Bold premise: a simple preoperative walking speed test can reveal who will truly thrive after a hip replacement. A 10-meter gait speed assessment, performed before surgery, may help clinicians and patients pinpoint the best timing for total hip arthroplasty (THA) and set realistic expectations for recovery.
A study published in The Journal of Bone and Joint Surgery investigated whether preoperative gait speed can forecast patient-reported outcomes after THA for hip osteoarthritis. By analyzing patient data, the researchers found that gait speed measured before surgery is a meaningful predictor of how patients report their pain, function, and overall satisfaction after THA.
Understanding why recovery varies
Total hip arthroplasty is a well-established procedure designed to restore mobility in individuals with severe hip damage, often from osteoarthritis. While long-term results are generally excellent, the pace and quality of recovery differ widely among patients. Current guidelines for recommending THA rely on limited evidence, highlighting the need for reliable preoperative indicators that forecast postoperative outcomes.
What the study did
Researchers from Kyushu University in Japan studied 274 patients with hip osteoarthritis who underwent THA. They collected preoperative data on symptom duration, pain intensity, hip range of motion, lower-limb muscle strength, and walking speed over a 10-meter distance. After surgery, patient-reported outcomes were measured using two tools: the Oxford Hip Score (OHS), which assesses hip pain and function, and the Forgotten Joint Score-12 (FJS-12), which gauges how aware patients are of their artificial joint during daily activities.
Key findings in plain terms
- Preoperative gait speed emerged as a significant predictor of postoperative outcomes. In other words, how fast a patient could walk before surgery correlated with how well they fared afterward.
- Hip flexion range of motion and hip flexion strength were also meaningfully linked to preoperative gait speed, suggesting that joint flexibility and muscle strength contribute to early walking performance.
- Specific gait speed thresholds were identified: 0.7 meters per second (m/s) predicted clinically meaningful improvement in hip pain, and 1.0 m/s predicted meaningful improvement in awareness of the prosthesis during daily life. Notably, a gait speed of 1.0 m/s stood out as the strongest independent predictor of excellent postoperative outcomes.
Why these numbers matter
The 1.0 m/s cutoff aligns with established criteria for sarcopenia and with typical walking speeds observed in adults aged 60–69, which range roughly from 1.2 to 1.4 m/s. This suggests that a slower preoperative walking speed (below 1.0 m/s) may indicate when THA could be most beneficial, serving as a practical benchmark for decision-making about surgery timing.
Gait speed as a practical, broadly applicable measure
Gait speed reflects the integrated performance of cardiovascular, neurological, and musculoskeletal systems. Because the test requires minimal equipment, it can be easily deployed across diverse clinical settings, making it a feasible and meaningful tool for preoperative assessment. A small drop in speed (for example, 0.1 m/s) has been associated with reduced survival in older adults, underscoring why even modest changes in gait speed can matter clinically.
Contributors to preoperative gait speed and how to improve it
Age, hip flexion range of motion, hip flexion strength, and pain intensity all influence preoperative gait speed. Evidence suggests that reducing hip joint stiffness and strengthening hip flexors can positively impact walking speed before surgery. Consequently, preoperative rehabilitation that focuses on preserving or improving hip range of motion, boosting hip flexor strength, and promoting overall physical activity may help patients achieve better postoperative outcomes, regardless of age.
Practical takeaways for patients and clinicians
- Measure gait speed before THA as part of a thorough preoperative evaluation to help predict postoperative recovery potential.
- Consider targeted prehabilitation focusing on hip flexibility, hip strength, and general activity to optimize gait speed and postoperative results.
- Use the 1.0 m/s threshold as a guide for timing decisions, while recognizing that individual factors—such as other joint conditions or the use of assistive devices—may influence gait speed measurements.
Limitations to keep in mind
Some measurements allowed walking with a cane, which could overestimate true capacity for some patients. The study also included individuals with arthritis in the spine or other joints, which might have affected gait speed overall. These factors should be considered when applying the findings to individual cases.
Reference
Nakao, Y., Hamai, S., Yamate, S., et al. (2025). Preoperative Gait Speed as a Predictor of Patient-Reported Outcomes After Total Hip Arthroplasty – Insights from Patient Acceptable Symptom State and K-Means Clustering Analyses. The Journal of Bone and Joint Surgery. DOI: 10.2106/JBJS.25.00542.
