Identifying Gait Abnormalities in Patients with Femoroacetabular Impingement Syndrome

83 Pages·2017·1.02 MB·English

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Electronic Thesis and Dissertation Repository
August 2012
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Brook A. Russell, Western University
Supervisor: Dr. Dianne Bryant, The University of Western Ontario
Joint Supervisor: Dr. Kevin Willits, The University of Western Ontario
A thesis submitted in partial fulfillment of the requirements for the Master of Science degree in
Kinesiology
© Brook A. Russell 2012
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Russell, Brook A., "Identifying Gait Abnormalities in Patients with Femoroacetabular Impingement
Syndrome" (2012). Electronic Thesis and Dissertation Repository. 657.
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IDENTIFYING GAIT ABNORMALITIES IN PATIENTS WITH
FEMOROACETABULAR IMPINGEMENT SYNDROME

(Spine title: Gait Abnormalities in FAI Patients)

(Thesis format: Monograph)

by

Brook A. Russell

Graduate Program in Kinesiology

A thesis submitted in partial fulfillment
of the requirements for the degree of
Master of Science

School of Graduate and Postdoctoral Studies
The University of Western Ontario
London, Ontario, Canada

© Brook A. Russell 2012

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THE UNIVERSITY OF WESTERN ONTARIO
School of Graduate and Postdoctoral Studies

CERTIFICATE OF EXAMINATION

Supervisor Examiners

______________________________ ______________________________
Dr. Dianne Bryant Dr. Doug Naudie

Joint Supervisor ______________________________
Dr. Trevor Birmingham

______________________________
Dr. Kevin Willits ______________________________
Greg Alcock

The thesis by

Brook AlexaRussell

entitled:

Identifying Gait Abnormalities in Patients with Femoroacetabular
Impingement Syndrome

is accepted in partial fulfillment of the
requirements for the degree of
Master of Science

______________________ _______________________________
Date Chair of the Thesis Examination Board

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Abstract

OBJECTIVE: To determine the biomechanical gait characteristics and quality of life of
adults with femoroacetabular impingement (FAI) and how their gait compares to the gait
of healthy controls. METHODS: Gait analyses were performed on 18 participants (9
FAI, 9 control) while walking barefoot in the Wolf Orthopeadic Biomechanics Lab. In
addition, FAI participants completed general and region specific quality of life
questionnaires. RESULTS: Hip moment (5.2%BW*ht vs. 4.96%BW*ht), toe out angle
(12.36° vs. 8.15°), and lateral (3.55° vs. 2.18°) and forward (4.34° vs. 3.93°) pelvic tilt
were not statistically different between groups. Trunk lean (1.33° vs. 0.36°), hip flexion
angle (25.74° vs. 24.23°), & hip power (1.22W vs. 0.61W; p-value=0.32) were greater in
the control group.CONCLUSION: The small sample size of this study does not allow the
authors to make conclusions on the abnormalities in gait biomechanics in FAI patients.
Further research with larger sample sizes is warranted.

Keywords: femoroacetabular impingement, gait, hip, biomechanics, quality of life,
adduction moment

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Co-Authorship Statement
With the assistance of Dr. Dianne Bryant and Dr. Kevin Willits, we designed a
prospective cohort study, in which I was responsible for patient recruitment and
conducting the gait analysis and ensuring completion of the questionnaires that we
collected. I was responsible for data collection, with the help of Ian Jones of the Wolf
Orthopaedic Biomechanics Lab, and data analysis. I wrote the original draft of the thesis,
including interpretation of the statistical results (with the assistance of Dr. Bryant). The
drafts were sent to Dr. Bryant and Dr. Willits for their comments and suggestions for
critical revision of the paper.

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Acknowledgements

The completion of this project would not have been possible without the tremendous
support and assistance I received from so many people along the way.

I would like to thank Dr. Dianne Bryant for her guidance and support throughout my
graduate studies. Her expertise in research methods, statistics, and writing was very
helpful, and I am sure what I have learned under her supervision will be useful to me not
only in the completion of this project, but in my future endeavors.

