Biomechanical walking features in patients with coxarthrosis by the GAITRite system data Part 2. The time parameters of walking
Background. The work is a continuation of the publication on the consideration of the geometric parameters of walking in patients with coxarthrosis after arthroplasty according to the data of the GAITRite system. The time parameters of walking in patients with coxarthrosis — duration of one step cycle, one leg standing, average normalized velocity and analysis of the integrated index of walking quality FAP are considered. Objective: to assess the dyna-mics of changes and the peculiarities of the time parameters of patient’s walking before and after total hip replacement with the pre-servation and reduction of the hip abductor moment arm (HAMA) after arthroplasty in the long-term follow-up period. Materials and methods. The parameters of patients’ walking were analyzed. After hip replacement, an asymmetric HAMA was detected on X-ray. The data of 46 patients with coxarthrosis were analyzed, they were divided into 2 groups: I (n = 26) — patients in whom after arthroplasty, the HAMA did not change, or the difference did not exceed 1.0 cm downwards; II (n = 20) — individuals whose HAMA reduction was more than 1.0 cm after hip replacement. The examination was carried out before the surgery, 1 year after and in the long-term period, from 5 to 7 years. Results. Based on the results of the statistical study, some patterns were revealed for patients in whom X-ray after arthroplasty revealed a decrease in HAMA (group II of patients), and for patients whose HAMA remained unchanged (group I of patients). Before hip replacement, the groups were equal in terms of walking parameters, that is, all the signs of walking disorders were observed in patients due to degenerative hip joint disease. Arthroplasty led to the restoration of walking parameters, although their normalization did not reach the average statistical reference norm, but virtually restored the symmetry of walking. One year after surgery, there was a significant improvement in walking parameters. In the long-term period, after 5–7 years, worsening of walking parameters was observed, and in some patients, deterioration of the indices reached values before the hip replacement. Especially it was noticeable in patients of group II. Conclusions. Based on the results of the study, it can be concluded that a decrease in the length of hip abductor moment arm greater than 1 cm from the contralateral limb in the long-term follow-up leads to a loss of walking skills, which patients were shown one year after surgery. That is, a long asymmetrical loading of muscles leads to a loss of walking symmetry, a decrease in the support ability of the prosthetic limb, which is manifested by a reduced time of support on this limb and a decreased duration of the step of the healthy limb. The consequence of these changes is the development and gradual progression of limping.
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