Does Surgical Approach During Total Hip Arthroplasty Alter Gait Recovery During the First Year Following Surgery? Robin M. Queen, PhD a, b , Jordan F. Schaeffer, MD a , Robert J. Butler, DPT, PhD b, c , Carl C. Berasi, BS d , Scott S. Kelley, MD a , David E. Attarian, MD a , Michael P. Bolognesi, MD a a Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina b Michael W. Krzyzewski Human Performance Lab, Duke University Medical Center, Durham, North Carolina c Division of Physical Therapy, Department Community and Family Medicine, Duke University Medical Center, Durham, North Carolina d Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina abstract article info Article history: Received 26 November 2012 Accepted 6 February 2013 Keywords: gait analysis total hip arthroplasty surgical approach Multiple surgical approaches exist for total hip arthroplasty (THA). Each approach has risks and benefits in regard to complications and changes in postoperative gait. This study examined the effect of three surgical approaches on postoperative gait mechanics. Thirty patients completed a self-selected speed level walking gait assessment preoperatively, 6 weeks, and 1 year after surgery. We found no difference between approaches 1 year following surgery for any study variable. Several differences existed between time points independent of surgical approach. Significant improvement was found in sagittal and frontal plane hip ROM, peak hip extension and adduction angle and moment, the functional measures, walking speed, and the Harris Hip Score. This study suggests that postoperative gait changes are similar for the three analyzed surgical approaches. © 2013 Elsevier Inc. All rights reserved. Total hip arthroplasty (THA) is one of the most common and successful procedures performed in orthopedics. Currently, an estimated 2.5% of the population over 40 years of age receives a total hip arthroplasty due to post-traumatic or degenerative joint disease, and recent studies have shown that over 90% of patients are satisfied with their operation 12 months after surgery [1–3]. In 2009, 266,760 primary total hip arthroplasties were performed, and with the aging population it is projected that this number will increase by 174% to 572,000 by 2030 [4]. Although overall patient satisfaction is high, common complications of THA include dislocation, abductor weakness, decreased range of motion, and a limp [5–9]. Multiple surgical approaches exist, each with their own advantages and disadvantages with regard to these adverse outcomes. The most common surgical approach used globally and in the United States is the posterior approach. This approach is used by an estimated 73% of surgeons in the United States and 55% of surgeons globally [10]. In the United States, 22% of surgeons use a direct lateral approach, and an estimated 5% use a muscle-splitting anterior or anterolateral approach [10]. Compared to the traditional posterior approach, the lateral approach has been associated with a lower rate of dislocation due to preservation of the posterior capsule, but increased abductor weakness and damage; potentially leading to an increased incidence of postoperative limp [5,9,11–13]. Abductor weakness is the primary cause of gait disturbance following THA due to its crucial role in controlling hip abduction and pelvic obliquity [13]. Muscle-splitting approaches such as the direct anterior and anterolateral approach described in this study are steadily gaining popularity due to the low risk of dislocation, less muscle damage, potential for earlier functional recovery, and patient demand [14–16]. Cross-sectional studies after THA surgery have suggested that a posterior surgical approach is more successful in improving hip joint symmetry when compared to the contralateral hip versus an anterior and anterolateral approach; however, the differences in these studies could be attributed to presurgical differences [17–19]. In addition, most studies that have investigated the longitudinal effect of different surgical approaches on gait mechanics have shown minimal differences in restoring symmetry in ground reaction forces, temporospatial parameters, and hip torques compared to preoperative values [14,20,21]. A number of studies have assessed gait changes in patients after THA [5–9,15,17–22]. postoperative THA patients typically show an increased range of motion and improved joint symmetry during gait, while changes in temporospatial parameters are less consistent [23–28]. A prior study at our institution compared changes in gait mechanics preoperatively and 6 weeks after surgery based on surgical approach The Journal of Arthroplasty 28 (2013) 1639–1643 The Conflict of Interest statement associated with this article can be found at http:// dx.doi.org/10.1016/j.arth.2013.02.008. Reprint requests: Robin M. Queen, PhD, Duke Department of Orthopaedic Surgery, Michael W. Krzyzewski Human Performance Lab, 102 Finch Yeager Building, DUMC 3435, Durham, NC 27710, USA. 0883-5403/2809-0035$36.00/0 – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.arth.2013.02.008 Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org