The effect of hip arthroplasty on gait. A review

Authors

  • Dimitrios G. Economopoulos
  • Anastasios K. Lilikakis
  • Lazaros A. Poultsides
  • Vasilios S. Nikolaou

Keywords:

hip replacement; gait changes; leg length discrepancy; global offset; femoral stem anteversion

Abstract

Hip arthroplasty is one of the most successful orthopaedic procedures because it offers pain relief and good postoperative function. However, some patients complain of gait changes and a marked reduction in their walking pace. These changes may be due to altered offset, leg length discrepancy and hardware positioning and may persist even a year after their operation . This review aims to assess hip replacement-related gait alterations as well as their causes and their clinical impact. Gait analysis after THR can provide important information that could improve our decision making in our clinical practice.

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Author Biographies

Dimitrios G. Economopoulos

MD MSc PhD, Consultant Orthopaedic Surgeon, 2nd Department of Orthopaedics, National and Kapodistrian University of Athens School of Medicine (corresponding author)

Anastasios K. Lilikakis

MD MSc, Consultant Orthopaedic Surgeon

Lazaros A. Poultsides

MD MSc PhD, Consultant Orthopaedic Surgeon, Assistant Professor in Orthopaedics and Trauma, Aristotle University of Thessaloniki

Vasilios S. Nikolaou

MD MSc PhD, Consultant Orthopaedic Surgeon, Professor in Orthopaedics and Trauma, 2nd Department of Orthopaedics, National and Kapodistrian University of Athens School of Medicine

References

1.Kolk S, Minten MJ, van Bon GE. Gait and gait-related activities of daily living after total hip arthroplasty: a systematic review. Clin Biomech (Bristol). 2014;29(6):705-718. doi:10.1016/j.clinbiomech.2014.05.008

2. Singh JA, Lewallen DG. Patient-level clinically meaningful improvements in activities of daily living and pain after total hip arthroplasty: data from a large US institutional registry. Rheumatology (Oxford). 2013;52(6):1109-1118. doi:10.1093/rheumatology/kes416

3. Kiyama T, Naito M, Shinoda T, Maeyama A. Hip abductor strengths after total hip arthroplasty via the lateral and posterolateral approaches. J Arthroplasty. 2010;25(1):76-80. doi:10.1016/j.arth.2008.11.001

4. Cichy B, Wilk M, Sliwiński Z. Changes in gait parameters in total hip arthroplasty patients before and after surgery. Med Sci Monit. 2008;14(3):CR159-CR169.

5. Withers TM, Lister S, Sackley C, Clark A, Smith TO. Is there a difference in physical activity levels in patients before and up to one year after unilateral total hip replacement? A systematic review and meta-analysis. Clin Rehabil. 2017;31(5):639-650. doi:10.1177/0269215516673884

6. Moyer R, Lanting B, Marsh J. Postoperative Gait Mechanics After Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. JBJS Rev. 2018;6(11):e1. doi:10.2106/JBJS.RVW.17.00133

7. Perron M, Malouin F, Moffet H, McFadyen BJ. Three-dimensional gait analysis in women with a total hip arthroplasty. Clin Biomech (Bristol). 2000;15(7):504-515. doi:10.1016/s0268-0033(00)00002-4

8. Vogt L, Brettmann K, Pfeifer K, Banzer W. Walking patterns of hip arthroplasty patients: some observations on the medio-lateral excursions of the trunk. Disabil Rehabil. 2003;25(7):309-317. doi:10.1080/0963828021000043752

9. Damm P, Zonneveld J, Brackertz S, Streitparth F, Winkler T. Gluteal muscle damage leads to higher in vivo hip joint loads 3 months after total hip arthroplasty. PLoS One. 2018;13(1):e0190626. doi:10.1371/journal.pone.0190626

10. Kovalak E, Özdemir H, Ermutlu C, Obut A. Assessment of hip abductors by MRI after total hip arthroplasty and effect of fatty atrophy on functional outcome. Acta Orthop Traumatol Turc. 2018;52(3):196-200. doi:10.1016/j.aott.2017.10.005

11. Bahl JS, Nelson MJ, Taylor M, Solomon LB, Arnold JB, Thewlis D. Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2018;26(7):847-863. doi:10.1016/j.joca.2018.02.897

12. Naili JE, Hedström M, Broström EW. Changes of and interrelationships between performance-based function and gait and patient-reported function 1 year after total hip arthroplasty. J Orthop Traumatol. 2019;20(1):14. doi:10.1186/s10195-019-0521-7

13. Kaufmann M, Nüesch C, Clauss M. Functional assessment of total hip arthroplasty using inertial measurement units: Improvement in gait kinematics and association with patient-reported outcome measures. J Orthop Res. 2023;41(4):759-770. doi:10.1002/jor.25421

14. Foucher KC, Hurwitz DE, Wimmer MA. Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients. J Biomech. 2007;40(15):3432-3437. doi:10.1016/j.jbiomech.2007.05.020

15. Foucher KC, Freels S. Preoperative factors associated with postoperative gait kinematics and kinetics after total hip arthroplasty. Osteoarthritis Cartilage. 2015;23(10):1685-1694. doi:10.1016/j.joca.2015.05.005

16. Gilbey HJ, Ackland TR, Wang AW, Morton AR, Trouchet T, Tapper J. Exercise improves early functional recovery after total hip arthroplasty. Clin Orthop Relat Res. 2003;(408):193-200. doi:10.1097/00003086-200303000-00025

