Comparison of joint mechanics of both lower limbs of tha patients with healthy participants during stair ascent and descent

Total hip arthroplasty (THA) is a common surgical procedure for patients suffering from osteoarthritis to relieve their pain and to attempt to restore their normal locomotion patterns. Although this procedure does not restore normal mobility during activities of daily living, it remains unclear how it affects the joint mechanics of both lower limbs during stair negotiation tasks. Hence, we compared the 3D joint mechanics of both lower limbs of THA patients with matched healthy controls during stair ascent and stair descent. 3D kinematics and kinetics of both lower limbs were recorded for 20 patients having undergone unilateral THA and 20 healthy, age and body mass index matched control participants. The THA patients generated limited power at the operated hip joint, and thus compensated with larger power generation at the contralateral ankle to lift the body weight to the next step. This stair ambulation strategy, as well as others, adopted by the THA patients implied decreased activation of the lower limb musculature, which may be indicative of a muscle strength deficiency or a post‐operatively adopted protective mechanism to unload the prosthesis. These asymmetric power production patterns should be addressed in rehabilitation programs pre‐ and post‐operatively. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:305–311, 2011

[1]  Y. Ivanenko,et al.  Asymmetric leg loading during sit-to-stand, walking and quiet standing in patients after unilateral total hip replacement surgery. , 2008, Clinical biomechanics.

[2]  Herman J. Woltring,et al.  A fortran package for generalized, cross-validatory spline smoothing and differentiation , 1986 .

[3]  Markku Kankaanpää,et al.  Hip muscle strength and muscle cross sectional area in men with and without hip osteoarthritis. , 2002, The Journal of rheumatology.

[4]  D. Felson,et al.  Effect of therapeutic exercise for hip osteoarthritis pain: results of a meta-analysis. , 2008, Arthritis and rheumatism.

[5]  D. Winter,et al.  Overall principle of lower limb support during stance phase of gait. , 1980, Journal of biomechanics.

[6]  H. Berg,et al.  Persisting muscle atrophy two years after replacement of the hip. , 2009, The Journal of bone and joint surgery. British volume.

[7]  Najia Shakoor,et al.  Nonrandom evolution of end-stage osteoarthritis of the lower limbs. , 2002, Arthritis and rheumatism.

[8]  Hideki Yoshikawa,et al.  Recovery of walking speed and symmetrical movement of the pelvis and lower extremity joints after unilateral THA. , 2004, Journal of biomechanics.

[9]  E S Growney,et al.  Reproducibility of the kinematics and kinetics of the lower extremity during normal stair‐climbing , 1997, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  T. Andriacchi,et al.  A study of lower-limb mechanics during stair-climbing. , 1980, The Journal of bone and joint surgery. American volume.

[11]  H. Yoshikawa,et al.  A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. , 2009, The Journal of arthroplasty.

[12]  L. Snyder-Mackler,et al.  Altered loading during walking and sit‐to‐stand is affected by quadriceps weakness after total knee arthroplasty , 2005, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[13]  D. Beverland,et al.  Temporospatial parameters of hip replacement patients ten years post-operatively , 2009, International Orthopaedics.

[14]  R. Riener,et al.  Stair ascent and descent at different inclinations. , 2002, Gait & posture.

[15]  E Byrne,et al.  Quadriceps muscle wasting persists 5 months after total hip arthroplasty for osteoarthritis of the hip: a pilot study , 2001, Internal medicine journal.

[16]  J. G. Andrews,et al.  A biomechanical investigation of the human hip. , 1978, Journal of biomechanics.

[17]  J. Helgerud,et al.  Early Postoperative Maximal Strength Training Improves Work Efficiency 6–12 Months after Osteoarthritis-Induced Total Hip Arthroplasty in Patients Younger Than 60 Years , 2010, American journal of physical medicine & rehabilitation.

[18]  D. Hurwitz,et al.  Do gait adaptations during stair climbing result in changes in implant forces in subjects with total hip replacements compared to normal subjects? , 2008, Clinical biomechanics.

[19]  D. Winter,et al.  An integrated biomechanical analysis of normal stair ascent and descent. , 1988, Journal of biomechanics.

[20]  Kharma C. Foucher,et al.  Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients. , 2007, Journal of biomechanics.

[21]  C L Vaughan,et al.  Abduction-adduction moments at the knee during stair ascent and descent. , 1996, Journal of biomechanics.

[22]  A. Protopapadaki,et al.  Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals. , 2007, Clinical biomechanics.

[23]  D. Hurwitz,et al.  Asymmetric knee loading in advanced unilateral hip osteoarthritis. , 2003, Arthritis and rheumatism.

[24]  H. K. Ramakrishnan,et al.  Repeatability of kinematic, kinetic, and electromyographic data in normal adult gait , 1989, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.