R.M. Queen, Kevin P. Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA R.M. Queen, Department of Orthopaedic Surgery, Virginia Tech-Carilion School of Medicine, Roanoke, VA, USA J.C. Campbell, D. Schmitt, Department of Evolutionary Anthropology, Duke University, Durham, NC, USA J.C. Campbell, School of Medicine, Duke University, Durham, NC, USA.
Clin Orthop Relat Res. 2019 Aug;477(8):1839-1847. doi: 10.1097/CORR.0000000000000809.
total hip arthroplasty (THA) is associated with decreased pain and improved function, including increased walking speed, but it does not always improve overall joint mechanics during activities of daily living such as level walking and stair climbing. The hip's ability to generate power to move and allow for smooth and efficient forward motion is critical to success after surgery. Although osteoarthritis (OA) of the hip limits the power of the affected joint, it is not known whether other joints in the affected limb or in the contralateral limb need to produce more power to compensate. Additionally, it is not known whether alterations in the production of power before and after surgery are gender-specific.
QUESTIONS/PURPOSES: (1) Is there a change in the power production of the bilateral ankles, knees, and hips during level walking before and after patients undergo unilateral THA, and are there important gender-specific differences in these findings? (2) How do these findings differ for stair climbing?
Three-dimensional motion and ground reaction force data were collected for 13 men and 13 women who underwent primary, unilateral THA. This was a secondary analysis of previously collected data on gait mechanics from 60 patients who underwent THA. In the initial study, patients were included if they were scheduled to undergo a primary, unilateral THA within 4 weeks of the study and were able to walk without an assistive device. Patients were recruited from the practices of four surgeons at a single institution from 2008 to 2011. Patients were included in the current study if they were enrolled in the previous study, attended all three assessment visits (preoperative and 6 weeks and 1 year postoperative), and, during the preoperative visit, were able to walk without using an assistive device and climb stairs without using a handrail. Patients walked and ascended stairs at a self-selected speed at the three assessment visits. The power of each ankle, knee, or hip was calculated in Visual 3D using kinematic and kinetic data collected using motion capture. Power for each joint was normalized to the total power of the bilateral lower limbs by dividing the individual joint power by the total lower-extremity joint power. A mixed-model repeated-measures ANOVA was used to determine differences in normalized joint power for the ankle, knee, and hip, based on gender, limb (surgical-side versus nonsurgical-side) and timepoint (preoperative and 6 weeks and 1 year postoperative).
Surgical-side absolute (preoperative: -0.2 ± 0.2 [CI, -0.3 to -0.2], 1 year postoperative: -0.5 ± 0.3 [CI, -0.6 to - 0.5]; p < 0.001) and normalized (preoperative: 0.05 ± 0.04 [CI, 0.03-0.06], 1 year postoperative: 0.08 ± 0.04 [CI, 0.06-0.09]; p = 0.020) hip power production increased during walking. Surgical-side absolute (preoperative: 1.1 ± 0.3 [CI, 1.0-1.3], 1 year postoperative: 1.6 ± 0.2 [CI, 1.3-2.0]; p = 0.005) and normalized (preoperative: 0.16 ± 0.04 [CI, 0.14-0.18], 1 year postoperative: 0.21 ± 0.06 [CI, 0.18-0.24]; p = 0.008) hip power production increased during stair climbing, while nonsurgical ankle absolute (preoperative: 0.9 ± 0.5 [CI, 0.6 - 1.2], 1 year postoperative: 0.6 ± 0.3 [CI, 0.4-0.8]; p = 0.064) and normalized (preoperative: 0.13 ± 0.06 [CI, 0.10-0.16], 1 year postoperative: 0.08 ± 0.04 [CI, 0.06-0.10]; p = 0.015) power decreased during stair climbing after THA. No consistent effect of gender was observed.
In this gait-analysis study, power was improved in hip joints that were operated on, and power production in the ipsilateral and contralateral ankles and ipsilateral hips was reduced during level walking and stair climbing. The success of surgical intervention must be based on restoring reasonable balance of forces in the lower limb. Patients with OA of the hip lose power production in this joint and must compensate for the loss by producing power in other joints, which then may become arthritic. To determine future interventions, an understanding of whether changes in forces or joint angle affect the change in joint power is needed. Based on these results, THA appeared to effectively increase hip power and reduce the need for compensatory power production in other joints for both men and women in this patient cohort.
