Changes in lower limb muscle strength and corresponding gait changes following hip fractures in older adults: a...

This narrative review synthesizes available evidence on changes in lower limb muscle strength and corresponding gait alterations following hip fracture in older adults, aiming to provide a biomechanically grounded framework for precision rehabilitation. A structured literature search was conducted across major electronic databases (PubMed, Scopus, Web of Science, Embase, and the Cochrane Library) from inception to January 31, 2026, and findings were synthesized descriptively. The evidence indicates that muscle strength decline exhibits group-specific patterns: hip abductor weakness is associated with pelvic instability and Trendelenburg gait; quadriceps atrophy correlates with knee instability and limited flexion-extension; and weakness of the gluteus maximus and calf muscles appears linked to reduced stride length and diminished propulsive force. Recovery of muscle strength and gait typically follows a trajectory of rapid decline, gradual improvement within the first six months, and long-term persistence of sub-baseline levels, with bilateral asymmetry often lasting 1-2 years post-surgery; gait speed, stride length, and symmetry frequently remain impaired despite rehabilitation. These findings suggest that biomechanically informed, muscle group-specific training-guided by individual gait analysis-may enhance functional recovery and reduce fall risk, encouraging clinicians to move beyond generic lower-limb strengthening programs toward targeted, mechanism-based interventions.