Gait pattern in patients treated with a total hip arthroplasty due to an acute displaced cervical neck fracture: a randomised comparison between 29 cases with a cemented femoral stem and 16 cases with an uncemented femoral stem.

Abstract

The choice between cemented or uncemented stem fixation in the treatment of a femoral neck fracture may influence patient rehabilitation and the resulting gait pattern, due to potential differences in implant positioning and fixation. We used gait analysis to study temporal gait parameters, hip kinematics and kinetics in patients who, 2 years previously, had been randomised to treatment with a cemented or uncemented stem and due to an acute femoral neck fracture. 45 Patients implanted with a cemented Lubinus SP II (n = 29) and an uncemented (n = 16) Corail stem were studied. Gait analysis was performed using a 16-camera motion capture system and force plates. 28 subjects served as controls. Temporal gait parameters, hip kinematics and kinetics were analysed. The patients had no or minimum pain (median Harris pain score 44, range 40-44) and the majority had no limp (median Harris limp score 11, range 5-11). Temporospatial gait parameters and abduction-adduction motions and moments did not differ between patients with cemented or uncemented stems (p > 0.05). Patients with cemented stems did, however, show more hip flexion and less extension during walking than those with an uncemented stem (p < 0.05). Moreover, the flexion-extension range was less in the cemented group (p < 0.04). Compared with controls, the hip fracture patients walked more slowly, with a shorter stride length and a longer stance phase. Increased hip flexion and reduced extension in patients using the Lubinus SP II cemented stem could be an effect of its anteverted neck, but this question requires further study. Despite acute treatment with THA, hip fracture patients demonstrated a change in gait pattern compared with controls 2 years after the operation. This suggests that these changes are caused by the presence of an implant, or the soft-tissue trauma partly caused by the surgery than by any degenerative disease present in patients undergoing elective surgery.ClinicalTrials.gov Identifier: NCT04791605.