Hip kinematics and kinetics in total hip replacement patients stratified by age and functional capacity

Abstract

To examine functional differences in total hip replacement patients (THR) when stratified either by age or by functional ability as defined by self-selected walking speed. THR patients and a control group underwent three-dimensional motion analysis under self-selected normal and fast walking conditions. Patients were stratified into five age groups for comparison with existing literature. The THR cohort was also stratified into three functional groups determined by their self-selected gait speed (low function <1S.D of total cohort’s mean walking speed; high function >1S.D; normal function within 1S.D). Hip kinematics, ground reaction forces, joint moments and joint powers in all three planes (x-y-z) were analysed. 137 THR and 27 healthy control patients participated. When stratified by age, during normal walking the youngest two age groups walked quicker than the oldest two groups (p<0.0001) but between-group differences were not consistent across age strata. The differences were diminished under the fast walking condition. When stratified by function, under normal walking conditions, the low function and normal function THR groups had a reduced extension angle (mean=1.75°, SD=±7.75, 1.26°±7.42, respectively) compared to the control group (-6.07°±6.43; p<0.0001). The low function group had a reduced sagittal plane hip power (0.75watts/kg±0.24), reduced flexor (0.60Nm/kg±0.85) and extensor moment (0.51Nm/kg±0.17) compared to controls (p<0.0001). These differences persisted under the fast walking condition. There were systematic differences between patients when stratified by function, in both walking conditions. Age related differences were less systematic. Stratifying by biomechanical factors such as gait speed, rather than age, might be more robust for investigating functional differences.