Level I, prognostic study.
全髋关节置换术 (THA) 可减轻疼痛并改善功能，包括提高步行速度，但它并不总是能改善日常活动如水平行走和爬楼梯时的整体关节力学。髋关节产生动力以移动并实现平稳高效的向前运动的能力对手术后的成功至关重要。尽管髋关节骨关节炎 (OA) 会限制受累关节的力量，但尚不清楚受影响肢体或对侧肢体的其他关节是否需要产生更多的力量来进行补偿。此外，尚不清楚手术前后的动力变化是否具有性别特异性。
问题/目的：(1) 在接受单侧 THA 的患者进行水平行走前后，双侧踝关节、膝关节和髋关节的力量产生是否发生变化，这些发现是否存在重要的性别特异性差异？(2) 爬楼梯时这些发现有何不同？
对 13 名男性和 13 名女性进行了三维运动和地面反力数据采集，这些患者接受了单侧初次 THA。这是对先前 60 名接受 THA 的患者步态力学数据的二次分析。在最初的研究中，纳入了计划在研究的 4 周内接受单侧初次 THA 的患者，且患者能够在无辅助设备的情况下行走。患者是从一家机构的四位外科医生的实践中招募的，招募时间为 2008 年至 2011 年。如果患者在之前的研究中被纳入研究、参加了所有三次评估访问（术前和术后 6 周和 1 年），并且在术前访问时能够在无辅助设备的情况下行走且能够不用扶手爬楼梯，那么患者就可以参加当前的研究。患者在三次评估访问时以自选择的速度行走和爬楼梯。使用运动捕捉收集的运动学和动力学数据，在 Visual 3D 中计算每个踝关节、膝关节或髋关节的功率。通过将个体关节功率除以双侧下肢的总关节功率，将每个关节的功率归一化为双侧下肢的总功率。使用混合模型重复测量方差分析，根据性别、肢体（手术侧与非手术侧）和时间点（术前和术后 6 周和 1 年），确定踝关节、膝关节和髋关节的归一化关节功率的差异。
手术侧绝对（术前：-0.2 ± 0.2 [CI，-0.3 至-0.2]，术后 1 年：-0.5 ± 0.3 [CI，-0.6 至-0.5]；p < 0.001）和归一化（术前：0.05 ± 0.04 [CI，0.03-0.06]，术后 1 年：0.08 ± 0.04 [CI，0.06-0.09]；p = 0.020）髋关节力量在行走时增加。手术侧绝对（术前：1.1 ± 0.3 [CI，1.0-1.3]，术后 1 年：1.6 ± 0.2 [CI，1.3-2.0]；p = 0.005）和归一化（术前：0.16 ± 0.04 [CI，0.14-0.18]，术后 1 年：0.21 ± 0.06 [CI，0.18-0.24]；p = 0.008）髋关节力量在爬楼梯时增加，而非手术侧踝关节绝对（术前：0.9 ± 0.5 [CI，0.6-1.2]，术后 1 年：0.6 ± 0.3 [CI，0.4-0.8]；p = 0.064）和归一化（术前：0.13 ± 0.06 [CI，0.10-0.16]，术后 1 年：0.08 ± 0.04 [CI，0.06-0.10]；p = 0.015）在 THA 后爬楼梯时的功率降低。未观察到性别一致的影响。
在这项步态分析研究中，手术关节的力量增加，而水平行走和爬楼梯时，对侧和同侧踝关节和髋关节的力量产生减少。手术干预的成功必须基于恢复下肢合理的力量平衡。髋关节骨关节炎患者会失去该关节的力量产生能力，必须通过产生其他关节的力量来进行补偿，这可能会导致这些关节出现关节炎。为了确定未来的干预措施，需要了解力或关节角度的变化是否会影响关节力量的变化。基于这些结果，THA 似乎有效地增加了髋关节的力量，并减少了男性和女性患者队列中其他关节进行补偿性力量产生的需求。
I 级，预后研究。
