Changes in Lower Limb Axial Alignment, Gait Biomechanics, and Plantar Force in Crowe Type IV Hip Dysplasia After Total Hip Arthroplasty: A Mean Ten-Year Follow-Up Retrospective Cohort Study

Huiling Chen; Junqing Wang; Yan Li; Steve T. L. Pambayi; Shijiu Yin; Jing Yang; Yong Nie; Yi Zeng

doi:10.1111/os.70258

Orthopaedic Surgery ›› 2026, Vol. 18 ›› Issue (3) :459 -473. DOI: 10.1111/os.70258

CLINICAL ARTICLE

Changes in Lower Limb Axial Alignment, Gait Biomechanics, and Plantar Force in Crowe Type IV Hip Dysplasia After Total Hip Arthroplasty: A Mean Ten-Year Follow-Up Retrospective Cohort Study

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Abstract

Objectives: Total hip arthroplasty (THA) is the gold standard for treating Crowe IV developmental dysplasia of the hip (DDH). However, its long-term effects on lower limb alignment, gait biomechanics, and plantar force in these patients remain underexplored, which is discussed in this article.

Methods: We conducted a retrospective cohort study that included 43 DDH Crowe IV patients who underwent THA between February 2008 and October 2019 and a control group of 43 matched healthy volunteers. Postoperative functional outcomes and quality of life were assessed using the Harris Hip Score, KOOS, AOFAS, and WOMAC scores. Lower limb alignment parameters (MAD, HKA, aTFA, mLDFA, mMPTA, and FO), knee alignment (HMFC, HLFC), and ankle alignment (mLDTA, FACO, and TT) were measured preoperatively, postoperatively, and at follow-up. Gait analysis and plantar force measurements were performed at the final follow-up.

Results: With an average follow-up of 10.2 years, patients showed significant improvement in functional and quality of life scores compared to pre-surgery. Preoperatively, all patients had knee valgus and ankle varus on the affected side. After THA, most parameters showed reduced valgus alignment, except for HKA and HLFC. On the unaffected side, MAD, aTFA, and HKA indicated preoperative valgus, which was fully corrected post-THA. Gait analysis revealed restricted lower limb motion and abnormal plantar force distribution that persisted postoperatively in Crowe IV DDH patients.

Conclusions: THA partially corrected abnormal lower limb alignment, gait parameters, and plantar force distribution in DDH Crowe IV patients over long-term follow-up.

Keywords

Crowe IV DDH / gait analysis / lower limb alignment / plantar force / THA

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Huiling Chen, Junqing Wang, Yan Li, Steve T. L. Pambayi, Shijiu Yin, Jing Yang, Yong Nie, Yi Zeng. Changes in Lower Limb Axial Alignment, Gait Biomechanics, and Plantar Force in Crowe Type IV Hip Dysplasia After Total Hip Arthroplasty: A Mean Ten-Year Follow-Up Retrospective Cohort Study. Orthopaedic Surgery, 2026, 18 (3) : 459-473 DOI:10.1111/os.70258

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