Eitzen Ingrid, Fernandes Linda, Kallerud Heidi, Nordsletten Lars, Knarr Brian, Risberg May Arna
Norwegian Research Centre for Active Rehabilitation, Oslo, Norway.
J Orthop Sports Phys Ther. 2015 Jul;45(7):539-49. doi: 10.2519/jospt.2015.5441. Epub 2015 May 21.
Longitudinal laboratory study.
(1) To compare gait characteristics between individuals with early-stage hip osteoarthritis who underwent total hip replacement (THR) and those who did not undergo THR, and (2) to evaluate whether gait characteristics, function, and symptoms declined among individuals who did not undergo THR during a 6- to 7-year follow-up.
The natural history of symptoms, function, and gait changes secondary to hip osteoarthritis, including potential differences at an early stage of disease, is unknown.
Forty-three individuals (mean age, 58.9 years) with radiographic and symptomatic hip osteoarthritis participated. Outcome measures included 3-D gait analysis; self-reported pain, stiffness, and function; hip range of motion; and the six-minute walk test. Baseline comparisons between individuals who later underwent THR and those who did not undergo THR were made using independent t tests or Mann-Whitney U tests. Comparisons of baseline measures and 6- to 7-year follow-up for the nonoperated individuals were conducted with paired-samples t tests or Wilcoxon signed-rank tests (P<.05).
Twelve (27.9%) of the 43 individuals initially evaluated had not undergone THR at the 6- to 7-year follow-up. At baseline, these individuals had larger sagittal plane hip and knee joint excursions, larger joint space width, lower body mass index, and superior self-reported function compared with the individuals who later underwent THR. At the 6- to 7-year follow-up, the individuals who did not undergo THR exhibited no decline in gait characteristics, minimum joint space, or overall function. Furthermore, their self-reported pain had significantly decreased (P = .024).
Individuals who did not undergo THR during a 6- to 7-year follow-up period did not exhibit a decline in gait, function, or symptoms compared to those who underwent THR. These findings are suggestive of a phenotype of hip osteoarthritis with a very slow disease progression, particularly in regard to pain.
Prognosis, level 1b.
纵向实验室研究。
（1）比较接受全髋关节置换术（THR）的早期髋关节骨关节炎患者与未接受THR的患者之间的步态特征；（2）评估在6至7年的随访期间，未接受THR的患者的步态特征、功能和症状是否下降。
继发于髋关节骨关节炎的症状、功能和步态变化的自然史，包括疾病早期的潜在差异，尚不清楚。
43例（平均年龄58.9岁）有影像学和症状性髋关节骨关节炎的患者参与研究。结局指标包括三维步态分析、自我报告的疼痛、僵硬和功能、髋关节活动范围以及六分钟步行试验。使用独立t检验或曼-惠特尼U检验对后来接受THR的患者和未接受THR的患者进行基线比较。对未手术患者的基线测量值和6至7年随访结果进行配对样本t检验或威尔科克森符号秩检验（P<0.05）。
在最初评估的43例患者中，12例（27.9%）在6至7年随访时未接受THR。与后来接受THR的患者相比，这些患者在基线时矢状面髋关节和膝关节的活动度更大、关节间隙宽度更大、体重指数更低且自我报告的功能更好。在6至7年随访时，未接受THR的患者的步态特征、最小关节间隙或整体功能均未下降。此外，他们自我报告的疼痛显著减轻（P = 0.024）。
在6至7年随访期间未接受THR的患者与接受THR的患者相比，步态、功能或症状均未下降。这些发现提示了一种疾病进展非常缓慢的髋关节骨关节炎表型，尤其是在疼痛方面。
预后，1b级。
