Original article| Volume 93, ISSUE 11, P2015-2021, November 2012

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

Published:April 05, 2012DOI:


      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.


      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.


      Prospective cohort study.


      University hospital.


      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.


      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.


      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.


      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.

      Key Words

      List of Abbreviations:

      AO/OTA (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association), ORIF (open reduction and internal fixation)
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        • Letournel E.
        Acetabulum fractures: classification and management.
        Clin Orthop. 1980; 151: 81-106
        • Judet R.
        • Judet J.
        • Letournel E.
        Fractures of the acetabulum: classification and surgical approaches for open reduction.
        J Bone Joint Surg Am. 1964; 46: 1615-1646
        • Matta J.M.
        • Merritt P.O.
        Displaced acetabular fractures.
        Clin Orthop Relat Res. 1988; 230: 83-97
        • Matta J.M.
        Operative treatment of acetabular fractures through the ilioinguinal approach.
        Clin Orthop Relat Res. 1994; 305: 10-19
        • Wright R.
        • Barrett K.
        • Christie M.J.
        • Johnson K.D.
        Acetabular fractures: long-term follow-up of open reduction and internal fixation.
        J Orthop Trauma. 1994; 8: 397-403
        • Kebaish A.S.
        • Roy A.
        • Rennie W.
        Displaced acetabular fractures: long-term follow-up.
        J Trauma. 1991; 31: 1539-1542
        • Matta J.M.
        Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within 3 weeks after the injury.
        J Bone Joint Surg Am. 1996; 78: 1632-1645
        • Briffa N.
        • Pearce R.
        • Hill A.M.
        • Bircher M.
        Outcomes of acetabular fracture fixation with ten years' follow-up.
        J Bone Joint Surg Br. 2011; 93: 229-236
        • Giannoudis P.V.
        • Grotz M.R.
        • Papakostidis C.
        • Dinopoulos H.
        Operative treatment of displaced fractures of the acetabulum.
        J Bone Joint Surg Br. 2005; 87: 2-9
        • Murphy D.
        • Kaliszer M.
        • Rice J.
        • McElwain J.P.
        Outcome after acetabular fracture: prognostic factors and their inter-relationships.
        Injury. 2003; 34: 512-517
        • Letournel E.
        The treatment of acetabular fractures through the ilioinguinal approach.
        Clin Orthop Relat Res. 1993; 292: 62-76
        • Moroni A.
        • Caja V.L.
        • Sabato C.
        • Zinghi G.
        Surgical treatment of both-column fractures by staged combined ilioinguinal and Kocher-Langenbeck approaches.
        Injury. 1995; 26: 219-224
        • Mehlman C.T.
        • Meiss L.
        • DiPasquale T.G.
        Hyphenated-history: the Kocher-Langenbeck surgical approach.
        J Orthop Trauma. 2000; 14: 60-64
        • Goulet J.A.
        • Bray T.J.
        Complex acetabular fractures.
        Clin Orthop Relat Res. 1989; 240: 9-20
        • Routt Jr, M.L.
        • Swiontkowski M.F.
        Operative treatment of complex acetabular fractures.
        J Bone Joint Surg Am. 1990; 72: 897-904
        • Dickinson W.H.
        • Duwelius P.J.
        • Colville M.R.
        Muscle strength testing following surgery for acetabular fractures.
        J Orthop Trauma. 1993; 7: 39-46
        • Borrelli Jr, J.
        • Goldfarb C.
        • Catalano L.
        • Evanoff B.A.
        Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs.
        J Orthop Trauma. 2002; 16: 449-457
        • Engsberg J.R.
        • Steger-May K.
        • Anglen J.O.
        • Borrelli Jr, J.
        An analysis of gait changes and functional outcome in patients surgically treated for displaced acetabular fractures.
