Investigating pelvic drop gait abnormality in adolescent hip pathology patients.

Autor: Anable NR; Scottish Rite for Children, Dallas, TX, USA. Electronic address: Nicholas.Anable@tsrh.org., Luginsland LA; Scottish Rite for Children, Dallas, TX, USA., Carlos C Jr; Scottish Rite for Children, Dallas, TX, USA., Stevens WR Jr; Scottish Rite for Children, Dallas, TX, USA., Loewen AM; Scottish Rite for Children, Dallas, TX, USA., Jeans KA; Scottish Rite for Children, Dallas, TX, USA., Sucato DJ; Scottish Rite for Children, Dallas, TX, USA.
Jazyk: angličtina
Zdroj: Gait & posture [Gait Posture] 2024 May; Vol. 110, pp. 65-70. Date of Electronic Publication: 2024 Mar 11.
DOI: 10.1016/j.gaitpost.2024.03.007
Abstrakt: Background: Trendelenburg gait describes contralateral pelvic drop during single leg stance (SLS) with occasional lateral trunk lean compensation over the stance limb. However, quantitative research on 'uncompensated Trendelenburg' gait (pelvic drop independent of lateral trunk lean) remains sparse among populations that commonly utilize this gait pattern, such as adolescent hip pathology patients.
Research Question: How prevalent is uncompensated Trendelenburg among various adolescent hip pathologies and how is it related to hip load, hip abduction strength, and self-reported hip pain?
Methods: Gait, strength, and pain data were collected among 152 pre-operative patients clinically diagnosed with acetabular hip dysplasia, femoroacetabular impingement, Legg-Calvé-Perthes, or slipped capital femoral epiphysis (SCFE). Patients with ≥ 5.4° of dynamic pelvic drop in SLS were divided into a 'pelvic drop' group and screened to exclude those with excessive ipsilateral trunk lean. They were then compared to the 'stable pelvis' patients using a Mann-Whitney test.
Results: Dysplasia patients represented the highest proportion of the pelvic drop group (46%). The pelvic drop group showed a significant increase in self-reported hip pain (p = 0.011), maximum hip abductor moment (p = 0.002), and peak coronal power absorption at the affected hip during SLS loading response, (p < 0.001) while showing no difference in abduction strength (p = 0.381).
Significance: Uncompensated Trendelenburg gait may lead to increased loading of the affected hip in adolescent hip pathology patients. Disadvantageous hip biomechanics can create increased abductor muscle demand among these pathological populations, with dysplasia patients showing the highest prevalence. Maximal abduction strength did not correlate with pelvic drop. Future work should aim to identify and quantify causal factors. Increased coronal hip power absorption during weight acceptance warrants clinical attention, as there may be a detrimental, over-reliance on passive hip structures to support load among a population that that is already predisposed to hip osteoarthritis.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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