Open Access Highly Accessed Research article

Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-month postoperative comparison

Nicola C Casartelli12*, Julia F Item-Glatthorn1, Mario Bizzini1, Michael Leunig3 and Nicola A Maffiuletti1

Author Affiliations

1 Neuromuscular Research Laboratory, Schulthess Clinic, Zurich, Switzerland

2 INSERM U1093 - Cognition, Action and Sensory Plasticity, University of Burgundy, Dijon, France

3 Hip Service, Schulthess Clinic, Zurich, Switzerland

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BMC Musculoskeletal Disorders 2013, 14:176  doi:10.1186/1471-2474-14-176

Published: 3 June 2013



The recovery of gait ability is one of the primary goals for patients following total arthroplasty of lower-limb joints. The aim of this study was to objectively compare gait differences of patients after unilateral total hip arthroplasty (THA), total knee arthroplasty (TKA) and total ankle arthroplasty (TAA) with a group of healthy controls.


A total of 26 TAA, 26 TKA and 26 THA patients with a mean (± SD) age of 64 (± 9) years were evaluated six months after surgery and compared with 26 matched healthy controls. Subjects were asked to walk at self-selected normal and fast speeds on a validated pressure mat. The following spatiotemporal gait parameters were measured: walking velocity, cadence, single-limb support (SLS) time, double-limb support (DLS) time, stance time, step length and step width.


TAA and TKA patients walked slower than controls at normal (p<0.05) and fast speeds (p<0.01). The involved side of TAA and TKA patients showed shorter SLS compared to controls at both normal and fast speeds (p<0.01). Regardless of walking speed, the uninvolved side of TAA and TKA patients demonstrated longer stance time and shorter step length than controls (p<0.01). TAA patients showed shorter SLS of the involved side, longer stance time and shorter step length of the uninvolved side compared to the contralateral side at both normal and fast speeds (p<0.001).


Gait disability after unilateral lower-limb joint arthroplasty was more marked for distal than for proximal joints at six months after surgery, with a proximal-to-distal progression in the impairment (TAA>TKA>THA). THA patients demonstrated no gait differences compared with controls. In contrast, TAA and TKA patients still demonstrated gait differences compared to controls, with slower walking velocity and reduced SLS in the involved limb. In addition, TAA patients presented marked side-to-side asymmetries in gait characteristics.

Gait; Arthroplasty; Hip; Knee; Ankle