Influence of body mass index on sagittal hip range of motion and gait speed recovery six months after total hip arthroplasty
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In practice, obesity leads to poor functional outcomes after total hip arthroplasty (THA). However, in clinical research, the influence of body mass index (BMI) on the gait recovery and kinematics for THA is not well documented. The purpose of this study was to assess the influence of BMI on gait parameters pre-operatively and six months after THA for hip osteoarthritis (OA) patients.
We included 76 THA for hip OA: non-obese group (G1): 49 (BMI < 30 kg/2) and obese group (G2): 37 (BMI ≥ 30 kg/m2) with a control group of 61 healthy people. Clinical evaluation (HOOS) and a 3D gait analysis (gait speed and flexion range of the hip (ROM)) were performed before and six months after THA: The gains between the two visits were calculated and we looked for correlations between outcomes and BMI.
Preoperative gait speed and hip ROM were significantly lower in obese patients (speed G1: 0.81 ± 0.22 m/s vs. G2: 0.64 ± 0.23 m/s, p = 0.004 and hip ROM G1: 26.1° ± 7.3 vs. G2: 21.4° ± 6.6, p = 0.005), and obese patients were more symptomatic. At six months, gait speed and hip ROM were significantly lower for all patients compared with the control group. No correlation between gait velocity, hip ROM, and BMI was found. Biomechanical and clinical gains were comparable in the two groups.
All patients, including obese patients, have significant functional improvement after THA, objectively assessed by gait speed. Even if patients did not fully recover to the level of a healthy control person after THA, functional gain is comparable irrespective of BMI.
KeywordsGait analysis Total hip arthroplasty Obese BMI Biomechanics
Compliance with ethical standards
Conflict of interest
Authors declare that they have no conflict of interest.
IRB/ethical committee approval
The study protocol was approved by the local ethics committee (CPP Est 1. Dijon. France). It was conducted in accordance with the principles of good clinical practice and the declaration of Helsinki, and it is referenced in the clinical trials website: NCT02042586.
- 2.Reyes C, Leyland KM, Peat G, Cooper C, Arden NK, Prieto-Alhambra D (2016) Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: a population-based cohort study. Arthritis Rheumatol 68:1869–1875. https://doi.org/10.1002/art.39707 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Kiadaliri AA, Lohmander LS, Moradi-Lakeh M, Petersson IF, Englund M (2017) High and rising burden of hip and knee osteoarthritis in the Nordic region, 1990-2015. Acta Orthop 1–7. https://doi.org/10.1080/17453674.2017.1404791
- 4.Maisongrosse P, Lepage B, Cavaignac E, Pailhe R, Reina N, Chiron P, Laffosse J-M (2014) Obesity is no longer a risk factor for dislocation after total hip arthroplasty with a double-mobility cup. Int Orthop. https://doi.org/10.1007/s00264-014-2612-7
- 9.Girardi FM, Liu J, Guo Z, Valle AGD, MacLean C, Memtsoudis SG (2018) The impact of obesity on resource utilization among patients undergoing total joint arthroplasty. Int Orthop. https://doi.org/10.1007/s00264-018-4059-8
- 14.Kim Y-H, Park J-W, Kim J-S (2014) Outcome of an ultrashort metaphyseal-fitting anatomic cementless stem in highly active obese and non-obese patients. Int Orthop. https://doi.org/10.1007/s00264-014-2520-x
- 15.Judge A, Batra RN, Thomas GE, Beard D, Javaid MK, Murray DW, Dieppe PA, Dreinhoefer KE, Peter-Guenther K, Field R, Cooper C, Arden NK (2014) Body mass index is not a clinically meaningful predictor of patient reported outcomes of primary hip replacement surgery: prospective cohort study. Osteoarth Cartil 22:431–439. https://doi.org/10.1016/j.joca.2013.12.018 CrossRefGoogle Scholar
- 20.Ornetti P, Parratte S, Gossec L, Tavernier C, Argenson J-N, Roos EM, Guillemin F, Maillefert JF (2010) Cross-cultural adaptation and validation of the French version of the Hip disability and Osteoarthritis Outcome Score (HOOS) in hip osteoarthritis patients. Osteoarthr Cartil 18:522–529. https://doi.org/10.1016/j.joca.2009.12.007 CrossRefPubMedGoogle Scholar
- 22.Cohen J (1988) Statistical power analysis for the behavioral sciences. L. Erlbaum AssociatesGoogle Scholar
- 23.Martz P, Bourredjem A, Laroche D, Arcens M, Labattut L, Binquet C, Maillefert J-F, Baulot E, Ornetti P (2017) Röttinger approach with dual-mobility cup to improve functional recovery in hip osteoarthritis patients: biomechanical and clinical follow-up. Int Orthop 41:461–467. https://doi.org/10.1007/s00264-016-3245-9 CrossRefPubMedGoogle Scholar
- 26.Weber M, Weber T, Woerner M, Craiovan B, Worlicek M, Winkler S, Grifka J, Renkawitz T (2015) The impact of standard combined anteversion definitions on gait and clinical outcome within one year after total hip arthroplasty. Int Orthop 39:2323–2333. https://doi.org/10.1007/s00264-015-2777-8 CrossRefPubMedGoogle Scholar
- 28.Kolk S, Minten MJM, van Bon GEA, Rijnen WH, Geurts ACH, Verdonschot N, Weerdesteyn V (2014) Gait and gait-related activities of daily living after total hip arthroplasty: a systematic review. Clin Biomech (Bristol, Avon) 29:705–718. https://doi.org/10.1016/j.clinbiomech.2014.05.008 CrossRefGoogle Scholar
- 32.Lübbeke A, Duc S, Garavaglia G, Finckh A, Hoffmeyer P (2009) BMI and severity of clinical and radiographic signs of hip osteoarthritis. Obesity. https://doi.org/10.1038/oby.2008.663
- 33.Bonnefoy-Mazure A, Martz P, Armand S, Sagawa Junior Y, Suva D, Turcot K, Miozzari HH, Lübbeke A Influence of body mass index on sagittal knee range of motion and gait speed recovery one year after total knee arthroplasty. J Arthroplast. https://doi.org/10.1016/j.arth.2017.03.008
- 35.Horsak B, Schwab C, Clemens C, Baca A, Greber-Platzer S, Kreissl A, Kranzl A (2018) Is the reliability of 3D kinematics of young obese participants dependent on the hip joint center localization method used? Gait Posture 59:65–70. https://doi.org/10.1016/j.gaitpost.2017.09.029 CrossRefPubMedGoogle Scholar