Restricted accessResearch articleFirst published online 2026-3
The relationship between perceived leg-length discrepancy and spatiotemporal gait parameters in the early postoperative period following total hip arthroplasty
The purpose of this study was to investigate the relationship between the presence of perceived leg-length discrepancy (PLLD) and spatiotemporal gait parameters in the early postoperative period following total hip arthroplasty (THA).
Methods:
A total of 63 patients (age 73.19 ± 9.00 years) who underwent primary unilateral THA were included in the study. PLLD was assessed using the Block test, and spatiotemporal gait parameters were measured 3 weeks postoperatively with the Walkway MW-1000 system. Statistical analysis was performed using analysis of covariance (ANCOVA), adjusting for confounders such as height, muscle strength, and postoperative structural leg-length discrepancy, to examine the independent association between PLLD and spatiotemporal gait parameters.
Results:
ANCOVA analysis revealed significant differences between the PLLD group and the non-PLLD group. The PLLD group exhibited longer operative single support time, longer non-operative double support time, and wider step width than the non-PLLD group.
Conclusions:
This study demonstrates the relationship between PLLD and spatiotemporal gait parameters. As such, it provides important insights for gait assessment and how this might be used in rehabilitation programmes following THA. Improving PLLD and gait symmetry may help to lower the risk of postoperative falls.
FaldiniC.Leg length discrepancy after primary total hip replacement. Musculoskelet Surg2023; 107: 1–5.
2.
IwakiriKOhtaYFujiiT, et alChanges in patient-perceived leg length discrepancy following total hip arthroplasty. Eur J Orthop Surg Traumatol2021; 31: 1355–1361.
3.
NakanowatariTSuzukamoYSugaT, et alTrue or apparent leg length discrepancy: which is a better predictor of short-term functional outcomes after total hip arthroplasty?J Geriatr Phys Ther2013; 36: 169–174.
4.
MahmoodSSMukkaSSCrnalicS, et alThe influence of leg length discrepancy after total hip arthroplasty on function and quality of life: a prospective cohort study. J Arthroplasty2015; 30: 1638–1642.
5.
IversenMDChudasamaNLosinaE, et alInfluence of self-reported limb length discrepancy on function and satisfaction 6 years after total hip replacement. J Geriatr Phys Ther2011; 34: 148–152.
6.
WaibelFWABerndtKJentzschT, et alSymptomatic leg length discrepancy after total hip arthroplasty is associated with new onset of lower back pain. Orthop Traumatol Surg Res2021; 107: 102761.
7.
KawabataYKimuraM.Relationship of early postoperative perceived leg length discrepancy to the progression of osteoarthritis in the contralateral hip after unilateral total hip arthroplasty–a retrospective cohort study using propensity score matching. J Phys Ther Sci2023; 35: 300–305.
ZhangYHeWChengT, et alTotal hip arthroplasty: leg length discrepancy affects functional outcomes and patient’s gait. Cell Biochem Biophys2015; 72: 215–219.
10.
SabharwalSKumarA.Methods for assessing leg length discrepancy. Clin Orthop Relat Res2008; 466: 2910–2922.
11.
OmichiYGotoTWadaK, et alImpact of the hip-spine relationship and patient-perceived leg length discrepancy after total hip arthroplasty: a retrospective study. J Orthop Sci2023; 29: 854–860.
12.
LiJMcWilliamsABJinZ, et alUnilateral total hip replacement patients with symptomatic leg length inequality have abnormal hip biomechanics during walking. Clin Biomech (Bristol)2015; 30: 513–519.
13.
SamsonMMCroweAde VreedePL, et alDifferences in gait parameters at a preferred walking speed in healthy subjects due to age, height and body weight. Aging (Milano)2001; 13: 16–21.
14.
Abdul JabbarKASeahWTLauLK, et alFast gait spatiotemporal parameters in adults and association with muscle strength - the Yishun study. Gait Posture2021; 85: 217–223.
15.
CinnamonCCLongworthJABrunnerJH, et alStatic and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty. Clin Biomech (Bristol)2019; 67: 127–133.
16.
SliwinskiMMSistoSABataviaM, et alDynamic stability during walking following unilateral total hip arthroplasty. Gait Posture2004; 19: 141–147.
17.