I would like to thank Dr. Kevin Willits for his supervision and assistance in executing the
recruitment of patients for this study, as well as his clinical input in the design and
writing of my thesis.

I would like to thank Kathy, Marsha, and Anne as well as the many residents and fellows
that were part of the orthopedic department throughout my study who were always
willing to answer my questions and help in any way possible.

I would like to thank Ian Jones for all his help in the WOBL in executing data collection
as well as post-processing and trouble-shooting. He was an invaluable resource in my
journey of learning the way motion-capture works and the useful information we receive
from it. His positive, open attitude brightened my days and I am sure that without his
assistance I would have not been able to complete this project.

I would like to thank all the other students at the WOBL as well as in the sports medicine
program for their support and assistance throughout the project.

I would like to especially thank my parents and brother for their never-ending support as
well as my friends for always making sure I never gave up (A.J, B.J, N.S, M.E, K.C).

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Table of Contents
CERTIFICATE OF EXAMINATION ........................................................................... ii
Abstract .............................................................................................................................. iii
Co-Authorship Statement .................................................................................................. iv
Acknowledgments .............................................................................................................. v
Table of Contents ............................................................................................................... vi
List of Tables .................................................................................................................. viii
List of Figures ................................................................................................................... ix
List of Appendices ............................................................................................................. x
Chapter 1 ............................................................................................................................. 1
1 Introduction .................................................................................................................... 1
Chapter 2 ............................................................................................................................. 5
2 Literature Review ........................................................................................................... 5
2.1 Introduction ............................................................................................................. 5
2.2 Anatomy of the hip ................................................................................................. 6
2.3 Etiology and Prevalence ......................................................................................... 9
2.4 Pathomechanics..................................................................................................... 11
2.5 Diagnosis............................................................................................................... 13
2.6 Treatment Options ................................................................................................ 17
Non-Surgical ............................................................................................................... 17
Surgical ................................................................................................................. 18
2.7 Gait and FAI: Current Research ........................................................................... 22
Chapter 3 ........................................................................................................................... 26
3 Objectives ..................................................................................................................... 26
Chapter 4 ........................................................................................................................... 27
4 Methods ........................................................................................................................ 27
4.1 Study design .......................................................................................................... 27
4.2 Eligibility criteria .................................................................................................. 27
4.3 Subject recruitment ............................................................................................... 27
4.4 Procedure .............................................................................................................. 28
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4.41 Gait Analysis ........................................................................................................ 28
4.42 Marker Placement ................................................................................................ 29
4.5 Data Reduction ...................................................................................................... 29
4.6 Sample Size ........................................................................................................... 30
4.7 Outcome Measures................................................................................................ 30
4.71 Quality of Life ...................................................................................................... 31
4.72 Activities and Participation .................................................................................. 31
4.73 Pain ....................................................................................................................... 32
4.8 Follow-up .............................................................................................................. 33
Chapter 5 ........................................................................................................................... 34
5 Statistical Analysis ....................................................................................................... 34
Chapter 6 ........................................................................................................................... 35
6 Results .......................................................................................................................... 35
Chapter 7 ........................................................................................................................... 41
7 Discussion .................................................................................................................... 41
7.2 Limitations ............................................................................................................. 45
7.3 Strengths ................................................................................................................. 46
7.4 Summary ................................................................................................................ 47
References ........................................................................................................................ 48
Appendices ....................................................................................................................... 64
Curriculum Vitae .............................................................................................................. 72

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List of Tables
Table 1: Demographic Data on Study Participants ................................................................ 36
Table 2: Unadjusted Biomechanical Outcomes .................................................................... 38
Table 3: Adjusted Biomechanical Outcomes ........................................................................ 39

viii
List of Figures
Figure 1: Anatomy of the hip .................................................................................................... 7
Figure 2: Normal, CAM, and Pincer Movement of the hip joint ........................................... 12
Figure 3: Clinical tests for Femoroacetabular Impingement .................................................. 15
Figure 4: Alpha angle as seen on Radiograph ........................................................................ 17
Figure 5: Flow diagram of Patient Screening ......................................................................... 35

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