Effects of hip osteoarthritis on lower body joint kinematics during locomotion tasks: a systematic review and meta-analysis

Abstract

Introduction: Motion analysis can be used to gain information needed for disease diagnosis as well as for the design and evaluation of intervention strategies in patients with hip osteoarthritis (HOA). Thereby, joint kinematics might be of great interest due to their discriminative capacity and accessibility, especially with regard to the growing usage of wearable sensors for motion analysis. So far, no comprehensive literature review on lower limb joint kinematics of patients with HOA exists. Thus, the aim of this systematic review and meta-analysis was to synthesise existing literature on lower body joint kinematics of persons with HOA compared to those of healthy controls during locomotion tasks.

Methods: Three databases were searched for studies on pelvis, hip, knee and ankle kinematics in subjects with HOA compared to healthy controls during locomotion tasks. Standardised mean differences were calculated and pooled using a random-effects model. Where possible, subgroup analyses were conducted. Risk of bias was assessed with the Downs and Black checklist.

Results and discussion: A total of 47 reports from 35 individual studies were included in this review. Most studies analysed walking and only a few studies analysed stair walking or turning while walking. Most group differences were found in ipsi- and contralateral three-dimensional hip and sagittal knee angles with reduced ranges of motion in HOA subjects. Differences between subjects with mild to moderate and severe HOA were found, with larger effects in severe HOA subjects. Additionally, stair walking and turning while walking might be promising extensions in clinical gait analysis due to their elevated requirements for joint mobility. Large between-study heterogeneity was observed, and future studies have to clarify the effects of OA severity, laterality, age, gender, study design and movement execution on lower limb joint kinematics.

Systematic review registration: PROSPERO (CRD42021238237).

Keywords: clinical gait analysis; gait; hip osteoarthritis; kinematics; locomotion; motion analysis; stair walking; turning.

Figure 1

PRISMA flow diagram (29).

Figure 2

Forest plot of standardised and pooled effect sizes (random-effects model) with I² heterogeneity statistics for: (A) ipsilateral peak hip extension during gait cycle (GC), (B) ipsilateral peak hip extension during stance phase (ST), (C) ipsilateral hip sagittal angle at toe-off (TO), (D) ipsilateral hip sagittal range of motion (ROM) across gait cycle; during gait.

Figure 3

Forest plot of standardised and pooled effect sizes (random-effects model) with I² heterogeneity statistics for subgroup analyses on: (A) ipsilateral peak hip extension during gait cycle (GC), (B) ipsilateral peak hip extension during stance phase (ST); during gait.

Figure 4

Forest plot of standardised and pooled effect sizes (random-effects model) with I² heterogeneity statistics for subgroup analyses on: (A) ipsilateral hip sagittal range of motion (ROM) across gait cycle (GC), (B) ipsilateral hip sagittal angle at toe-off (TO); during gait.

Figure 5

Forest plot of standardised and pooled effect sizes (random-effects model) with I² heterogeneity statistics for contralateral peak hip extension during stance phase (ST); during gait.

Figure 6

Forest plot of standardised and pooled effect sizes (random-effects model) with I² heterogeneity statistics for (A) ipsilateral hip frontal range of motion (ROM) across gait cycle (GC), (B) ipsilateral hip transverse ROM across GC; during gait.

Figure 7

Forest plot of standardised and pooled effect sizes (random-effects model) with I² heterogeneity statistics for: (A) ipsilateral knee peak flexion during gait cycle (GC), (B) ipsilateral knee sagittal range of motion (ROM) across GC; during gait.

Figure 8

Forest plot of standardised and pooled effect sizes (random-effects model) with I² heterogeneity statistics for: (A) contralateral knee peak extension during stance phase (ST), (B) contralateral knee sagittal range of motion (ROM) across gait cycle (GC), (C) contralateral knee sagittal ROM across ST; during gait.