Motion analysis as an outcome measure for hip arthroplasty

doi:10.1016/j.surge.2011.02.002

The Surgeon

Volume 9, Issue 5, October 2011, Pages 284-291

https://doi.org/10.1016/j.surge.2011.02.002 Get rights and content

Abstract

We review the available literature on the use of motion analysis as an outcome measure following total hip arthroplasty. Several studies have investigated spatio-temporal parameters of gait, kinematics, kinetics and electromyographic outputs following hip arthroplasty. We undertook to review all these studies to evaluate the value of motion analysis as an outcome measure. The search of the literature yielded eight studies. Motion analysis demonstrates functional improvement in patients post-operatively, but the values of the variables measured do not reach the same levels as control subjects. Motion analysis does not show much difference post-operatively between patients operated on by different technique or incision. Furthermore, motion analysis can identify subtle functional limitations which may not be detectable with conventional outcome measures.

Introduction

Total hip arthroplasty (THA) is one of the most common orthopedic procedures. Various methods have been used to assess the outcome of THA, including imaging, physical examination, and scores from questionnaires such as the WOMAC and the Harris Hip Score.¹ Although such measures enable functional outcome to be assessed, they do not provide an objective method of quantifying motion post-operatively.

Motion analysis enables kinematic and kinetic data to be obtained, and can also be used to provide a means of quantifying movement patterns both pre- and post-operatively, and has much potential for use as an outcome measure for hip arthroplasty. Motion analysis may be able to detect very subtle post-operative functional limitations which cannot be detected by other conventional means.² Furthermore, kinematic data could detect aberrant force transmission across a joint which may be associated with component wear.

Motion analysis has been used as an outcome measure following hip arthroplasty. However, no attempt has been made to review the literature and findings presented. There are marked variations between the studies with regards to the actual parameters of motion analysis tested along with variations in subject characteristics. This review compares findings from the studies using motion analysis, and analyses the methods used.

Section snippets

Search strategy

A search for articles on motion analysis following hip arthroplasty was conducted in January 2011. The online databases of Pubmed, Ovid Medline, the Cochrane Library, EMBASE, CINAHL and Google Scholar were searched using combinations of the following key terms: ‘motion analysis’, ‘gait analysis’, ‘outcome measure’, ‘hip arthroplasty’, ‘hip replacement’. Limits were set to retrieve only articles which used human subjects. Full texts of relevant abstracts were obtained. The reference lists of

Results

Subject characteristics and outcome measures assessed are reported in Table 2, Table 3 respectively.

The mean score for each section of the Coleman Methodology Criteria is shown in Table 4.

The overall score for each study is shown in Table 5.

The eight studies have a relatively low Coleman Methodology Score. Scores are particularly low for the study size, mean duration of follow-up, and the description of post-operative rehabilitation.

Discussion

Bennett et al⁴ compared the gait of age-stratified hip replacement patients with a control group of healthy subjects. Spatio-temporal parameters and kinematic outcomes were significantly worse than the control group post-operatively. In this study, the subjects were tested ten years post-operatively, but the authors do not mention whether the control group was matched regarding height, weight and gender to the subject group. This is important, because height and weight can particularly affect

Conclusion

In general, motion analysis demonstrates improvement post-operatively but the values do not reach the same levels as controls. There also appears to be very little difference in motion analysis outcomes between patients operated on by different techniques or approaches. Only one study suggested better kinematic outcomes following resurfacing hip arthroplasty when compared with standard total hip arthroplasty.¹² Motion analysis enables subtle functional limitations to be detected, which may not

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The study objective is to analyze subjects having a normal hip and compare in vivo kinematics to subjects before and after receiving a total hip arthroplasty.
Twenty subjects, 10 with a normal hip and 10 with a preoperative, degenerative hip were analyzed performing normal walking on level ground while under fluoroscopic surveillance. Seven preoperative subjects returned after receiving a total hip arthroplasty using the anterior surgical approach by a single surgeon. Using 3-dimensional to 2-dimensional registration techniques, joint models were overlayed on fluoroscopic images to obtain transformation matrices in the image space. From these images, displacements of the femoral head and acetabulum centers were computed, as well as changes in contact patches between the 2 surfaces throughout the gait cycle.
Implanted hips experienced the least amount of separation, compression, and overall sliding throughout the entire gait cycle, but they did show signs of edge loading contact patterns. Conversely, the degenerative hips experienced the most compression, sliding, and separation, with the maximum amount of sliding being 6.9 mm. The normal group ranged in the middle, with the maximum amount of sliding being 1.75 mm.
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Therefore, it is important to quantify the in-vivo biomechanics of the hip joint during functional activities. Previous studies assessed in-vivo three-dimensional (3D) hip kinematics in patients with THA during gait using motion capture systems (Bennett et al., 2008; Ewen et al., 2012; Perron et al., 2000; Sinha et al., 2011). Significant decreases in gait speed and the hip extension were observed in THA patients (Bennett et al., 2008; Perron et al., 2000).
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Motion analysis as an outcome measure for hip arthroplasty

Abstract

Introduction

Section snippets

Search strategy

Results

Discussion

Conclusion

Gait Posture

Clin Biomech

Clin Biomech

Gait Posture

J Orthop Res

Arch Phys Med Rehabil

J Arthroplasty

Knee

Clin Geriatr Med

Gait Posture