Impact of subject-specific step width modification on the knee and hip adduction moments during gait

• Published in: Gait & posture Vol. 89; no. NA; pp. 161 - 168
• Main Authors: Stief, Felix, Holder, Jana, Feja, Zoe, Lotfolahpour, Arian, Meurer, Andrea, Wilke, Jan
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.09.2021
• Subjects: Adult; Biomechanical Phenomena; Compensatory mechanism; Gait; Gait analysis; Hip Joint; Hip joint moment; Hip osteoarthritis; Humans; Knee Joint; Knee joint moment; Step width; Walking; Young Adult; Compensatory mechanism; Step width; Hip osteoarthritis; Knee joint moment; Hip joint moment; Gait analysis
• ISSN: 0966-6362; 1879-2219; 1879-2219
• DOI: 10.1016/j.gaitpost.2021.07.008

•Effect of 4 step width (SW) conditions on knee and hip joint moments were tested.•An increase in SW reduces frontal plane knee and hip joint moments during gait.•The effect of SW on the hip joint is slightly greater compared to the knee joint.•A reduction in SW has no effect on frontal plane knee and hip joint moments.•An increased SW is a simple gait adaptation to reduce knee and hip joint moments. Patients with hip osteoarthritis (OA) exhibit an increased step width (SW) during walking before and up to 2 years after total hip arthroplasty. Wider SW is associated with a reduction in the external knee adduction moment (KAM), but there is a lack of research regarding the effect of SW on the hip adduction moment (HAM). Is a wider SW an effective compensatory mechanism to reduce the hip joint loading? We hypothesized that (1) an increased SW reduces, (2) a decreased SW increases the KAM/HAM, and (3) secondary kinematic gait changes have an effect on the KAM/HAM. Twenty healthy individuals (24.0 ± 2.5 years of age) underwent instrumented gait analyses with 4 different subject-specific SW modifications (habitual, halved, double, and triple SW). The resulting external KAMs and HAMs were compared using statistical parametric mapping (SPM). Post hoc testing demonstrated significantly lower HAM for both the double (p < 0.001, 15–31 % and 61–98 % of the stance phase) and the triple SW (p < 0.001, 1–36 % and 58–98 %) compared to the habitual SW. The extent of the reduction at the first and second peak was comparable for HAM (15–25 % reduction) and less pronounced at the first peak of KAM (9–11 % reduction) compared to the second peak of KAM (19–28 % reduction). In contrast, halving the SW did not lead to a significant change in KAM or HAM compared to the habitual SW (p > 0.009). An increase in SW is an effective and simple gait mechanism to reduce the frontal plane knee and hip joint moments. However, hypothesis 2 could not be confirmed, as halving the SW did not cause a significant change in KAM or HAM. Given the results of the present study, gait retraining with regard to an increased SW may be an adequate, noninvasive option for the treatment of patients with hip OA.