TY - ABST

T1 - Can Gait Deviation Index be used effectively for the evaluation of gait pathology in total hip arthroplasty An explorative randomized trial

AU - Jensen, Carsten

AU - Rosenlund, Signe

AU - Nielsen, Dennis Brandborg

AU - Overgaard, Søren

AU - Holsgaard-Larsen, Anders

PY - 2014/3

Y1 - 2014/3

N2 - Purpose:Three-dimensional (3D) gait analysis is widely used in thequantitative evaluation of gait. However, 3D gait analysis produces alarge volume of data, and simplifying such complex data into a singlemeasure of patients overall gait ‘quality’ would be valuable in clinicalpractice. The Gait Deviation Index (GDI), used to evaluate treatment inchildren with cerebral palsy, has been proposed as such a measure. Theexperience with GDI in osteoarthritis (OA) patients following total hiparthroplasty (THA) is unknown. The aim of our study was to use the GDIto evaluate post-operative gait quality changes in patients with hip OAfollowing two types of THA.Methods: A total of 38 patients (11 females and 27 males, age 56 5.6,BMI 27.8 3.6) with unilateral end-stage primary hip osteoarthritiswere evaluated pre-operatively, two- and six-months after total hiparthroplasty, using 3D gait analysis while walking at self-selectedspeed. Upon completion of the pre-operative assessment, the patientswere randomly assigned to either resurfacing hip arthroplasty (RHA) orconventional total hip arthroplasty(THA). All patients were allowedearly postoperative weight-bearing, and had rehabilitation supervisedby an in-hospital physiotherapist. All patients completed the gaitevaluation at each follow-up. From the entire variability in kinematic variables across a gait cycle, rather than a small number of discreteparameters, the GDI was calculated for each limb (n ¼ 76 limbs). Thenormative mean and standard deviation (mean ¼ 94.7; SD ¼ 8.4) fromour age-matched controls (n ¼ 20) were used as reference. A fixedeffectsmultilevel regression model was employed to evaluate thetreatment effects.Results: No interaction was observed between treatment and time (p ¼0.33) or limb and time (p ¼ 0.53). The pre-operative GDI mean valuewas 83.4 10.9, showing patients had a moderate deviation fromnormative gait before surgical treatment. After surgicaltreatment, the GDI score improved significantly by 4.9 [:95CI: 2.1 to 7.9]equal to a 0.8 average increase in GDI per month of follow-up. Therewasno difference in GDI scores between the two surgical treatmentsgroups; 1.8 [:95CI: -2.8 to 6.4]. However, the GDI score for the nonoperatedlimbwas higher than the GDI score for the non-operated limb;2.5 [:95CI: 0.1 to 4.8].Conclusions: Our results show that, THA and RHA patients recoveredequally well from the respective treatments. The GDI increased significantlyafter THA surgery, which indicates an overall improvement ingait quality for both treatment groups. The difference between theoperated and the non-operated limb showed that asymmetrical gaitpattern do not disappear following THA. Further research is required toestablish the clinical relevant difference for the GDI score, and todetermine the association with pain and OA severity.

AB - Purpose:Three-dimensional (3D) gait analysis is widely used in thequantitative evaluation of gait. However, 3D gait analysis produces alarge volume of data, and simplifying such complex data into a singlemeasure of patients overall gait ‘quality’ would be valuable in clinicalpractice. The Gait Deviation Index (GDI), used to evaluate treatment inchildren with cerebral palsy, has been proposed as such a measure. Theexperience with GDI in osteoarthritis (OA) patients following total hiparthroplasty (THA) is unknown. The aim of our study was to use the GDIto evaluate post-operative gait quality changes in patients with hip OAfollowing two types of THA.Methods: A total of 38 patients (11 females and 27 males, age 56 5.6,BMI 27.8 3.6) with unilateral end-stage primary hip osteoarthritiswere evaluated pre-operatively, two- and six-months after total hiparthroplasty, using 3D gait analysis while walking at self-selectedspeed. Upon completion of the pre-operative assessment, the patientswere randomly assigned to either resurfacing hip arthroplasty (RHA) orconventional total hip arthroplasty(THA). All patients were allowedearly postoperative weight-bearing, and had rehabilitation supervisedby an in-hospital physiotherapist. All patients completed the gaitevaluation at each follow-up. From the entire variability in kinematic variables across a gait cycle, rather than a small number of discreteparameters, the GDI was calculated for each limb (n ¼ 76 limbs). Thenormative mean and standard deviation (mean ¼ 94.7; SD ¼ 8.4) fromour age-matched controls (n ¼ 20) were used as reference. A fixedeffectsmultilevel regression model was employed to evaluate thetreatment effects.Results: No interaction was observed between treatment and time (p ¼0.33) or limb and time (p ¼ 0.53). The pre-operative GDI mean valuewas 83.4 10.9, showing patients had a moderate deviation fromnormative gait before surgical treatment. After surgicaltreatment, the GDI score improved significantly by 4.9 [:95CI: 2.1 to 7.9]equal to a 0.8 average increase in GDI per month of follow-up. Therewasno difference in GDI scores between the two surgical treatmentsgroups; 1.8 [:95CI: -2.8 to 6.4]. However, the GDI score for the nonoperatedlimbwas higher than the GDI score for the non-operated limb;2.5 [:95CI: 0.1 to 4.8].Conclusions: Our results show that, THA and RHA patients recoveredequally well from the respective treatments. The GDI increased significantlyafter THA surgery, which indicates an overall improvement ingait quality for both treatment groups. The difference between theoperated and the non-operated limb showed that asymmetrical gaitpattern do not disappear following THA. Further research is required toestablish the clinical relevant difference for the GDI score, and todetermine the association with pain and OA severity.

U2 - 10.1016/j.joca.2014.02.169

DO - 10.1016/j.joca.2014.02.169

M3 - Konferenceabstrakt i tidsskrift

VL - 22

SP - S85-S86

JO - Osteoarthritis and Cartilage

JF - Osteoarthritis and Cartilage

SN - 1063-4584

IS - Supplement

M1 - 135

T2 - Osteoarthritis Research Society International

Y2 - 29 November 2010

ER -