        J Orthop Trauma. 2009; 23: 346-353
        • Letournel E.
        • Judet R.
        Fractures of the acetabulum.
        in: Elson R.A. 2nd ed. Springer, New York1993 (translator/editor)
        • Orthopaedic Trauma Association Committee for Coding and Classification
        Fracture and dislocation classification compendium.
        J Orthop Trauma. 2007; 21: S59-S67
        • Matta J.M.
        • Mehne D.K.
        • Roffi R.
        Fractures of the acetabulum.
        Clin Orthop Relat Res. 1986; 205: 241-250
        • Matta J.M.
        • Anderson L.M.
        • Epstein H.C.
        • Hendricks P.
        Fractures of the acetabulum.
        Clin Orthop. 1986; : 230-240
        • d'Aubigne R.M.
        • Postel M.
        Functional results of hip arthroplasty with acrylic prosthesis.
        J Bone Joint Surg Am. 1954; 36: 451-475
        • Bohannon R.W.
        • Andrews A.W.
        Interrater reliability of hand-held dynamometry.
        Phys Ther. 1987; 67: 931-933
        • Bohannon R.W.
        Test-retest reliability of hand-held dynamometry during a single session of strength assessment.
        Phys Ther. 1986; 66: 206-209
        • Prodromos C.C.
        • Andriacchi T.P.
        • Galante J.O.
        A relationship between gait and clinical changes following high tibial osteotomy.
        J Bone Joint Surg Am. 1985; 67: 1188-1194
        • Kepple T.M.
        • Siegel K.L.
        • Stanhope S.J.
        Relative contributions of the lower extremity joint moments to forward progression and support during gait.
        Gait Posture. 1997; 6: 1-8
        • Norris C.M.
        Abdominal muscle training in sport.
        Br J Sports Med. 1993; 27: 19-27
        • Hurwitz D.E.
        • Hulet C.H.
        • Andriacchi T.P.
        • Rosenberg A.G.
        • Galante J.O.
        Gait compensations in patients with osteoarthritis of the hip and their relationship to pain and passive hip motion.
        J Orthop Res. 1997; 15: 629-635
        • Rutherford D.J.
        • Hubley-Kozey C.
        Explaining the hip adduction moment variability during gait: implications for hip abductor strengthening.
        Clin Biomech. 2009; 24: 267-273
        • Hurwitz D.E.
        • Foucher K.C.
        • Sumner D.R.
        • Andriacchi T.P.
        • Rosenberg A.G.
        • Galante J.O.
        Hip motion and moments during gait relate directly to proximal femoral bone mineral density in patients with hip osteoarthritis.
        J Biomech. 1998; 31: 919-925
        • Sutherland A.G.
        • D'Arcy S.
        • Smart D.
        • Ashcroft G.P.
        Abductor weakness and stresses around acetabular components of total hip arthroplasty: a finite element analysis.
        Int Orthop. 1999; 23: 275-278
        • Tanaka Y.
        Gait analysis of patients with osteoarthritis of the hip and those with total hip arthroplasty.
        Biomed Mater Eng. 1998; 8: 187-196
        • Chang A.
        • Hayes K.
        • Dunlop D.
        • et al.
        Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression.
        Arthritis Rheum. 2005; 52: 3515-3519
        • Foroughi N.
        • Smith R.M.
        • Lange A.K.
        • Baker M.K.
        • Fiatarone Singh M.A.
        • Vanwanseele B.
        Lower limb muscle strengthening does not change frontal plane moments in women with knee osteoarthritis: a randomized controlled trial.
        Clin Biomech. 2011; 26: 167-174
        • Mündermann A.
        • Asay J.L.
        • Mündermann L.
        • Andriacchi T.P.
        Implications of increased medio-lateral trunk sway for ambulatory mechanics.
        J Biomech. 2008; 41: 165-170
        • Pennal G.F.
        • Davidson J.
        • Garside H.
        • Plewes J.
        Results of treatment of acetabular fractures.
        Clin Orthop. 1980; : 115-123
        • Oh C.W.
        • Kim P.T.
        • Park B.C.
        • et al.
        Results after operative treatment of transverse acetabular fractures.
        J Orthop Sci. 2006; 11: 478-484