The characteristics of gait pattern in patients with hip osteoarthritis

Riki Tanaka, Masamori Shigematsu, Tsutomu Motooka,
Masaaki Mawatari, Takao Hotokebuchi.

Department of Orthopaedic Surgery, Faculty of Saga University, 
Nabeshima 5-1-1,Saga-City 849-8501, Saga, Japan
Address for Correspondence:
Riki Tanaka
Department of Orthopaedic Surgery, Faculty of Saga University, Nabeshima 5-1-1,Saga-City 849-8501, Saga, Japan
Phone: +81 952 34 2343
Fax :    +81 952 34 2059
E-mail: uekirik@cc.saga-u.ac.jp

Abstract:

We aimed to investigate the characteristics of gait pattern in the patients with hip osteoarthritis (OA).  To this end, we performed gait analysis of 207 patients with unilateral hip OA and on a control group of 35 healthy elderly subjects.  All the patients were analyzed during free walking along a 5-m walkway equipped with a ground-reaction force plate.  The following spatiotemporal parameters were assessed: step length, stride length, single support duration, cadence, and velocity.  There were significant reductions in gait parameters in the hip OA patients compared with the control group.  Hip OA patients had a significantly lower velocity (P < 0.001), cadence (P < 0.001), stride length (P < 0.001), step length on both sides (P < 0.001), and single support duration of the involved side (P < 0.001) compared with the control group.  The most evident differences between the hip OA patients and the controls were the shorter step length and a decreased single support duration on the involved side.  We conclude that a shorter step length and a decreased single support duration are prominent features of gait in patients with more severe hip OA.  The findings of this study advance our understanding of how hip OA affects gait changes in the lower limbs.

J.Orthopaedics 2009;6(2)e14

Keywords:

gait analysis; hip osteoarthritis; spatiotemporal parameters

Introduction:

Osteoarthritis (OA) of the hip is one of the most common hip joint diseases.  Although different functional scores are widely used to assess the improvement after surgery, the patients’ responses are often subjective and the disparities between the patients’ and doctors’ evaluations can be significant [1].  Gait analysis assigns one continuous factor score to each patient, and it can evaluate all patients on the same scale.  Therefore, gait analysis is a useful tool in the evaluation of hip disease.

 Many studies have reported the use of accelerometers [2], video cameras [3], walkways [4, 5], footswitches [6], or force plates [7].  However, several of the techniques used are complicated in design [4, 8], expensive, or interfere with the patient’s gait [3, 5, 6, 7, 8].  Complicated systems are not suitable for clinical usage.  In this study, we used a non-invasive system that makes it possible to measure gait parameters in subjects who are simply required to walk on a walkway.  Simplified analysis using spatiotemporal parameters is desirable for clinical usage and expands the clinical use of gait analysis.  Such systems have an advantage in that they avoid influencing or inconveniencing the examined patients; are easy to use, even by non-expert operators; and provide quick, easily interpretable results.  The purpose of this study was to investigate the characteristics of gait pattern in patients with unilateral hip OA using a spatiotemporal gait parameter.

Materials and Methods:

This study was carried out on a group of 207 patients (34 males and 173 females) with severe unilateral hip OA and a control group of 35 healthy elderly subjects (9 males and 26 females).  There were no statistically significant differences between the ages, heights, and weights of the two groups (Table 1).  None of the patients exhibited any symptoms involving the contralateral hip, lumbar vertebrae, knees, or ankles.  We also excluded those patients who were unable to walk unsupported for more than 5 s.  The study was approved by the local ethics committee and written- informed consent was obtained from all subject.

ns, not significant (P > 0.05

Table 1. Subject characteristics

Radiological observations were used to classify OA into early, advanced, and terminal stages.  The early stage was characterized by a slight narrowing of the joint space and/or abnormal subchondral sclerosis; the advanced stage was characterized by a marked narrowing of the joint space and/or the detection of some cystic changes and small osteophytes in the femoral head and acetabulum; and the terminal stage was characterized by the obliteration of the joint space along with a marked number of osteophytes.  On the basis of this classification system, advanced-stage hip OA was diagnosed in 41 patients and terminal-stage hip OA was diagnosed in 166 patients.  The mean preoperative leg length discrepancy was 1.5 cm (range, 0–7 cm).  The Harris hip score [9] averaged 46.9 (range, 11–88).

For gait analysis, all the patients and control group subjects were analyzed during free walking along a 5-m walkway equipped with a ground-reaction force plate (Gait Scan 8000; Nitta Inc.).  The patients’ walking was tested for 5-s periods at a sampling rate of 60 Hz.  We performed at least 3 walking trials for each patient.  Using this analysis system, we were able to measure the distribution pattern of the anti-power and the sole pressure in relation to the spatiotemporal parameters of the ambulating subjects.  We evaluated the step length (cm), step length ratio (involved/uninvolved, dominant/non-dominant), stride length (cm), stride length (% stature), single support duration (% cycle), cadence (step/min), and velocity (m/s).  The results of this evaluation were compared with those obtained from the control group.

