Gait Alteration and Biomechanical Changes after Total Hip Arthroplasty: A Systematic Review and Meta-analysis

ABSTRACT: Total hip arthroplasty (THA) is a widely used orthopaedic procedure that aims to restore mobility in patients with degenerative hip joint disease. Despite surgical correction, the extent to which postoperative gait biomechanics return to normal remains unclear. This systematic review and meta-analysis compared gait and biomechanical outcomes in adults following unilateral THA with those of healthy age-matched controls, synthesising data from studies published up to December 2024. The review included randomised control trials and observational studies that employed three-dimensional (3D) motion-capture camera systems and force platforms to assess spatiotemporal, kinematic, and kinetic gait parameters. In total, 23 studies involving 2,477 patients after THA met the inclusion criteria. The findings demonstrated that THA patients exhibited persistent gait alterations, including reduced hip range of motion, increased pelvic tilt, slower walking speed, and shorter stride and step lengths compared with healthy controls. In contrast, kinetic parameters such as hip joint moments and ground reaction forces did not show significant differences between groups. These results suggest that although gait function improves after THA, complete biomechanical normalisation is rarely achieved. The presence of residual deficits underscores the need for standardised outcome reporting. It highlights the importance of targeted hip-muscle rehabilitation to optimise postoperative gait biomechanics and improve long-term functional outcomes in THA patients.