In vivo hip joint loads during three methods of walking with forearm crutches. 2013

Philipp Damm, and Verena Schwachmeyer, and Joern Dymke, and Alwina Bender, and Georg Bergmann
Julius Wolff Institute, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. philipp.damm@charite.de

BACKGROUND Patients with osteoarthritis, joint implants or fractures use crutches in order to reduce lower limb loading. However, insufficient information exists on how much the loading is then in fact reduced. This situation was studied by using seven patients who had instrumented hip implants. METHODS Part I: To investigate the effectiveness of forearm crutches, crutch and hip joint contact forces were measured in seven patients with instrumented hip prostheses. Additionally, the bending moments in the implant neck and torsion around its stem were determined. Reductions of peak loads during 3, 4, and 2-point gaits were compared with loads present when walking without crutches. Part II: This examines joint load reduction during a 4-point gait from one to 12 weeks post-operatively. RESULTS Part I: During a 3, 4, and 2-point gait, the joint force was 17, 12, and 13% lower than it was while walking without crutches. The corresponding reductions of the bending moment were 16, 11, and 12%, while the maximum torque decreased by 19, 21, and 10%. Part II: The reductions of contact forces in comparison with walking without crutches were highest during the first 4 weeks after surgery. One and 4 weeks post-operatively, the force maximum was 21 and 8% lower than it was after 3 months. When compared with the initial values of the 1st week, crutch forces decreased by 28% in the 4th week and by 38% in the 3rd month. CONCLUSIONS Average reductions of the joint load by more than 20% are achieved only during the first 4 post-operative weeks. Because fractures are in most cases relatively stable after 6 weeks, and bone ingrowth into implant interfaces is nearly finished after this time, a single crutch and a 2-point gait can be prescribed during the 5th and 6th post-operative week.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010003 Osteoarthritis A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. Arthritis, Degenerative,Osteoarthrosis,Osteoarthrosis Deformans,Arthroses,Arthrosis,Arthritides, Degenerative,Degenerative Arthritides,Degenerative Arthritis,Osteoarthritides,Osteoarthroses
D011184 Postoperative Period The period following a surgical operation. Period, Postoperative,Periods, Postoperative,Postoperative Periods
D003446 Crutches Wooden or metal staffs designed to aid a person in walking. (UMDNS,1999)
D005260 Female Females
D005268 Femoral Vein The vein accompanying the femoral artery in the same sheath; it is a continuation of the popliteal vein and becomes the external iliac vein. Femoral Veins,Vein, Femoral,Veins, Femoral
D005542 Forearm Part of the upper extremity in humans and primates extending from the ELBOW to the WRIST. Antebrachium,Antebrachiums,Forearms
D005684 Gait Manner or style of walking. Gaits
D006621 Hip Joint The joint that is formed by the articulation of the head of FEMUR and the ACETABULUM of the PELVIS. Acetabulofemoral Joint,Acetabulofemoral Joints,Hip Joints,Joint, Acetabulofemoral,Joint, Hip,Joints, Acetabulofemoral,Joints, Hip

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