A Question A Day (W3D1)

Madam M underwent Total Hip Replacement of the left hip one month ago. Her physiotherapist
noticed that she walks with a limping gait as shown in the video clip.

https://www.youtube.com/watch?v=ZUPQp5oxXj8

Q1. Name the abnormal gait of Madam M and state the findings from your observation. (4 marks)

Trendelenburg Gait. There’s a drop in the right hip up when she’s standing on the left leg
(during right leg swing phase)

Q2. Outline the pathophysiology of her abnormal gait. (2 marks)

When there’s a neuromuscular weakness in the left hip abductors (gluteus medius &
minimus), it can’t keep or maintain the pelvis, so a stabilizing effect of these muscles which
causes a trunk list laterally over the weak hip to maintain the center of gravity, causing a
contralateral side droop.

Where is the other underlying cause?

Damage to superior gluteal nerve / gluteus medius muscle from hip arthroplasty

Q3. How do you differentiate her abnormal gait from “short limb gait” of the opposite side? (2
marks)

Looking at the knee flexion during walking. There seems to be more flexion of the right knee during
walking as compared to the left side.

Q4. Is Madam M holding the walking stick at the correct side? Kindly explain. (2 marks)

Mdm M is holding walking stick at the wrong side. It should be at the side of the hip where
she can’t support to counteract the downward pelvic tilting on that side.

The Trendelenburg gait that is demonstrated by this patient can be due to the cause(s) below:

A. Weakness of the gluteal muscles from superior gluteal nerve injury.

B. Incision of gluteal medius muscle during THR.

C. Shortening of proximal femur from undersized prosthesis in THR.

D. All of above.

Ans: D