Changes in Gait Pattern and Hip Muscle Strength After Open Reduction and Internal Fixation of Acetabular Fracture

Abstract Kubota M, Uchida K, Kokubo Y, Shimada S, Matsuo H, Yayama T, Miyazaki T, Takeura N, Yoshida A, Baba H. Changes in gait pattern and hip muscle strength after open reduction and internal fixation of acetabular fracture. Objectives To characterize changes in the gait pattern at 3 and 12 months after surgery for acetabular fracture, to assess the relationship between various gait parameters and hip muscle strength, and to determine the factors associated with gait disorders that correlate with gait parameters measured at 12 months after surgery. Design Prospective cohort study. Setting University hospital. Participants Patients (N=19) with acetabular fractures were treated by open reduction and internal fixation (ORIF) and examined at 3 and 12 months postoperatively. The study also included a similar number of sex- and age-matched control subjects. Interventions Postoperative rehabilitation program. Main Outcome Measures Spatiotemporal, kinematic, and kinetic variables of gait and strength of hip flexor, adductor, and abductor muscles at 3 and 12 months after ORIF. Results Walking velocity at 3 months after ORIF was slower in the patients than in the control subjects; however, walking velocity at 12 months was similar in the 2 groups. Although most of the kinematic and kinetic variables showed recovery to control levels at 3 and 12 months after ORIF, recovery was incomplete for pelvic forward tilt and hip abduction moment even at 12 months after ORIF. The greatest loss of muscle strength was noted in the hip abductors, where the average deficit was 35.4% at 3 months and 24.6% at 12 months. There was a significant relationship between hip abductor muscle strength and hip abduction moment at 3 months ( R2 =.63); however, this relationship diminished at 12 months ( R2 =.14). The presence of associated injuries correlated with lack of recovery of the peak hip abduction moment. Conclusions Pelvic forward tilt and peak hip abduction moment showed incomplete recovery at 12 months after ORIF with subsequent conventional and home exercise rehabilitation programs. Our results suggest that improvement of hip abductor muscle strength in the early postoperative period could improve the peak hip abduction moment.