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Gait Analysis Reveals that Total Hip Arthroplasty Increases Power Production in the Hip During Level Walking and Stair Climbing

Queen, Robin M. PhD, FACSM; Campbell, James C. BS; Schmitt, Daniel PhD

Clinical Orthopaedics and Related Research®: August 2019 - Volume 477 - Issue 8 - p 1839–1847
doi: 10.1097/CORR.0000000000000809

Background 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?

Methods 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).

Results 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.

Conclusions 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 of Evidence Level I, prognostic study.

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

R.M. Queen, Kevin P. Granata Biomechanics Lab, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University,300 Norris Hall, Blacksburg, VA 24061 USA, Email:

Each author certifies that neither he or she, nor any member of his or her immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Duke University, Durham, NC, USA, and Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.

Received September 30, 2018

Accepted April 24, 2019

Online date: May 16, 2019

© 2019 Lippincott Williams & Wilkins LWW
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