BenedettiMCataniFBenedettiE, et alTo what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty?Int Orthop2010; 34: 1115–1121.
18.
HerissonOFeldenAHamadoucheM, et alValidity and reliability of intraoperative radiographs to assess leg length during total hip arthroplasty: correlation and reproducibility of anatomic distances. J Arthroplasty2016; 31: 2784–2788.
19.
IeiriATushimaEIshidaK, et alReliability of measurements of hip abduction strength obtained with a hand-held dynamometer. Physiother Theory Pract2015; 31: 146–152.
20.
HiranoMKatohMGomiM, et alValidity and reliability of isometric knee extension muscle strength measurements using a belt-stabilised hand-held dynamometer: a comparison with the measurement using an isokinetic dynamometer in a sitting posture. J Phys Ther Sci2020; 32: 120–124.
21.
KawabataYKimuraM.[Does the range of motion of hip abduction exercises in the loaded position immediately improve perceived leg length discrepancy in patients undergoing total hip arthroplasty?]Phys Ther Jpn2022; 56: 119–125.
22.
KawabataYKarimataYKimuraM.Is decrescent shoe lift insertion effective for reducing perceived leg length discrepancy after total hip arthroplasty?Phys Ther Jpn2016; 43: 486–492.
23.
SandersOWangBKontsonK.Concurrent validity evidence for pressure-sensing walkways measuring spatiotemporal features of gait: a systematic review and meta-analysis. Sensors (Basel)2024; 24: 4537.
24.
NishimuraHEndoKSuzukiH, et alGait analysis in cervical spondylotic myelopathy. Asian Spine J2015; 9: 321–326.
25.
ChangMCLeeBJYangD, et alThe association between cognition and gait disturbance in central nervous system demyelinating disorder with mild disability. BMC Neurol2023; 23: 177.
26.
PeterkaRJGruber-FoxAHeekePK.Asymmetry measures for quantification of mechanisms contributing to dynamic stability during stepping-in-place gait. Front Neurol2023; 14: 1145283.
27.
FukuchiCAFukuchiRKDuarteM.Effects of walking speed on gait biomechanics in healthy participants: a systematic review and meta-analysis. Syst Rev2019; 8: 153.
28.
VatchevaKPLeeMMcCormickJB, et alMulticollinearity in regression analyses conducted in epidemiologic studies. Epidemiology (Sunnyvale)2016; 6: 227.
29.
PerryJBurnfieldJM.Head, trunk, and pelvis. In: PerryJBurnfieldJM (eds.) Gait analysis: normal and pathological function. 2nd ed.New Jersey: Slack, 2010, pp.121–130.
30.
Pereiro-BucetaHBecerro-de-Bengoa-VallejoRLosa-IglesiasME, et alThe effect of simulated leg-length discrepancy on the dynamic parameters of the feet during gait: cross-sectional research. Healthcare (Basel)2021; 9: 932.
31.
O’TooleGCMakwanaNKLunnJ, et alThe effect of leg length discrepancy on foot loading patterns and contact times. Foot Ankle Int2003; 24: 256–259.
32.
WhiteSCGilchristLAWilkBE.Asymmetric limb loading with true or simulated leg-length differences. Clin Orthop Relat Res2004; (421): 287–292.
33.
TurulaKBFribergOLindholmTS, et alLeg length inequality after total hip arthroplasty. Clin Orthop Relat Res1986; (202): 163–168.
34.
Herrero-LarreaAMiñarroANarvaizaL, et alNormal limits of home-measured spatial gait parameters of the elderly population and their association with health variables. Sci Rep2018; 8: 13193.
35.
BautmansIJansenBVan KeymolenB, et alReliability and clinical correlates of 3D-accelerometry-based gait analysis outcomes according to age and fall-risk. Gait Posture2011; 33: 366–372.
36.
PatersonKHillKLythgoN.Stride dynamics, gait variability and prospective falls risk in active community dwelling older women. Gait Posture2011; 33: 251–255.
37.
WyldeVWhitehouseSLTaylorAH, et alPrevalence and functional impact of patient-perceived leg length discrepancy after hip replacement. Int Orthop2009; 33: 905–909.
38.
IkutomoHNagaiKTagomoriK, et alGait abnormality predicts falls in women after total hip arthroplasty. J Arthroplasty2018; 33: 3215–3219.
