Gait kinematics and hip disability after intertrochanteric fracture surgery: Is there a relationship?

BACKGROUND/AIM: Walking ability is key for independence in daily life in older adults following intertrochanteric fractures (ITF), yet gait impairments in this population remain poorly described. This study aimed to evaluate gait impairments in patients after ITF surgery and investigate the relationship between gait kinematics and hip-related disability.

METHODS

Gait analysis was performed in 21 ITF patients at 3 and 6 months (M) post-surgery with intramedullary nails, and in 21 controls. Lower-limb kinematics and spatiotemporal gait parameters were computed. Hip disability was assessed through the Hip Disability and Osteoarthritis Outcome Score (HOOS). Differences in HOOS and gait parameters within and between groups were determined using t-tests; kinematic differences were examined with Hotelling's tests and general linear models, using statistical parametric mapping (SPM). Linear regression tested associations between pelvic/hip kinematics profiles and HOOS, using SPM.

RESULTS

Improvements in HOOS between post-surgery time-points were detected. Spatiotemporal and lower-limb kinematic parameters did not differ from 3 M to 6 M (e.g., speed: 3M=0.63 m/s; 6M=0.66m/s; p > 0.05). Spatiotemporal variables were different from the healthy group (e.g., speed=1.25 m/s; p < 0.05) at both time points. Increased pelvic obliquity upward of the fractured side during swing was associated with worse HOOS Activities Daily Living (ADL) (R2=0.39,%stride=85%) at 3 M, and reduced hip extension motion with lower HOOS at 6 M postoperatively (ADL: R2=0.62,%stride=56%; sports/recreational: R2=0.54,%stride=56%).

DISCUSSION: Our findings suggest partial recovery of hip-related disability by 6 M post-surgery, yet persistent gait impairments compared to healthy individuals. Kinematic deficits around the hip and pelvis appear to hinder overall mobility and may serve as a mediator in self-perceived activities and participation.