Contralateral Lower-Limb Functional Status Before Total Hip Arthroplasty: An Important Indicator for Postoperative Gait Speed

J Bone Joint Surg Am. 2021 Jun 16;103(12):1093-1103. doi: 10.2106/JBJS.20.00949.


Background: Postoperative gait speed, especially comfortable gait speed, is an important factor for predicting function after total hip arthroplasty (THA). In this study, we examined factors related to gait speed, including preoperative lower and upper-limb functional parameters and postoperative lower-limb alignment. In addition, we examined factors related to postoperative good comfortable gait speed (≥1.34 m/s: one indicator of a good clinical outcome). The purpose of this study was to determine if better preoperative functional parameters had a positive effect on postoperative gait speed.

Methods: This prospective case-control study included 91 patients with hip osteoarthritis who underwent unilateral THA. Patients who had undergone a prior hip surgical procedure or had Crowe type-3 and 4 hips, complications after THA, knee osteoarthritis-related pain, and severe lumbar conditions were excluded. The 1-leg standing time (OLST) and knee extensor strength of the operatively treated side and the contralateral side and the functional reach test were examined preoperatively and at 1 year postoperatively. The leg-length discrepancy and global offset compared with the contralateral side and leg lengthening were examined using 3-dimensional models captured through computed tomographic scans.

Results: The preoperative contralateral side OLST was a significant factor (p < 0.001) for postoperative comfortable gait speed, and the preoperative contralateral-side knee extensor strength was a significant factor (p = 0.018) for postoperative maximum gait speed. Leg-length discrepancy and differences in global offset after THA were not significant factors for postoperative gait speed. The preoperative comfortable gait speed with a cutoff value of 1.115 m/s (area under the receiver operating characteristic curve, 0.690 [95% confidence interval, 0.569 to 0.810]; p = 0.003; sensitivity of 65.5% and specificity of 74.2%) was an independent factor associated with a good postoperative comfortable gait speed. Preoperative contralateral-side OLST was a significant factor (p = 0.027) for preoperative comfortable gait speed.

Conclusions: The preoperative contralateral-side, lower-limb functional status is a significant factor for postoperative gait speed. Early surgical intervention before the contralateral-side function declines or a preoperative rehabilitation intervention on the contralateral side may improve THA outcome.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip*
  • Case-Control Studies
  • Female
  • Functional Status*
  • Humans
  • Lower Extremity / physiopathology*
  • Male
  • Middle Aged
  • Osteoarthritis, Hip / physiopathology*
  • Osteoarthritis, Hip / surgery*
  • Prospective Studies
  • Recovery of Function
  • Sensitivity and Specificity
  • Treatment Outcome
  • Walking Speed / physiology*