Gait asymmetry following an anterior and anterolateral approach to total hip arthroplasty

Abstract

Background Patients with osteoarthritis of the hip demonstrate a limp while ambulating, and persistent asymmetric limb loading following unilateral total hip arthroplasty might induce further complications in the affected and contralateral limbs. The purpose of this study was to investigate pre- to postsurgical changes in gait symmetry in patients receiving either an anterior or anterolateral hip replacement. Methods Three-dimensional kinematic and kinetic gait analyses were performed on 12 patients undergoing anterior surgery, 11 patients undergoing anterolateral surgery and 10 age-matched controls while level walking. A two-way mixed model analysis of variance with repeated measures was utilized to determine differences in symmetry indices and pelvic obliquity between groups and across time. Findings At presurgery, greater single limb support time and step length asymmetry was demonstrated by both patient groups when compared to controls. While the anterior hip replacement patients demonstrated greater improvement in gait symmetry by 6 weeks postsurgery, both patient groups approached control levels by 16 weeks postsurgery. No significant differences were seen between patient groups for pelvic obliquity, limb loading or temporal-distance symmetry at any time point. Interpretation Patients undergoing either anterior or anterolateral hip replacement enhanced their gait symmetry by 16 weeks following surgery. Improvement in gait symmetry at 6 weeks postsurgery, as compared to presurgery, was detected in patients undergoing anterior hip replacement. However, no such improvement was observed in patients receiving the anterolateral approach. Findings of this study highlight the potential impact of surgical approach on short-term changes in gait asymmetry.