a Department of Orthopedics , Rijnstate Hospital , Arnhem ;
b Department of Operating Rooms , Radboud University Medical Center , Nijmegen , The Netherlands.
Acta Orthop. 2019 Jun;90(3):231-236. doi: 10.1080/17453674.2019.1594096. Epub 2019 Apr 1.
Background and purpose - Gait analysis performed under increased physical demand may detect differences in gait between total (THA) versus resurfacing hip arthroplasty (RHA), which are not measured at normal walking speed. We hypothesized that patients after RHA would reach higher walking speeds and inclines compared with THA. Additionally, an RHA would enable a more natural gait when comparing the operated with the healthy contralateral hip. Patients and methods - From a randomized controlled trial comparing THA with RHA with at least 5 years' follow-up patients with a UCLA score of more than 3 points (n = 34) were included for an instrumented treadmill gait analysis. 25 patients with a unilateral implant (primary analysis-16 THA versus 9 RHA) and 9 patients with a bilateral implant (sub-analysis-n = 5 RHA + THA; n = 4 THA + THA). Spatiotemporal parameters, ground reaction forces, and range of motion were recorded at increasing walking speeds and inclines. Functional outcome scores were obtained. Results - At a normal walking speed of 1.1 m/s and at increasing inclines no differences were recorded in gait between the 2 groups with a unilateral hip implant. With increasing walking speed the RHA group reached a higher top walking speed (TWS) (adjusted difference 0.07 m/s, 95% CI -0.11 to 0.25) compared with THA. Additionally, RHA patients tolerated more weight on the operated side at TWS (155 N, CI 49-261) and as such weight-bearing approached the unaffected contralateral side. For the RHA group a "between leg difference" of 8 N (CI 3-245) was measured versus -129 N (CI -138 to -29) for THA (adjusted difference 144 N, CI 20-261). Hip flexion of the operated side at TWS was higher after RHA compared with THA (adjusted difference 8°, CI 1.7-14). Interpretation - In this study RHA patients reached a higher walking speed, and preserved a more normal weight acceptance and a greater range of hip flexion against their contralateral healthy leg as compared with patients with a THA.
背景与目的-在增加身体需求下进行的步态分析可能会检测到全髋关节置换术（THA）与表面髋关节置换术（RHA）之间的步态差异，而这些差异在正常行走速度下无法测量。我们假设 RHA 术后患者的行走速度和坡度会高于 THA 术后患者。此外，与对侧健康髋关节相比，RHA 术后患者的髋关节能够实现更自然的步态。患者和方法-本研究为一项比较 THA 与 RHA 的随机对照试验，纳入了至少随访 5 年且 UCLA 评分为 3 分以上（n = 34）的患者，进行仪器化跑步机步态分析。25 例单侧植入物患者（主要分析-16 例 THA 与 9 例 RHA）和 9 例双侧植入物患者（亚分析-5 例 RHA + THA；4 例 THA + THA）。在增加步行速度和坡度时，记录时空参数、地面反力和运动范围。获得功能结果评分。结果-在正常行走速度为 1.1m/s 和增加坡度时，单侧髋关节植入物的两组之间在步态方面没有差异。随着行走速度的增加，RHA 组达到了更高的最高行走速度（TWS）（调整后的差异为 0.07m/s，95%CI-0.11 至 0.25）。此外，RHA 患者在 TWS 时能够在患侧承受更多的体重（155N，CI 49-261），因此承重接近对侧未受影响的侧。对于 RHA 组，测量到“两腿之间的差异”为 8N（CI 3-245），而 THA 组为-129N（CI-138 至-29）（调整后的差异为 144N，CI 20-261）。与 THA 相比，RHA 术后患者在 TWS 时患侧髋关节的屈曲角度更高（调整后的差异为 8°，CI 1.7-14）。解释-在这项研究中，与 THA 患者相比，RHA 患者的行走速度更高，并且能够更好地接受患侧的体重，同时髋关节的屈曲范围也更大，更接近对侧健康的髋关节。
