Rates of total hip replacement are spiralling upwards in Australia, highlighting the urgent need to improve current evidence-based treatment options for hip osteoarthritis (OA). Conservative non-drug interventions are recommended for management of hip OA, though many patients report only small-to-modest improvements in symptoms. This may be because treatments are largely based on evidence from knee OA literature. Lower hip loading has been implicated in the progression of hip OA and is potentially modifiable with movement retraining. The proposed study tested the extent to which hip loading could be normalised by changing the way people with hip OA walk – in real-time. We integrated our newly developed real-time biofeedback technology to personalise and enhance motor learning and tested sustained effects for symptoms after 6-weeks. We also sought feedback from participants regarding their comfort when walking over the 6-week period, perceived change in biomechanics and pain, and acceptability of personalised load modification as a treatment for hip OA.
Twenty people with mild-to-moderate hip OA participated in the study. Biomechanics and patient-reported data were collected at baseline and patient-reported data were collected at 6-week follow-up. Most participants with hip OA could immediately increase their hip load through personalised movement retraining by an amount expected to stimulate cartilage heath and reported an improvement in symptoms after 6-weeks. However, the hip’s load response to each modification was unique across participants, emphasising the need for personalised interventions for management of hip OA.
Conservative treatments for hip OA are cost-effective, yet they are under-used, have unsatisfactory outcomes, and do not alter the disease-course. We aimed to design and test a new disease-course altering treatment for hip OA. We used a within-participant design to compare the feasibility of three biomechanical parameters for increasing hip load when participants were provided with real-time visual biofeedback during walking, and prospectively evaluated any associated changes in pain and function 6-weeks following personalised retraining. We have shown, for the first time, that people with hip OA can increase hip load by as much as 12% through movement retraining with assistance from visual biofeedback. We have also identified which biomechanical parameters are most effective for modulating hip load, and critically, shown that many patients who implemented their personalised load modification strategy while walking for 6-weeks reported clinically important improvements in hip pain and function. Results from this pilot study support the feasibility of personalised hip loading retraining using real-time biofeedback technology for management of hip OA.
The study aimed to design and test a new disease-course altering treatment for hip OA by evaluating (1) the extent to which hip load could be modulated by changing external biomechanical parameters with assistance from real-time biofeedback during walking in people with hip OA; (2) which biomechanical parameter(s) were most effective for increasing hip load in people with hip OA; (3) associated changes in pain and physical function following 6-weeks of walking using a prescribed personalised load modification strategy in people with hip OA; and (4) the extent to which people with hip OA considered personalised load modification a feasible and acceptable treatment.
We discovered that (1) hip load could be increased by up to 12% through movement retraining with assistance from visual biofeedback in participants with hip OA – this finding is particularly significant because increasing joint load by even 5% may be enough to stimulate cartilage health; (2) two of the biomechanical parameters we assessed were equally effective for increasing hip load in participants with hip OA; (3) most participants with hip OA reported clinically meaningful improvements in hip pain and function after 6-weeks of walking using their prescribed personalised load modification strategy; and (4) the majority of participants with hip OA were confident when walking using their personalised load modification strategy.
Patient-centred stakeholders have demanded non-surgical and non-drug treatments, including biomechanical strategies, be a top OA research priority. The most frequently asked question by people with hip OA is “What can I do myself to decrease symptoms?”. We combined our novel technology with extensive scientific and clinical expertise to design and test a new biomechanical treatment which, unlike currently available options, has potential to alter the disease-course. Study findings confirmed that people with hip OA can modify hip loading through personalised laboratory-based retraining. Next, we will design a well-powered study to establish the extent to which hip load must be increased to be associated with a clinically meaningful improvement in symptoms.
We plan to move outside the laboratory by designing smart technology to provide continuous real-time reinforcement of beneficial hip loading strategies during activities of daily living to people with hip OA. Moving outside the laboratory will empower people with hip OA to self-manage their condition and drive their own improvements in symptoms. In the future, this conservative management strategy will have great potential to significantly advance patient management, clinical practice and policy, and substantially reduce health care costs.