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Temporiti F1, Zanotti G1, Furone R1, Barbaglia A1, Grappiolo G1, Loppini M2, Gatti R1,2
1Humanitas Research Hospital, Rozzano, Milan, Italy, 2Humanitas University, Pieve Emanuele, Milan, Italy
Background: Three-dimensional gait analysis is a valid tool to assess patients before and after total hip arthroplasty (THA). THA represents an effective and definitive treatment for hip osteoarthritis, able to improve quality of life and function in activities of daily living. Despite the excellent functional recovery, these patients present gait adaptations and asymmetries, which often persist until one year after surgery. In the last few years, simultaneous bilateral THA was introduced for bilateral hip pathologies, resulting in similar clinical functional outcome to unilateral THA. However, no studies analyze the gait variables after simultaneous bilateral compared to unilateral THA. In fact, simultaneous bilateral THA patients could produce different gait patterns from unilateral ones, due to the lack of possibilities to develop adaptation with the unaffected limb.
Purpose: The aim of the study was to investigate gait characteristics in patients operated of simultaneous bilateral respect to unilateral THA.
Methods: Thirty-six patients admitted to our Institute for simultaneous bilateral THA (n=19) or unilateral THA (n=17) were enrolled in the study. Three-dimensional gait analysis was performed using an optical motion capture system the day before and seven days after surgery. Twenty-two retro-reflective markers were placed on bony landmarks according to Davis protocol and anthropometric measures were collected in order to detect gait spatio-temporal and kinematics variables. Spatio-temporal parameters consist of gait speed, cadence, stride length, stance, swing, double and single support duration. Kinematics was assessed through the Gait Variable Score (GVS), consisting of a synthetic index that describe the pelvis, hip, knee and ankle kinematics deviations from an healthy age-matched population.
Results: No significant between-group differences were recorded at baseline in all measurements. At seventh day after surgery, bilateral THA patients revealed longer stance (bilateral: 69±6.8% of the gait cycle, unilateral: 64.2±3.5% of the gait cycle; p=0.001) and shorter swing phases (bilateral: 31±6.4% of the gait cycle, unilateral: 35.8±3.5% of the gait cycle ; p=0.002) than unilateral THA patients. Furthermore, a better Pelvic Tilt GVS (bilateral: 7.1±3.7, unilateral: 9.2±3.3; p=0.04) and Pelvic Rotation GVS (bilateral: 4.2±1.9, unilateral: 5.4±1.7 ; p=0.023) was observed in bilateral THA patients. The within-group comparison revealed a significant worsening in all spatio-temporal parameters in both groups (p 0.001) due to surgery.
Conclusion(s): Bilateral THA patients show a better pelvic kinematics profile than unilateral THA patients. On the other hand, bilateral THA results in a shorter swing and longer stance duration respect to unilateral THA. This could be due to a reduced propulsion in the pre-swing phase of the also operated contralateral lower limb of bilateral THA patients.
Implications: Simultaneous bilateral THA patients reveal a different gait pattern compared to unilateral ones, consisting of a better kinematic profile and worse spatio-temporal parameters. Our findings should induce physiotherapists to consider different approaches in the ambulation training of these patients.
Keywords: Bilateral total hip arthroplasty, gait analysis, kinematics
Funding acknowledgements: The authors did not receive any funding.
Purpose: The aim of the study was to investigate gait characteristics in patients operated of simultaneous bilateral respect to unilateral THA.
Methods: Thirty-six patients admitted to our Institute for simultaneous bilateral THA (n=19) or unilateral THA (n=17) were enrolled in the study. Three-dimensional gait analysis was performed using an optical motion capture system the day before and seven days after surgery. Twenty-two retro-reflective markers were placed on bony landmarks according to Davis protocol and anthropometric measures were collected in order to detect gait spatio-temporal and kinematics variables. Spatio-temporal parameters consist of gait speed, cadence, stride length, stance, swing, double and single support duration. Kinematics was assessed through the Gait Variable Score (GVS), consisting of a synthetic index that describe the pelvis, hip, knee and ankle kinematics deviations from an healthy age-matched population.
Results: No significant between-group differences were recorded at baseline in all measurements. At seventh day after surgery, bilateral THA patients revealed longer stance (bilateral: 69±6.8% of the gait cycle, unilateral: 64.2±3.5% of the gait cycle; p=0.001) and shorter swing phases (bilateral: 31±6.4% of the gait cycle, unilateral: 35.8±3.5% of the gait cycle ; p=0.002) than unilateral THA patients. Furthermore, a better Pelvic Tilt GVS (bilateral: 7.1±3.7, unilateral: 9.2±3.3; p=0.04) and Pelvic Rotation GVS (bilateral: 4.2±1.9, unilateral: 5.4±1.7 ; p=0.023) was observed in bilateral THA patients. The within-group comparison revealed a significant worsening in all spatio-temporal parameters in both groups (p 0.001) due to surgery.
Conclusion(s): Bilateral THA patients show a better pelvic kinematics profile than unilateral THA patients. On the other hand, bilateral THA results in a shorter swing and longer stance duration respect to unilateral THA. This could be due to a reduced propulsion in the pre-swing phase of the also operated contralateral lower limb of bilateral THA patients.
Implications: Simultaneous bilateral THA patients reveal a different gait pattern compared to unilateral ones, consisting of a better kinematic profile and worse spatio-temporal parameters. Our findings should induce physiotherapists to consider different approaches in the ambulation training of these patients.
Keywords: Bilateral total hip arthroplasty, gait analysis, kinematics
Funding acknowledgements: The authors did not receive any funding.
Topic: Musculoskeletal: lower limb; Human movement analysis; Orthopaedics
Ethics approval required: Yes
Institution: Humanitas Clinical and Research Hospital
Ethics committee: Internal Ethical Committee of the Humanitas Clinical and Research Hospital
Ethics number: 172/17
All authors, affiliations and abstracts have been published as submitted.
