Preoperative Gait Analysis Predicts Surgical Candidacy and Clinical Severity in Hip Osteoarthritis

BACKGROUND: Hip osteoarthritis (OA) is a common cause of chronic pain, functional limitation, and eventual total hip arthroplasty (THA). Surgical decision-making is mainly based on radiographic findings and patient-reported outcomes, which may not adequately reflect functional impairment during dynamic activities. This study examined the relationships between preoperative gait parameters and structural, pain-related, and functional indicators in hip osteoarthritis and assessed their relevance to 12-months postoperative outcomes. METHODS: This single-center study included patients who had hip osteoarthritis undergoing unilateral THA and matched nonoperative controls. All participants underwent preoperative three-dimensional gait analysis and clinical evaluation, including joint space width, visual analog scale, Harris Hip Score, and Hip disability and Osteoarthritis Outcome Score. Associations were assessed using regression and hierarchical models to evaluate whether gait parameters improved prediction of 12-months postoperative outcomes. RESULTS: Narrower joint space width and lower Harris Hip Score were associated with THA (both P = 0.012). After adjustment, step length and knee range of motion remained positively associated with joint space width (P = 0.013 and P < 0.001), whereas atypical gait cycles on the affected side were associated with pain severity and functional status (both P < 0.001). Preoperative gait parameters did not improve prediction of postoperative pain at 12 months but improved prediction of functional outcomes (both P < 0.001). The receiver operating characteristic (ROC) analyses showed better discrimination by gait parameters than clinical variables, with the combined model performing best (area under the curve [AUC] = 0.953). CONCLUSIONS: Preoperative gait parameters are associated with structural degeneration, pain severity, and functional impairment in hip OA and add predictive value for postoperative functional outcomes. Gait analysis complements conventional assessments, supporting a more objective evaluation of disease severity and surgical decision-making.