Early diagnosis is possible

Osteoarthritis of the hip starts inconspicuously. However, initial symptoms, such as certain abnormalities in the movement pattern, could be detected much earlier, thus allowing more time for treatment. Movement scientist Hannah Steingrebe explains what her field can contribute to this issue. At Karlsruhe Institute of Technology (KIT), Germany, she conducted a meta-analysis for a systematic research overview of joint kinematics in cases of osteoarthritis of the hip.

life: Which parameters that are relevant for diagnosis and treatment of osteoarthritis of the hip can be recorded and described by movement science?

Hannah Steingrebe: Gait patterns are always patterns of the whole body. That’s why it was so important to not only consider the hip joint itself but also the knee, ankle and pelvis in our current meta-analysis (see box). Comprehensive understanding of abnormalities in the movement pattern allows us to identify the condition early and effectively. We hope that this allows patents to be treated at an earlier stage. Furthermore, the impact of treatment can then be quantified objectively. And last but not least, new treatment measures can be developed to individually address specific gait abnormalities.

What kind of kinematic dysfunctions did you identify during the meta-analysis?

Hannah Steingrebe: We examined numerous parameters in the 35 studies that were included. So there wasn’t just one dysfunction that was documented throughout. However, certain dysfunctions were identified much more often.

One parameter that showed a systematic change across 17 studies was the reduction in maximum hip extension. And across nine studies, we saw that this reduction in maximum hip extension leads to an overall reduction in range of motion in the sagittal plane. This then primarily affects forward and backward movements.

During further analysis of the impact of severity on this parameter, we noticed that the reduction in maximum extension is particularly pronounced in cases of advanced osteoarthritis. It was only partly apparent in cases of mild to moderate osteoarthritis. But the systematical reduction in the overall range of motion is recognizable even in cases of mild to moderate osteoarthritis.

Did you identify kinematic effects in the studies that indicate the effectiveness of certain treatment measures?

Hannah Steingrebe: We purposefully ignored effects caused by therapeutic interventions as a parameter in this analysis. However, we did notice that movement pattern abnormalities become increasingly obvious the more severe the osteoarthritis gets. Measures allowing patients to functionally use the anatomically existing freedom of movement in the hip joint to the greatest extent would certainly be helpful here, as well as successful pain treatment. If treatment isn’t started early, this could lead to a downward spiral of pain-induced relief postures, weakening of necessary muscles and excessive strain on passive structures and other joints. This is confirmed, for example, by the findings of a study we conducted to investigate the impact of a hip brace on pain perception and mobility in patients suffering from mild to moderate osteoarthritis of the hip.

Did you find any joint function parameters that have particular clinical significance for patients suffering from osteoarthritis of the hip?

Hannah Steingrebe: I feel that knowing about the reduction in the range of motion concerning flexion and, most of all, extension of the hip joint can be helpful in a clinical setting. Our meta-analysis shows that this is seen early and increases as the condition progresses. A routine check of the range of motion could lead to an early detection of abnormalities. Deviations of just a few degrees that can’t even be observed with the naked eye, or only barely, can be made visible using biomechanical movement analysis.

Does your analysis indicate directions that should be taken for further research?

Hannah Steingrebe: Our review has demonstrated that there are still a lot of research gaps. Normal walking has been researched a lot, for example, but other everyday movements, such as climbing the stairs, haven’t. There is also an excessive number of studies including patients with end-stage osteoarthritis of the hip. This is often the case because studies are designed to explore the effect of joint replacements, with patients being examined just before surgery. It would be helpful for the future to focus on patients in an early or mid-stage of the condition. Another problem in research is that osteoarthritis is diagnosed in different ways and is classified with different severities. In this case, it would help if there were both a radiological categorization and a functional categorization of the severity based on standardized questionnaires or functional tests.

Studies into osteoarthritis of the hip (HOA)

Study Director Hannah Steingrebe systematically assessed 35 HOA studies in a meta-analysis at ­Karlsruhe Institute of Technology (KIT) which described joint kinematics during locomotor tasks in patients suffering from osteoarthritis of the hip, comparing them to a healthy control group. Up to that point, there had not been a comprehensive review of joint kinematics of the lower limbs in HOA patients.

Steingrebe, H., H., Spancken, S., Sell, S. and Stein, T. (2023): Effects of hip osteoarthritis on lower body joint kinematics during locomotion tasks: a systematic review and meta-analysis. Frontiers in Sports and Active Living 5:1197883. doi: 10.3389/fspor.2023.1197883

Also at KIT, Hannah Steingrebe conducted an evaluation study (Evidence Class Ib) of the CoxaTrain hip brace. She examined the effects of the brace on patients suffering from osteoarthritis of the hip (Kellgren Lawrence Score 2–4) with regard to gait, joint function and pain perception in a controlled, randomized study design.

Steingrebe, H., Stetter, B., Sell, S. and Stein, T. (2022): Effects of Hip Bracing on Gait Biomechanics, Pain and Function in Subjects With Mild to Moderate Hip Osteoarthritis. Frontiers in Bioengineering and Biotechnology_July 2022_Volume 10_Article 888775; doi: 10.3389/fbioe.2022.888775

She substantiated that wearing the CoxaTrain reduces pain during movement as well as at rest and increases the possible walking distance. The white paper with selected findings of this study can be can be requested as a PDF by sending an e-mail to medical.affairs@bauerfeind.com.

Images: Udo Schönewald, privat, AdobeStock.com/yanapopovaiv