Gait and gait-related activities of daily living after total hip arthroplasty: A systematic review

BACKGROUND: Differences in the performance of gait and gait-related activities of daily living are known to persist after total hip arthroplasty compared to healthy controls, but the specific underlying deficits (spatiotemporal, kinematics and kinetics) are not completely understood. This review aimed to map the differences between patients and controls, and between the operated and non-operated limbs during various activities of daily living. METHODS: A computerized search with broad search terms was performed in the MEDLINE database. Primary inclusion criteria were: primary osteoarthritis as indication, comparison with healthy controls or comparison between the operated and the non-operated limbs, and follow-up period at least six months after surgery. FINDINGS: The literature search yielded 2177 citations, of which 35 articles were included. Compared to controls, reductions were identified in the operated hip in sagittal range of motion, peak extension, sagittal power generation, abduction moment and external rotation moment. During stair ascent, these reductions did not become more apparent, although deficits in hip kinetics in all three planes were found. Walking speed and step length were reduced compared to controls at longer-term follow-up, but not at short-term follow-up. INTERPRETATION: The hip abduction moment deficit was present both in level walking and in stair ascent in total hip arthroplasty patients compared to controls. Reduced sagittal hip power generation and external rotation moment were also found, of which the clinical relevance remains to be established. Due to a low number of studies, many of the longer-term effects of THA on gait and gait-related ADL are not yet accurately known