Gait kinematics of the hip, pelvis, and trunk associated with external hip adduction moment in patients with secondary hip osteoarthritis: toward determination of the key point in gait modification

Background A larger daily cumulative hip loading, which is the product of the external hip adduction moment (HAM) impulse during gait and the number of steps per day has been identified as a factor associated with the progression of secondary hip osteoarthritis (OA). The cause of the increased HAM impulse in patients with hip OA has not been identified. The purpose of this study was to identify the gait parameters associated with HAM impulse during gait in patients with secondary hip OA. Methods Fifty-five patients (age 22-65 years) with mild-to-moderate secondary hip OA participated in this cross-sectional study. The HAM impulse during gait was measured using a three-dimensional gait analysis system. To identify the gait parameters associated with HAM impulse, hierarchical multiple regression analysis was performed. The first model (basic model) included body weight and stance phase duration. The second models included gait parameters (gait speed; ground reaction force [GRF] in frontal plane; and hip, pelvic, and trunk angle in frontal plane) and hip pain in addition to the basic model. Results Body weight and stance phase duration explained 61% of the variance in HAM impulse. In the second model, which took into account body weight and stance phase duration, hip adduction angle (9.4%), pelvic tilt (6.5%), and trunk lean (3.2%) in addition to GRF explained the variance in the HAM impulse. Whereas larger hip adduction angle and pelvic tilt toward the swing limb were associated with a larger HAM impulse, larger trunk lean toward the stance limb was associated with smaller HAM impulse. Conclusion In patients with excessive hip adduction and pelvic tilt toward the swing limb during gait, gait modification may contribute to the reduction of hip joint loading.

背景 更大的每日累积髋关节负荷，即步态期间髋关节外展力矩（HAM）冲量与每日步数的乘积，已被确定为与继发性髋关节骨关节炎（OA）进展相关的一个因素。髋关节OA患者HAM冲量增加的原因尚未明确。本研究的目的是确定继发性髋关节OA患者步态中与HAM冲量相关的步态参数。 方法 55名22 - 65岁患有轻度至中度继发性髋关节OA的患者参与了这项横断面研究。使用三维步态分析系统测量步态期间的HAM冲量。为了确定与HAM冲量相关的步态参数，进行了分层多元回归分析。第一个模型（基础模型）包括体重和站立相持续时间。第二个模型除基础模型外，还包括步态参数（步态速度；额状面的地面反作用力[GRF]；以及额状面的髋关节、骨盆和躯干角度）和髋关节疼痛。 结果 体重和站立相持续时间解释了HAM冲量方差的61%。在考虑体重和站立相持续时间的第二个模型中，除GRF外，髋关节内收角度（9.4%）、骨盆倾斜（6.5%）和躯干倾斜（3.2%）解释了HAM冲量的方差。髋关节内收角度越大以及骨盆向摆动侧倾斜越大与HAM冲量越大相关，而躯干向站立侧倾斜越大与HAM冲量越小相关。 结论 对于在步态中髋关节过度内收且骨盆向摆动侧倾斜的患者，步态调整可能有助于减少髋关节负荷。