Asymmetric leg loading during sit-to-stand, walking and quiet standing in patients after unilateral total hip replacement surgery

Abstract

Background: Asymmetric limb loading persists well after unilateral total hip replacement surgery and represents a risk of the development of osteoarthritis in the non-operated leg. Here we studied bilateral limb loading in hip arthroplasty patients for a variety of everyday activities.

Methods: Twenty-seven patients and 27 healthy age-matched control subjects participated in the study. They were asked to stand up from a chair, to stand quietly, to perform isometric maximal voluntary contractions and to walk along a 10 m path at a natural and fast speed. Two force platforms measured vertical forces under each foot during quiet standing and sit-to-stand maneuver. Temporal variables of gait were measured using footswitches.

Findings: In all tasks patients tended to preferentially load the non-operated limb, though the amount of asymmetry depended on the task being most prominent during standing up (inter-limb weight bearing difference exceeded 20%, independent of speed or visual conditions). In contrast, when performing maximal voluntary contractions, or during walking and quiet standing, the inter-limb difference in the maximal force production, stance/swing phase durations or weight bearing was typically less than 10%.

Interpretation: The results suggest that the amount of asymmetry might not be necessarily the same for different tasks. Asymmetric leg loading in patients can be critical during sit-to-stand maneuver in comparison with quiet standing and walking, and visual information seems to play only a minor role in the control of the weight-bearing ability. The proposed asymmetry indices might be clinically significant for development of post-surgical rehabilitation.