Impact of spinal-hip types on gait patterns in patients with end-stage hip disease.

BACKGROUND

Patients with end-stage hip disease are classified into distinct spinal-hip types according to sagittal spinal-hip parameters. Each type employs specific compensatory strategies to maintain balance, but the associated alterations in gait patterns remain unclear. This study characterized the gait differences among patients with different spinal-hip types.

METHODS

This prospective observational study used EOS imaging to obtain full-length sagittal images and classify patients into spinal-hip types. The study included 10 patients in each type (A, B, and C) and 10 healthy controls. Gait analysis was performed to evaluate the spatiotemporal and kinematic parameters, followed by the gait profile score (GPS) analysis. The Kruskal-Wallis test was used to compare relevant parameters across the four groups, with post-hoc comparisons conducted using the Bonferroni method.

RESULTS

Significant differences among the types were observed in stride length (P = 0.003), stance phase percentage (P = 0.001), and swing phase percentage (P < 0.001), with type C showing the shortest stride and type A exhibiting the shortest stance phase. The sagittal range of motion (ROM) of the pelvis and hip varied significantly across the gait cycle (both P < 0.001), with type A exhibiting the largest pelvic ROM and the smallest hip ROM. Types A and C showed lower sagittal center of mass displacement during the stance phase (P < 0.001). Type A exhibited the most restricted knee ROM during the swing phase (P < 0.001). The GPS was highest in type A, followed by type C, while type B and healthy controls had the lowest scores (P < 0.001).

CONCLUSIONS

Patients with different spinal-hip types exhibited distinct gait adaptations to compensate for sagittal deformities. Patients with severe sagittal imbalance exhibited compensatory increased pelvic swing and demonstrated diminished functional scores. Preoperative assessment is essential for optimizing total hip arthroplasty outcomes and guiding rehabilitation.