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

Background: 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). Research question: 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. Methods: 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). Results: 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). Significance: 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.

Automated summary

Increasing step width is an effective and simple gait mechanism to reduce frontal plane knee and hip joint moments, offering a potential noninvasive treatment option for patients with hip osteoarthritis. However, decreasing step width did not lead to significant changes in knee or hip joint loading, suggesting that hypothesis 2 was not supported in this study.