Abstract Background: Total hip replacement (THR) is typically evaluated using radiographic outcomes and clinical scores. However, restoration of anatomical alignment may not reflect true functional recovery. Objective: To analyze the relationship between radiological alignment and gait symmetry in patients who underwent unilateral uncemented THR. Materials and Methods: Forty-five patients (mean age: 28.3 ± 3.1 years; 71.1% male) with 1-year follow-up after uncemented THR were assessed. Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores, and radiological parameters (femoral offset, neck-shaft angle, version) were recorded. Gait analysis was performed using 3D motion capture, evaluating stride time, step width, stride length, and step length across operated, non-operated, and normal limbs. Results: Radiological alignment was satisfactory (offset: 32.93 ± 4.30 mm; neck-shaft angle: 130.64° ± 4.60°; version: 17.02° ± 1.37°). HHS and WOMAC were 70.24 ± 2.77 and 17.71 ± 1.00, respectively. Despite these, stride time was significantly longer in the operated limb (1.20 ± 0.02 s) than in nonoperated (1.18 ± 0.00 s) and normal limbs (1.10 ± 0.00 s, P < 0.0001). Step width was greater bilaterally (0.14 ± 0.01 m) compared to normal (0.08 ± 0.01 m, P < 0.0001). Stride length and step length were not significantly different. Conclusion: Functional gait recovery lags behind anatomical alignment after THR. Persistent gait asymmetries highlight the need for integrating biomechanical evaluation with radiological outcomes in post-THR care.
Akram et al. (2026) studied this question.