(6):1513–1518. doi: 10.1007/s00264-008-0710-0.

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