17. Allen CL, Hooper GJ, Frampton CM. Do larger femoral heads improve the functional outcome in total hip arthroplasty?. J Arthroplasty. 2014;29(2):401-404. doi:10.1016/j.arth.2013.06.017

18.Stolarczyk A, Stolarczyk M, Oleksy Ł. Analysis of biomechanical gait parameters in patients after total hip replacement operated via anterolateral approach depending on size of the femoral head implant: retrospective matched-cohort study. Arch Orthop Trauma Surg. 2022;142(12):4015-4023. doi:10.1007/s00402-021-04264-6

19. Mahmood SS, Mukka SS, Crnalic S, Wretenberg P, Sayed-Noor AS. Association between changes in global femoral offset after total hip arthroplasty and function, quality of life, and abductor muscle strength. A prospective cohort study of 222 patients. Acta Orthop. 2016;87(1):36-41. doi:10.3109/17453674.2015.1091955

20. Sariali E, Klouche S, Mouttet A, Pascal-Moussellard H. The effect of femoral offset modification on gait after total hip arthroplasty. Acta Orthop. 2014;85(2):123-127. doi:10.3109/17453674.2014.889980

21. van Drongelen S, Kaldowski H, Tarhan T, Assi A, Meurer A, Stief F. Are changes in radiological leg alignment and femoral parameters after total hip replacement responsible for joint loading during gait?. BMC Musculoskelet Disord. 2019;20(1):526. doi:10.1186/s12891-019-2832-5

22. Chamnongkich S, Asayama I, Kinsey TL, Mahoney OM, Simpson KJ. Difference in hip prosthesis femoral offset affects hip abductor strength and gait characteristics during obstacle crossing. Orthop Clin North Am. 2012;43(5):e48-e58. doi:10.1016/j.ocl.2012.07.008

23. Sato H, Maezawa K, Gomi M. Effect of femoral offset and limb length discrepancy on hip joint muscle strength and gait trajectory after total hip arthroplasty. Gait Posture. 2020;77:276-282. doi:10.1016/j.gaitpost.2020.02.008

24. Dorr LD, Wan Z, Malik A, Zhu J, Dastane M, Deshmane P. A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. J Bone Joint Surg Am. 2009;91(11):2598-2604. doi:10.2106/JBJS.H.01225

25. Lee YK, Kim JW, Kim TY, Ha YC, Koo KH. Validity of the intra-operative measurement of stem anteversion and factors for the erroneous estimation in cementless total hip arthroplasty using postero-lateral approach. Orthop Traumatol Surg Res. 2018;104(3):341-346. doi:10.1016/j.otsr.2017.11.023

26. Esbjörnsson AC, Kiernan S, Mattsson L, Flivik G. Geometrical restoration during total hip arthroplasty is related to change in gait pattern - a study based on computed tomography and three-dimensional gait analysis. BMC Musculoskelet Disord. 2021;22(1):369. doi:10.1186/s12891-021-04226-4

27. Tokuhara Y, Kadoya Y, Kim M, Shoundou M, Kanno T, Masuda T. Anterior knee pain after total hip arthroplasty in developmental dysplasia. J Arthroplasty. 2011;26(6):955-960. doi:10.1016/j.arth.2010.07.007

28. Akiyama K, Nakata K, Kitada M. Changes in axial alignment of the ipsilateral hip and knee after total hip arthroplasty. Bone Joint J. 2016;98-B(3):349-358. doi:10.1302/0301-620X.98B3.35468

29. Beard D, Palan J, Andrew J, Nolan J, Murray D. Incidence and effect of leg length discrepancy following total hip arthroplasty. Physiotherapy, 2008; 94(2), 91-96. doi:10.1016/j.physio.2008.01.005

30. Renkawitz T, Weber T, Dullien S. Leg length and offset differences above 5mm after total hip arthroplasty are associated with altered gait kinematics. Gait Posture. 2016;49:196-201. doi:10.1016/j.gaitpost.2016.07.011

31. Lai KA, Lin CJ, Jou IM, Su FC. Gait analysis after total hip arthroplasty with leg-length equalization in women with unilateral congenital complete dislocation of the hip--comparison with untreated patients. J Orthop Res. 2001;19(6):1147-1152. doi:10.1016/S0736-0266(01)00032-8

32. Benedetti MG, Catani F, Benedetti E, Berti L, Di Gioia A, Giannini S. To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty?. Int Orthop. 2010;34(8):1115-1121. doi:10.1007/s00264-009-0855-5

33. Scuderi G, Cuomo F, Scott WN. Lateral release and proximal realignment for patellar subluxation and dislocation. A long-term follow-up. J Bone Joint Surg Am. 1988;70(6):856-861.

34. Kandemir U, Yazici M, Alpaslan AM, Surat A. Morphology of the knee in adult patients with neglected developmental dysplasia of the hip. J Bone Joint Surg Am. 2002;84(12):2249-2257. doi:10.2106/00004623-200212000-00019

35. Sun JY, Ma HY, Shen JM. Factors influencing knee valgus alignment in Crowe type IV hip dysplasia after total hip arthroplasty. J Orthop Traumatol. 2021;22(1):41. doi:10.1186/s10195-021-00601-y

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Published

2025-05-05

Issue

Vol. 76 No. 1 (2025): Acta Orthopaedica et Traumatologica Hellenica

Section

Review

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