Impact of subject-specific step width modification on the knee and hip adduction moments during gait |
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| Institution: | 1. University Hospital Frankfurt, Department of Orthopedics (Friedrichsheim), Marienburgstraße 2, 60528 Frankfurt/Main, Germany;2. Goethe University Frankfurt, Department of Sports Medicine, Ginnheimer Landstraße 32, 60487 Frankfurt/Main, Germany;1. Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Tel Hashomer, Israel;2. Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;3. Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel;1. HAVAE EA6310 (Handicap, Aging, Autonomy, Environment), FIRAH, University of Limoges, 87042 Limoges, France;2. Department of Physical Medicine and Rehabilitation in the University Hospital Center, 87042 Limoges, France;1. Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand;2. Department of Companion Animal and Wildlife Clinic, Faculty of Veterinary Medicine, Chiang Mai University, Thailand;3. Control One LLC, Atlanta, GA, USA;1. Australian National University Medical School, Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, Australia;2. University of Canberra Health Research Institute, University of Canberra, Canberra, Australia;3. Australian National University Medical School, Canberra, Australia;1. Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 2ET, UK;2. National Alkaptonuria Centre, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK;3. Department of Physical Therapy, University of North Georgia, 159 Sunset Drive, HNS #444, Dahlonega, GA 30597 |
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| Abstract: | BackgroundPatients with hip osteoarthritis (OA) exhibit an increased step width (SW) during walking before and up to 2 years after total hip arthroplasty. Wider SW is associated with a reduction in the external knee adduction moment (KAM), but there is a lack of research regarding the effect of SW on the hip adduction moment (HAM).Research questionIs a wider SW an effective compensatory mechanism to reduce the hip joint loading? We hypothesized that (1) an increased SW reduces, (2) a decreased SW increases the KAM/HAM, and (3) secondary kinematic gait changes have an effect on the KAM/HAM.MethodsTwenty healthy individuals (24.0 ± 2.5 years of age) underwent instrumented gait analyses with 4 different subject-specific SW modifications (habitual, halved, double, and triple SW). The resulting external KAMs and HAMs were compared using statistical parametric mapping (SPM).ResultsPost hoc testing demonstrated significantly lower HAM for both the double (p < 0.001, 15–31 % and 61–98 % of the stance phase) and the triple SW (p < 0.001, 1–36 % and 58–98 %) compared to the habitual SW. The extent of the reduction at the first and second peak was comparable for HAM (15–25 % reduction) and less pronounced at the first peak of KAM (9–11 % reduction) compared to the second peak of KAM (19–28 % reduction). In contrast, halving the SW did not lead to a significant change in KAM or HAM compared to the habitual SW (p > 0.009).SignificanceAn increase in SW is an effective and simple gait mechanism to reduce the frontal plane knee and hip joint moments. However, hypothesis 2 could not be confirmed, as halving the SW did not cause a significant change in KAM or HAM. Given the results of the present study, gait retraining with regard to an increased SW may be an adequate, noninvasive option for the treatment of patients with hip OA. |
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| Keywords: | Step width Gait analysis Knee joint moment Hip joint moment Compensatory mechanism Hip osteoarthritis |
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