Changes over time of trunk symmetry during gait in total hip arthroplasty patients

Minoru Nagasaki, Keita Shimura
Purpose:

To investigate whether the symmetry of trunk movement during gait improves over time in postoperative THA patients.

Methods:

The subjects were 21 patients (age 60.4 ± 12.7 years, BMI 25.4 ± 4.7 kg/m2, 15 females and 6 males, 13 unilateral and 8 bilateral) who underwent THA between November 2022 and February 2024 and were available for measurement.

Subjects wore triaxial accelerometers at the trunk (6th thoracic spinous process) and pelvis (superior border of superior posterior iliac spine and mid sacrum), and trunk sway was measured while walking on a 10-m flat surface. Walking conditions were no cane and walking with comfortable speed. Measurements were taken three times: preoperatively, at 1 month postoperatively (1POM), and at 3 months postoperatively (3POM). Trunk and pelvic symmetry during gait were calculated in the application from accelerometer data measured with a two-point trunk sway meter (Micro Stone Co.). The Kruskal-Wallis test was used to compare differences in trunk and pelvic symmetry at three time points and the Scheffe method was used as a post-test. The significance level was set at p0.05.

Results:

The median pelvic symmetry (inter-quartile range) was 0.29 (0.09, 0.47) preoperatively, 0.62 (0.36, 0.79) for 1POM, and 0.63 (0.43, 0.65) for 3POM, showing a significant difference between preoperative and 1POM and between preoperative and 3POM (p 0.05). On the other hand, there was no significant difference in trunk symmetry between preoperative 0.19 (0.05, 0.44), 1POM 0.42 (0.14, 0.66), and 3POM 0.51 (0.29, 0.69).

Conclusion(s):

We investigated changes in trunk symmetry during gait over time in postoperative THA patients. The pelvic symmetry was significantly improved at 1 month postoperatively, while the trunk symmetry showed some improvement with no significant difference. It has been reported that trunk asymmetry is associated with increased walking energy expenditure and increased risk of developing spinal disorders. The results suggest that early physiotherapy intervention may be necessary.

Implications:

This study demonstrated that the trunk asymmetry remained objectively regarding the abnormal gait subjectively perceived by THA postoperative patients. In the future, trunk asymmetry should be considered as an important part of physiotherapy interventions to achieve early improvement and increase patient satisfaction. 

Funding acknowledgements:
This work was unfunded.
Keywords:
total hip arthroplasty
symmetry
gait
Primary topic:
Musculoskeletal
Second topic:
Orthopaedics
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
All study procedures were approved by the ethics committee of Saiseikai Utsunomiya Hospital.
Provide the ethics approval number:
2024-22
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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