Can Bracing Affect Altered Gait Patterns in Femoroacetabular Impingement

OBJECTIVES: Altered gait patterns have been identified in patients with Femoroacetabular impingement (FAI), a 2(nd) order reversal in mid stance, that has been shown to be corrected with arthroscopic FAI surgery. Currently, most feel there is no adequate conservative treatment for this malady. The goal of this study is to determine if the gait abnormalities seen with femoroacetabular impingement (FAI) can be modified with bracing. METHODS: Eight individuals (4 Male, 34.5 ± 12.8 y.o., 24.0±2.3 BMI) who were diagnosed with FAI after reporting to clinic with groin pain were enrolled in this study. The study was approved by the University Internal Review Board before participants were enrolled. History, clinical exam, and imaging including an AP pelvis and cross table lateral radiograph of the affected hip and MR-arthrogram of the affected hip were utilized to make the diagnosis. Participants who enrolled had primarily unilateral hip symptoms, had positive impingement and labral stress tests on the affected side and were free of other lower extremity, back, and spine disorders. Three dimensional lower limb kinematics were collected using a camera and forceplate system with the subjects wearing reflective markers on anatomical landmarks. Participants were tested prior to surgery. Hip kinematics were collected for the symptomatic limb while the patients walked at a self selected normal walking speed, slowly jogged, and ascended a two stair setup. Three trials for each activity were completed with and without wearing a brace that was designed to externally rotate the femur in the treatment of patellofemoral disorders for a total of 6 trials per activity. Peak hip flexion, extension, abduction, adduction, internal rotation, and external rotation were calculated over the stance phase for each trial. Averages were calculated over the 3 trials for each activity both with and without the brace. Intra-subject differences were compared between the braced and unbraced trials using a student’s paired t-test. RESULTS: While wearing the brace, FAI individuals displayed a significant reduction in internal rotation in walking and jogging, a significant reduction in adduction across all 3 activities, and a significant reduction in flexion during jogging. Secondary motions of interest were external rotation, which was increased with the brace in all 3 activities, hip abduction, which was not significantly different while wearing the brace in all 3 activities, and extension, which was also no significantly different with the brace in all 3 activities. Speed was not significantly different with and without the brace. CONCLUSION: The results of this study support the hypothesis that the brace decreases hip adduction and internal rotation over the 3 tested activities. A reduction in peak hip adduction was observed in all 3 activities and internal rotation was observed in this group during walking and jogging. The results of this study indicate the brace as a viable means to reduce the hip motions that tend to lead to pain and soft tissue damage and may be helpful when designing conservative treatment regimens.