Methodology of gait assessment for identifying mechanisms of decompensatory musculoskeletal fatigue in patients with hip arthritis

Introduction Gait analysis is an objective tool for assessing treatment results and musculoskeletal function in patients with orthopedic pathology. Safety of compensatory mechanisms and the fatigue component seen with repeated measurements and being dependent on the clinical situation are essential for the patients.

The objective was to develop a methodology of gait assessment for identifying mechanisms of decompensatory musculoskeletal fatigue in patients with hip arthritis including those with THA of the contralateral limb.

Material and methods The study included 41 patients with Kellgren – Lawrence grade III and  IV  hips. Gait  analysis was performed using the Stedis-Step treadmill and five Neurosens inertial sensors (Neurosoft LLC, Ivanovo, Russia), recording the spatiotemporal and kinematic characteristics of movements in  the  lumbosacral  spine, hip and knee joints being synchronized with the step cycle. Patients were divided into two groups according to gait assessment protocol including Group 1 (n = 26) with three series of two‑minute tests with a break of at least 20 minutes; Group 2 (n = 15) with three series of two-minute walks without a break with the total length of six minutes.

Results A 20-minute rest was enough to reproduce baseline gait parameters. Walking parameters including maximum flexion phase, stance period and range of motion could serve as markers for early detection of  mechanisms of decompensatory muscle fatigue. The total hip arthroplasty on the contralateral side significantly affected the gait parameters.

Discussion New methods of no-break gait assessment facilitated decompensation and fatigue mechanisms identified in patients with hip arthritis. Reduced movement amplitude during short-term load indicated increasing fatigue even over a brief period (6 minutes).

Conclusion The methodology allowed for the identification of mechanisms of decompensatory musculoskeletal fatigue in patients with hip arthritis including those with THA of the contralateral limb, early diagnosis, improved monitoring and rehabilitation.

1. Boekesteijn RJ, Smolders JMH, Busch VJJF, et al. Independent and sensitive gait parameters for objective evaluation in knee and hip osteoarthritis using wearable sensors. BMC Musculoskelet Disord. 2021;22(1):242. doi: 10.1186/s12891-021-04074-2.

2. Costa D, Lopes DG, Cruz EB, et al. Trajectories of physical function and quality of life in people with osteoarthritis: results from a 10 year population-based cohort. BMC Public Health. 2023;23(1):1407. doi: 10.1186/s12889-023-16167-9.

3. GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508-e522. doi: 10.1016/S2665-9913(23)00163-7.

4. Джигкаев А.Х., Тынтерова А.М., Козенков И.И. и др. Клинико-функциональный и нейропсихологический статус пациентов, поступивших на эндопротезирование суставов. Гений ортопедии. 2024;30(5):659-669. doi: 10.18019/1028-4427-2024-30-5-659-669.

5. Удинцева М.Ю., Волокитина Е.А., Колотыгин Д.А., Кутепов С.М. Первичное и ревизионное эндопротезирование тазобедренного сустава с восполнением дефектов вертлужной впадины. Гений ортопедии. 2024;30(6):797-810. doi: 10.18019/1028-4427-2024-30-6-797-810.

6. Rivera RJ, Karasavvidis T, Pagan C, et al. Functional assessment in patients undergoing total hip arthroplasty. Bone Joint J. 2024;106- B(8):764-774. doi: 10.1302/0301-620X.106B8.BJJ-2024-0142.R1.

7. Bahadori S, Middleton RG, Wainwright TW. Using Gait Analysis to Evaluate Hip Replacement Outcomes-Its Current Use, and Proposed Future Importance: A Narrative Review. Healthcare (Basel). 2022;10(10):2018. doi: 10.3390/healthcare10102018.

8. Королева С.В. Технология объективной оценки двигательных нарушений в динамике реабилитации у больных травматолого-ортопедического профиля. Физическая и реабилитационная медицина. 2022;4(1):47-52. doi: 10.26211/2658-4522-2022-4-1-47-52.

9. Moseng T, Vliet Vlieland TPM, Battista S, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis. 2024;83(6):730-740. doi: 10.1136/ard-2023-225041.

10. Павлов В.В., Мушкачев Е.А., Тургунов Э.Н. и др. Альтернативный способ измерения параметров сагиттального баланса у пациентов в положении сидя и стоя. Гений ортопедии. 2024;30(3):362-371. doi: 10.18019/1028-4427-2024-30-3-362-371.

11. Скворцов Д.В. Диагностика двигательной патологии инструментальными методами: анализ походки, стабилометрия. М.: Науч.-мед. фирма МБН; 2007:617.

12. Скворцов Д.В., Королева С.В. Динамика параметров ходьбы в процессе реабилитации после тотального эндопротезирования коленного сустава. Научно-практическая ревматология. 2019;57(6):704-707. doi: 10.14412/1995-4484-2019-704-707.

