Biomechanical Analysis to Guide Future Trends in Hip Replacement Surgery and Post-Operative Rehabilitation

Minimally invasive and traditional approaches to total hip arthroplasty yield positive outcomes for most patients six months following surgery. “Most of these patients are happy to simply walk well and experience less pain,” says John Nettrour, M.D., Penn State Hershey Bone and Joint Institute. Yet gait analysis research indicates that many hip replacement patients can be expected to exhibit continuing gait abnormalities that may limit daily function.¹ Following hip replacement, patients display diminished velocity, and stride length and an irregular cadence that can translate into a fall risk or limited ability to engage in daily physical activity, such as climbing or descending stairs.

Dr. Nettrour and other colleagues plan to use a new gait analysis and biomechanics laboratory recently established at Penn State Hershey Medical Center as an important tool to help patients normalize their gait following hip replacement surgery, improving long-term outcomes and daily function. Dr. Nettrour explains, “We’re interested in how variations in surgical technique may affect the recovery of a normal gait pattern over time. We hope approaches that minimize soft tissue injury can facilitate an easier recovery and ultimately yield better approximations of normal gait.”

Hip joint kinematics in total hip arthroplasty patients

Hip joint kinematics in total hip arthroplasty patients at 3, 6 and 12 months after surgery: prosthetic side and sound side. The standard deviation limits of the normal joint kinematics are also shown (dashed line).1 Copyright 2014, with permission from Elsevier.

Recovery may also involve unlearning bad gait “habits” acquired over time when a painful hip limits a patient’s mobility. Evidence shows that patients who undergo total hip replacement continue to show gait abnormalities 12 months after surgery; while some aspects of gait normalize at six months, the improvements do not appear to continue.¹

Dr. Nettrour recognizes that formal rehabilitation may be needed to help some patients attain a more normal gait pattern, explaining, “We also plan to perform formal gait re-training to help patients recover from surgery. Some patients will likely need a lot of help being re-trained to walk normally, often after years of altering their gait due to pain. It is not a fast process.”

John Fairbanks Nettrour, M.D.John Fairbanks Nettrour, M.D.
Assistant Professor, Orthopaedics and Rehabilitation
Orthopaedic Surgeon, Hip and Knee Arthroplasty
PHONE: 717-531-5638
FELLOWSHIP: Adult reconstruction, Florida Orthopaedic Institute, Temple Terrace, Fla.
RESIDENCY: Orthopedics, Mayo Graduate School of Medicine, Rochester, Minn.
MEDICAL SCHOOL: University of Pittsburgh School of Medicine, Pittsburgh, Pa.


  1. Agostini V, Ganio D, Facchin K, Cane L, Moreira Carneiro S, Knaflitz M. Gait parameters and muscle activation patterns at 3, 6 and 12 months after total hip arthroplasty. J Arthroplasty. 2014; 29:1265-72.

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