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Trendelenberg Gait?

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No really, there is such a thing. Apparently my ortho doc thinks I suffer from it althoutgh he never told me so. I only know about it because I am seeing a new ortho doc & requested my records, 6 years worth of them. There it was, this Trendelenberg Gait. Basically it means a dropping of one hip when stepping on that side due to muscle weakness or damage. The problem is that this wicked side to side sway I have which requires the use of a cane wasn't a problem until AFTER my TKR. I have suffered from advanced arthritis since my teens so it's no shock that my knee(s) need replacing. But I never had a chronic limp BEFORE the TKR. I've not walked unassisted since getting my knee 'fixed'. For some odd reason I walk a tiny bit better when barefooted. Every time I say that or demonstrate that to one of my healthcare profs they get a funny look. I'm just now realizing that my ortho doc has not been completely forthcoming with me about either my overall joint health or my surgery.
Not that I totally regret having an artificial knee, by no means. The pain was excruciating, like it is now on the left side. The surgery definitely improved the pain. But the tradeoff has been a severe limp, or an abnormal gait, apparently. I'm seeing the new guy next week. I'm armed with records and x-rays so hopefully he'll be able to get a handle on my situation quickly. I feel quite certain that I'm going to need a 2nd TKR on the left. It usually follows. But if I'm that much worse off after THIS procedure than the last I'll be in a wheelchair! Sorry this is so long. I just needed to vent. Can anyone relate?
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replied December 7th, 2012
Especially eHealthy
Oldspam,

Sorry that you are having problems.

It is actually quite rare to develop a Trendelenburg gait from a total knee arthroplasty. However, it is actually fairly common after of total hip arthroplasty.

A Trendelenburg gait (also called a gluteus medius lurch) is caused by weakness in the pelvic girdle muscles, specially the gluteus medius and minimus muscles. This is why it is seen commonly after a THA, where the medius muscle is often detached during the approach to the hip joint. But, in a total knee, the pelvic muscles are not touched.


There is also two types of Trendelenburg gait; compensated and uncompensated. It is difficult to describe the difference, it is easier if one sees it. But, in the uncompensated one, due to weakness of the medius, the patient's trunk drops to the side opposite the weak muscles, and the hip on the same side as the weak muscles thrusts out sideways. In the compensated gait, the patient will lean his body way over the weak side, to balance the trunk, so that there is no drop of the pelvis. Again, it is easier to see someone demonstrating the difference.


So, again, the gluteus medius lurch, or Trendelenburg gait, is caused by weakness of the lateral pelvic girdle muscles, speciafically the gluteus medius and minimus. There are many reasons why these muscles can be weak: polio, nerve damage, spinal conditions, trauma to the pelvis, residuals of hip surgery, certain muscle diseases, weakness from deconditioning, and habit.


I am not saying that your Trendelenburg gait did not start after your TKA, but the procedure for a total knee does not affect the muscles of the hip.

Thus, it is important to find out the etiology of the weakness in the pelvic muscles. You may need to have some electrical studies (EMG - electromyography, NCV - nerve conduction velocity) to determine if there is a nerve condition causing the weakness. If you have not had a gait analysis, that might be of great benefit to you. During a gait analysis, it can be determined exactly which muscles are not functioning properly.

It is important to find the exact cause of the condition, because some are reversible, while others are progressive. Thus, knowing the cause, you can be managed better.


Good luck. Wishing you the best during the holiday season.
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