Department of Rehabilitation Center, Kanazawa Medical University Hospital: 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa 920-0293, Japan.
Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan.
Clin Biomech (Bristol). 2024 Oct;119:106333. doi: 10.1016/j.clinbiomech.2024.106333. Epub 2024 Aug 22.
In walking in healthy adults, rotation of the hip joint affects stride length and shifts the center of gravity, but these are not seen in hip osteoarthritis which affects gait. In gait of total hip arthroplasty, there are few reports on changes in the horizontal plane. This study clarified the preoperative and early postoperative gait characteristics of patients undergoing total hip arthroplasty.
The analysis included 12 females who underwent initial total hip arthroplasty using a posterolateral approach. Gait was measured pre and postoperatively using a three-dimensional motion analysis device. Statistics were compared pre and postoperative range of motion, muscle strength, walking speed, stride length, gravity movement distance, trunk angle, hip joint angle, and joint moment.
The maximum hip abduction moment and trunk flexion angle to the surgical side were lower than in healthy subjects. The angle of internal rotation during the stance phase was significantly higher in the postoperative period. The distance of the center of gravity shift in the left and right directions was significantly decreased postoperatively.
Gait disturbance was seen preoperatively and remained after surgery. Walking after total hip arthroplasty provides the hip joint rotates inward which is closer to normal walking. However, no change was observed in the external rotation moment of the hip joint during walking. We suspect that the invasiveness of the posterolateral approach of total hip arthroplasty affects the muscles for external rotation of the hip joint. This can also cause in gait disturbances.
在健康成年人行走时，髋关节的旋转会影响步幅并改变重心，但在髋关节骨关节炎影响步态时，这些都不会出现。在全髋关节置换术的步态中，很少有关于水平面变化的报道。本研究阐明了全髋关节置换术患者术前和术后早期的步态特征。
分析了 12 名女性患者，她们均采用后外侧入路进行初次全髋关节置换术。使用三维运动分析设备测量术前和术后的步态。比较术前和术后的运动范围、肌肉力量、行走速度、步幅、重力移动距离、躯干角度、髋关节角度和关节力矩。
最大髋关节外展力矩和向手术侧的躯干屈曲角度均低于健康受试者。术后站立相内旋角度明显升高。术后左右方向的重心偏移距离明显减小。
术前和术后均存在步态障碍。全髋关节置换术后的行走提供了髋关节向内旋转的能力，这更接近正常行走。然而，在行走过程中髋关节的外展力矩没有变化。我们怀疑全髋关节置换术的后外侧入路的侵袭性会影响髋关节外旋的肌肉，这也可能导致步态障碍。
