步态和功能性适应

退行性病变患者和人工关节置换患者会改变其行走步态以完成日常活动，这种改变可以认为是对疼痛、肌肉无力或不稳定适应的结果。例如在行走中单腿支撑阶段，外展肌会收缩阻止躯干和抬起腿，向支撑腿摇摆。如果外展肌的肌力下降或外展肌力臂缩短，患者会在行走中表现出Trendelenburg步态，以减少对外展肌的需要。

全髋置换后的患者表现出典型的减慢步速和缩短步幅的步态特征，报道的一些关节炎不正常步态也是减慢步速的直接后果。习惯性增加正常下肢在行走中的负重时间，目的是增加患肢摇摆的时间，以带动患肢完成其弧形移动过程。降低步幅可以减少患肢最大的髋关节的屈曲度、降低在摆动患肢时膝关节屈曲度以及伸脚趾时踝关节的过伸程度。

在全髋置换术前，患者通常表现出丧失部分髋关节屈伸活动度和犹豫的步态，或者在起步阶段的屈曲动作。这些动作可能是由屈曲挛缩造成的，或因脊柱过度前凸补偿性减少伸髋动作。在冠状面，患者躯干转向患肢以增加稳定性，降低外展肌肌肉收缩的需要和髋关节关节面的应力；在水平面，增加的外旋可以在足跟着地时增加髋关节外侧的稳定性。

大量的全髋置换手术后，尽管患髋疼痛消失并改善了髋关节的功能，但是患者并不能完全恢复所有的髋关节功能。一般情况，髋关节置换术后，通过增加步幅、步频和髋关节活动度的方式增加了患者的步速，通过减少向一侧的蹒跚，其起步阶段更为协调和系统。在矢面，髋关节的活动范围更大，但仍然少于正常情况，这种活动范围的减少，使得前后方向上的髋关节应力也有所减少，减少了股骨柄扭转力矩可以增加髋关节的稳定性。

临床试验证实，股骨柄外翻放置在减少不正常步态方面好于股骨柄内翻放置。这可能说明患者在步态方面有生物力学的适应性，以适应增加的髋关节屈曲程度或由内翻髋造成股骨柄的微动。

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