The spatial-temporal gait characteristics of hip joint osteoarthritis: A systematic review and meta-analysis

Introduction: Hip osteoarthritis (OA) is a progressive musculoskeletal condition which is prevalent in older adults. There is no cure for hip OA and current management focuses on addressing the presenting symptoms of pain, stiffness and functional limitations in activities such as walking. An understanding of gait dysfunction in people with hip OA is therefore required in order to effectively manage the disease. The purpose of this systematic review, critical evaluation of the literature and meta-analysis was to determine how the spatial-temporal gait characteristics of hip OA are altered. Methods: Eleven electronic research databases were searched. Studies comparing spatial-temporal gait variables in hip OA with healthy controls or the affected and contra-lateral limbs in people with hip OA were included in the review. A methodological appraisal of 33 included studies was performed. A meta-analysis was undertaken with standardised effect sizes (Cohen's d) and corresponding 95% confidence intervals computed for spatial-temporal gait variables reported in these 33 articles. Data were grouped into 3 categories; gait speed, gait stability and gait symmetry related measures. Results: Gait speed measures: Mean gait speed was reduced in hip OA relative to control groups and was explained by decreased stride length and step length in the hip OA population. There was inconsistent evidence of the effect of hip OA on cadence. Gait stability related measures: There was moderate evidence of the effect of hip OA on double support duration with an overall increase reported in hip OA participants. The evidence for stance and swing duration was inconclusive. There was some evidence for increased step width in the affected limb of hip OA participants. Gait symmetry related measures: Consistent evidence was found for limb asymmetry with reduced step length and increased swing duration in the OA hip compared to the contralateral limb. Discussion: Spatial-temporal measures of walking are relatively simple to assess in a clinical setting and may be used to establish the extent of gait dysfunction and to monitor treatment progress in hip OA. This systematic review identified 33 articles that evaluated spatial-temporal characteristics of hip OA related to walking speed, gait stability and gait symmetry. Overall findings from the review confirmed the presence of gait adaptation in hip OA, most notably in terms of reduced walking speed and gait symmetry. Both gait speed and limb symmetry may be useful measures for assessing gait dysfunction in hip OA patients and monitoring treatment progress in the clinical environment.