Statistical analysis was performed using SPSS version 12.0 for Windows (SPSS III, Chicago).  We used a 2-sample t test for comparing the results of the control group with those of the patient group.  Differences associated with a probability (P) value less than 0.05 were regarded as statistically significant.

Results :

A comparison of spatiotemporal parameters between the healthy elderly subjects and the patients is shown in Table 2.  Hip OA patients had a significantly lower velocity (P < 0.001), cadence (P < 0.001), stride length (P < 0.001), step length on both sides (P < 0.001), and single support duration of the involved side (P < 0.001) compared with the control group.  Asymmetry of the gait parameters was observed in patients with unilateral OA of the hip during free level walking.  The step length of the involved side was significantly shorter than that of the uninvolved side (P < 0.001).  The single support duration of the involved side was significantly lower than that of the uninvolved side (P < 0.001).  The step length of the uninvolved side was significantly shorter than that of the control group (P < 0.001).  There were no significant difference between the single support duration of the uninvolved side of the patients and that of either side of the control group subjects.

i/u: involved side /uninvolved side, d/n: dominant side/non-dominant side, ns: not significant (P > 0.05)

Table 2:Values of the spatiotemporal parameters for the hip OA patients and control group subjects

Discussion :

This is one of the largest series on hip OA patients to analyze the resulting changes in functional gait patterns.  Previous studies that have considered the gait ability of hip OA patients have generally included small patient numbers.  Murray et al. [10], for example, reported the gait patterns of a group of 26 exclusively male patients with osteoarthritis and avascular necrosis.  Similarly, Wiedmer et al. [11] reported the gait patterns of a group of 32 patients and Brandes et al. [12] reported gait patterns of a group of 26 patients with osteoarthritis of the hip or knee.  This study reported the gait patterns of a large cohort of hip OA patients, facilitating analysis across the age range of patients usually presenting for total hip arthroplasty. 

The main results of our study indicated that hip OA patients have significantly decreased gait parameters compared with healthy elderly subjects.  Deficits in hip OA patients were small for the gait parameters tested (26.9% gait velocity, 18.8% cadence, 27.0% stride length) when compared with the control group.  The decrease in these 3 parameters in hip OA patients can be attributed to the shorter step length and the decreased single support duration on the involved side, which were the most evident differences between the hip OA patients and controls (28.4% and 18.3% lower, respectively, in the OA patients).  A decrease in gait parameters limits the ability to produce forward propulsion, but can be considered a strategy for reducing joint pain by reducing joint load.  This suggests that hip OA patients spend a greater portion of the gait cycle on both limbs, which represents a more stable and safe condition.  In comparison with the subjects in other studies [10, 12, 13 ], in our series, the velocity and cadence were lower, step and stride lengths were shorter, and single support duration was lower, although the mean age of the patients was not lower than that in other studies.  These differences may be attributed to the fact that we included patients with more severe hip pain, and that we analyzed all the patients by using simple and non-invasive techniques immediately before surgery.  This finding supports the view that levels of disability are associated with gait parameters. 

Levinger et al. [14] described similar gait patterns in knee OA patients, including slower velocity, lower cadence, shorter step and stride length, and lower single support duration compared with the control group.  However, the mean values for cadence, step length, and single support time did not differ significantly, indicating poor discrimination between patients and controls.  Weiss et al. [15] reported that rheumatoid arthritis (RA) patients had several decreased kinetic gait parameters in the lower limbs compared with controls.  However, single support time in the RA patients was not significantly shorter compared with the control group.  This finding indicates that the range of hip motion is very important for increasing the step length, and that hip joint loads in particular increase in the single support phase.  These results suggest that a shorter step length and a decreased single support duration are prominent features of gait in patients with more severe hip OA patients.

A descriptive study of gait patterns in hip OA patients is difficult due to the progressive nature of degenerative joint disease and also due to the fact that patients with hip OA rarely have only an insolated hip problem.  In order to make the present study more homogeneous, we accordingly excluded all patients exhibiting any symptoms in joints other than the hip.  Our clinical observations led us to believe that common deviations in hip OA patients’ gait patterns exist despite differences in clinical signs and symptoms and despite inter-individual differences.  In conclusion, hip OA patients experienced a shorter step length and a decreased single support duration during free walking.  The findings of this study advance our understanding of how hip OA affects gait changes in the lower limbs.

Reference :

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This is a peer reviewed paper 

Please cite as: Riki Tanaka: The characteristics of gait pattern in patients with hip osteoarthritis.

J.Orthopaedics 2009;6(2)e14

URL: http://www.jortho.org/2009/6/2/e14

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