Article
Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial1,

https://doi.org/10.1016/S0003-9993(03)00434-9Get rights and content

Abstract

Hesse S, Werner C, Seibel H, von Frankenberg S, Kappel E-M, Kirker S, Käding M. Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil 2003;84:1767–73.

Objective

To compare treadmill training with partial body-weight support (TT-BWS) and conventional physical therapy (PT) in ambulatory patients with hip arthroplasty.

Design

Randomized controlled trial.

Participants

Eighty patients with a fully loadable implant who could walk independently with crutches after unilateral total hip arthroplasty were randomized to receive either TT-BWS (treatment group) or conventional PT (controls), for 10 working days.

Interventions

Each patient received 45 minutes of individualized PT, either treadmill training plus PT in the experimental or PT alone in the control group.

Main outcome measures

The Harris score, recorded by blind assessors, served as the primary outcome measure. Secondary outcome measures were the hip extension deficit, gait velocity, gait symmetry, affected hip abductor power; hip abductor amplitude of electromyographic activation; and the interval from surgery to abandoning crutches.

Results

At the end of training, the treatment group’s Harris score was 13.6 points higher (P<.0001) than the control group’s score. Further, hip extension deficit was 6.8° less (P<.0001), gait symmetry was 10% greater (P=.001), affected hip abductor was stronger (Medical Research Council grades 4.24 vs 3.73; P<.0001), and the amplitude of gluteus medius activity was 41.5% greater (P=.001) than those measures for controls. Gait velocity did not differ in the 2 groups. These significant differences in favor of the treatment group persisted at 3 and 12 months. The treatment group abandoned crutches sooner than the control group (3 vs 8wk). In the treatment group, 39 patients finished treatment, 35 appeared at 3, and 26 at 12 months for follow-up. In the control group, the corresponding numbers were 40, 35, and 24 patients, respectively.

Conclusion

TT-BWS is more effective than conventional PT at restoring symmetrical independent walking after hip replacement.

Section snippets

Participants

Between September 1, 1999, and December 31, 2001, we recruited 812 patients with THA from 1 center, of whom 80 met our inclusion criteria. Inclusion criteria were (1) age under 75 years, (2) first time unilateral total hip replacement for osteoarthrosis or hip fracture, (3) willingness to participate in a 2-week rehabilitation program at Klinik Berlin, (4) fully loadable cemented or cement-free prosthesis, (5) ability to walk reciprocally with 2 forearm aluminum crutches with adjustable forearm

Results

Starting with 40 participants per group, 39 in the treatment group completed the trial and 35 made it to the first follow-up at 3 months. In the control group, 40 completed the trial, 35 made it to follow-up. With further dropouts, 26 patients in the treatment group and 24 in the control group completed the 12-month study (fig 1). The clinical data and the outcome measures did not differ significantly at the beginning of the study for the dropouts from either groups (14 in the treatment group,

Discussion

The treatment group was superior to the control group in every parameter measured, except walking velocity at the end of training and 3 and 12 months later. The patients in the treatment group abandoned their crutches earlier, and none had additional surgery on the same side. In the control group, 4 patients received a reimplant due to loosening within 1 year.

Both groups were homogeneous with respect to the clinical characteristics and the outcome measures before training, the net therapy time

Conclusion

A 10-day TT-BWS program proved superior in hip arthroplasty patients with a fully loadable implant as measured by the Harris score, hip extension deficit, walking symmetry, and hip abductor muscle strength. The repetitive practice of walking in conjunction with a more effective strengthening of the hip abductor may be the factors that explain the better outcome of the treadmill subjects.

Acknowledgements

We thank Manuela Schiesser and Stefanie Grunert for their help with the patients.

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    Supported by the Bundesversicherungsanstalt für Angestellte, BfA (grant no. 8011-106-31/31.46).

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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