13. Kobsar D, Masood Z, Khan H, et al. Wearable Inertial Sensors for Gait Analysis in Adults with Osteoarthritis-A Scoping Review. Sensors (Basel). 2020;20(24):7143. doi: 10.3390/s20247143.

14. Ibara T, Anan M, Karashima R, et al. Coordination Pattern of the Thigh, Pelvic, and Lumbar Movements during the Gait of Patients with Hip Osteoarthritis. J Healthc Eng. 2020;2020:9545825. doi: 10.1155/2020/9545825.

15. Ismailidis P, Nüesch C, Kaufmann M, et al. Measuring gait kinematics in patients with severe hip osteoarthritis using wearable sensors. Gait Posture. 2020;81:49-55. doi: 10.1016/j.gaitpost.2020.07.004.

16. Ismailidis P, Kaufmann M, Clauss M, et al. Kinematic changes in severe hip osteoarthritis measured at matched gait speeds. J Orthop Res. 2021;39(6):1253-1261. doi: 10.1002/jor.24858.

17. Homma D, Minato I, Imai N, et al. Three-dimensional evaluation of abnormal gait in patients with hip osteoarthritis. Acta Med Okayama. 2020;74(5):391-399. doi: 10.18926/AMO/60798.

18. Ghaffari A, Clasen PD, Boel RV, et al. Multivariable model for gait pattern differentiation in elderly patients with hip and knee osteoarthritis: A wearable sensor approach. Heliyon. 2024;10(17):e36825. doi: 10.1016/j.heliyon.2024.e36825.

19. Kobsar D, Charlton JM, Tse CTF, et al. Validity and reliability of wearable inertial sensors in healthy adult walking: a systematic review and meta-analysis. J Neuroeng Rehabil. 2020;17(1):62. doi: 10.1186/s12984-020-00685-3.

20. Rast FM, Labruyère R. Systematic review on the application of wearable inertial sensors to quantify everyday life motor activity in people with mobility impairments. J Neuroeng Rehabil. 2020;17(1):148. doi: 10.1186/s12984-020-00779-y.

21. Lee YJ, Wei MY, Chen YJ. Multiple inertial measurement unit combination and location for recognizing general, fatigue, and simulated fatigue gait. Gait Posture. 2022;96:330-337. doi: 10.1016/j.gaitpost.2022.06.011.

22. Gao Z, Zhu Y, Fang Y, et al. Automated recognition of asymmetric gait and fatigue gait using ground reaction force data. Front Physiol. 2023;14:1159668. doi: 10.3389/fphys.2023.1159668.

23. Ghidotti A, Regazzoni D, Rizzi C, et al. Applying Machine Learning to Gait Analysis Data for Hip Osteoarthritis Diagnosis. Stud Health Technol Inform. 2025;324:152-157. doi: 10.3233/SHTI250178.

24. Davis-Wilson H, Hoffman R, Cheuy V, et al. Gait compensations, pain, and functional performance during the six minute walk test in individuals with unilateral hip osteoarthritis. Clin Biomech (Bristol). 2024;120:106366. doi: 10.1016/j.clinbiomech.2024.106366.

25. Ritsuno Y, Morita M, Mukaino M, et al. Determinants of gait parameters in patients with severe hip osteoarthritis. Arch Phys Med Rehabil. 2024;105(2):343-351. doi: 10.1016/j.apmr.2023.08.021.

26. Hulet C, Hurwitz DE, Andriacchi TP, et al. Functional gait adaptations in patients with painful hip. Rev Chir Orthop Reparatrice Appar Mot. 2000;86(6):581-9. (In French)

27. Van Rossom S, Emmerzaal J, van der Straaten R, et al. The biomechanical fingerprint of hip and knee osteoarthritis patients during activities of daily living. Clin Biomech (Bristol). 2023;101:105858. doi: 10.1016/j.clinbiomech.2022.105858.

28. Aydemir B, Huang CH, Foucher KC. Gait speed and kinesiophobia explain physical activity level in adults with osteoarthritis: A crosssectional study. J Orthop Res. 2023;41(12):2629-2637. doi: 10.1002/jor.25624.

29. Maezawa K, Nozawa M, Gomi M, et al. Effect of limited range of motion of the hip joint and leg-length discrepancy on gait trajectory: an experiment to reproduce the asymmetric gait that occurs in patients with osteoarthritis of the hip joint. Hip Int. 2023;33(4):590 597. doi: 10.1177/11207000221102849.

30. Siebers HL, Eschweiler J, Quack VM, et al. Inertial measurement units for the detection of the effects of simulated leg length inequalities. J Orthop Surg Res. 2021;16(1):142. doi: 10.1186/s13018-021-02212-z.

31. Langley B, Page RM, Whelton C, et al. Do patients with well-functioning total hip arthroplasty achieve typical sagittal plane hip kinematics? A proof of concept study. Hip Int. 2023;33(2):247-253. doi: 10.1177/11207000211044471.