Does Total Hip Arthroplasty Surgical Approach Impact Signs of Trendelenburg Gait

Introduction: Surgical approaches for total hip arthroplasty (THA) disrupt different muscles which could impact gait. The study compared signs of Trendelenburg gait (e.g. trunk lean, pelvis drop) between patients that underwent lateral or posterior approaches for THA and healthy adults.

Methods: Healthy adults (n=21) and patients one year post-THA for hip osteoarthritis using lateral (n=19) or posterior (n=19) approaches were recruited for this cross-sectional study. Optical motion capture and reflective markers measured pelvis, hip, and trunk angles during gait. Principal component analysis determined important angle characteristics. One-way analysis of variance and effect sizes (d) compared groups.

Results: There were significant differences (p=0.02) in lateral pelvis tilt; healthy group had greater lateral pelvis tilt excursions than lateral (d=0.77) and posterior (d=0.78) THA groups (Figure). Hip adduction angle over mid-/late stance was significantly (p=0.03) higher in the healthy compared to posterior THA group (d=0.83). There were no differences in trunk lean.

Conclusion: No evidence of Trendelenburg gait existed one year post-THA, and there were no differences between THA approaches. In fact, both THA groups had less pelvis drop than the healthy group. Posterior THA group had less hip adduction during late stance, which might increase the base of support during weight transfer.

Summary: There were no signs of Trendelenburg gait one year after total hip arthroplasty in patients that had a posterior or lateral surgical approach compared to healthy adults.