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Rivera RJ, Karasavvidis T, Pagan C, Haffner R, Ast MP, Vigdorchik JM, Debbi EM. Functional assessment in patients undergoing total hip arthroplasty. Bone Joint J 2024; 106-B:764-774. [PMID: 39084648 DOI: 10.1302/0301-620x.106b8.bjj-2024-0142.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims Conventional patient-reported surveys, used for patients undergoing total hip arthroplasty (THA), are limited by subjectivity and recall bias. Objective functional evaluation, such as gait analysis, to delineate a patient's functional capacity and customize surgical interventions, may address these shortcomings. This systematic review endeavours to investigate the application of objective functional assessments in appraising individuals undergoing THA. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Eligible studies of THA patients that conducted at least one type of objective functional assessment both pre- and postoperatively were identified through Embase, Medline/PubMed, and Cochrane Central database-searching from inception to 15 September 2023. The assessments included were subgrouped for analysis: gait analysis, motion analysis, wearables, and strength tests. Results A total of 130 studies using 15 distinct objective functional assessment methods (FAMs) were identified. The most frequently used method was instrumented gait/motion analysis, followed by the Timed-Up-and-Go test (TUG), 6 minute walk test, timed stair climbing test, and various strength tests. These assessments were characterized by their diagnostic precision and applicability to daily activities. Wearables were frequently used, offering cost-effectiveness and remote monitoring benefits. However, their accuracy and potential discomfort for patients must be considered. Conclusion The integration of objective functional assessments in THA presents promise as a progress-tracking modality for improving patient outcomes. Gait analysis and the TUG, along with advancing wearable sensor technology, have the potential to enhance patient care, surgical planning, and rehabilitation.
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Affiliation(s)
- Richard J Rivera
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Cale Pagan
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Rowan Haffner
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Huang L, Han W, Qi W, Zhang X, Lv Z, Lu Y, Zou D. Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: a systematic review and meta-analysis. Front Surg 2023; 10:1225649. [PMID: 38033533 PMCID: PMC10684916 DOI: 10.3389/fsurg.2023.1225649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Background The choice of postoperative weight bearing protocol after uncemented total hip arthroplasty (THA) remains controversial. The aim of this study was to assess the efficacy and safety of immediate unrestricted weight bearing (UWB) compared with partial weight bearing (PWB) in patients undergoing uncemented THA. Methods Relevant articles were retrieved from electronic databases. Both randomized controlled trials (RCTs) and non-RCTs were included but analyzed separately. All functional and clinical outcomes with at least 2 independent study outcomes were meta-analyzed. Results A total of 17 studies were investigated. No adverse effect was found regarding micromotion of the femoral stem with immediate UWB following uncemented THA. There was also no correlation between immediate UWB and failure of ingrowth fixation and higher risks of femoral stem subsidence and surgical revision in RCTs. Harris hip score was better in patients with immediate UWB than those with PWB at 1 year post surgery, but the difference was not statistically significant. Conclusions Immediate UWB did not have extra harm compared with PWB in patients undergoing uncemented THA. UWB was not superior to PWB. Considering the improvement of Harris score and the compliance of patients, UWB can be encouraged in THA rehabilitation.
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Affiliation(s)
- Li Huang
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weiyu Han
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Weizhong Qi
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaomeng Zhang
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhou Lv
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yao Lu
- Department of Joint and Orthopedics, Orthopedic Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Danfeng Zou
- Huiqiao Medical Center, Nanfang Hospital of Southern Medical University, Guangzhou, China
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Başar B, Başar H. The effects of full weight-bearing mobilization on clinical outcomes and subsidence in cemented and uncemented hemiarthroplasty in osteoporotic patients: A retrospective single-center study. J Back Musculoskelet Rehabil 2022; 35:811-818. [PMID: 34957985 DOI: 10.3233/bmr-210024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early full weight-bearing mobilization is controversial in osteoporotic patients who have undergone uncemented hemiarthroplasty (UCH). OBJECTIVES The aim of the study was to compare the results of early full weight-bearing mobilization in CH and uncemented hemiarthroplasty (UCH). The effect of subsidence on the results was also evaluated. METHODS Fifty-nine patients who underwent CH and UCH were evaluated. The mean age was 79.8 years (10 females, 15 males) for CH and 75.5 years (10 females, 24 males) for UCH. All patients started immediate full weight-bearing mobilization and weight-bearing exercises. RESULTS There was no difference between the groups according to the Harris Hip Score. Both groups were evaluated in subgroups according to whether there is varus in the femoral stem. There was no difference between subgroups according to the Harris Hip Score. The femoral subsidence was not determined in CH group. In the UCH group, the subsidence was 1.13 ± 1.03 mm in varus femoral stem subgroup and 0.81 ± 0.85 mm in without femoral stem varus subgroup. There was no difference in subsidence between femoral stem with varus and without varus. The subsidence did not affect the Harris Hip Score. CONCLUSION Full weight-bearing mobilization could be safely preferred in UCH, as in CH. Femoral stem varus below 5 degrees does not affect the results and subsidence.
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Affiliation(s)
- Betül Başar
- Department of Physical Medicine and Rehabilitation, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hakan Başar
- Department of Orthopaedics and Traumatology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Alves SA, Preuße M, Hommel H, Duda GN, Agres AN. The Recovery of Weight-Bearing Symmetry After Total Hip Arthroplasty Is Activity-Dependent. Front Bioeng Biotechnol 2022; 10:813345. [PMID: 35284427 PMCID: PMC8907721 DOI: 10.3389/fbioe.2022.813345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/28/2022] [Indexed: 11/26/2022] Open
Abstract
This study aimed to characterize ipsilateral loading and return to weight-bearing symmetry (WBS) in patients undergoing total hip arthroplasty (THA) during activities of daily living (ADLs) using instrumented insoles. A prospective study in 25 THA patients was performed, which included controlled pre- and postoperative follow-ups in a single rehabilitation center of an orthopedic department. Ipsilateral loading and WBS of ADLs were measured with insoles in THA patients and in a healthy control group of 25 participants. Measurements in the THA group were performed at 4 different visits: a week pre-THA, within a week post-THA, 3–6 weeks post-THA, and 6–12 weeks post-THA, whereas the healthy control group was measured once. ADLs included standing comfortably, standing evenly, walking, and sit-to-stand-to-sit (StS) transitions. All ADLs were analyzed using discrete methods, and walking included a time-scale analysis to provide temporal insights in the ipsilateral loading and WBS waveforms. THA patients only improved beyond their pre-surgery levels while standing comfortably (ipsilateral loading and WBS, p < 0.05) and during StS transitions (WBS, p < 0.05). Nevertheless, patients improved upon their ipsilateral loading and WBS deficits observed within a week post-surgery across all investigated ADLs. Ipsilateral loading and WBS of THA patients were comparable to healthy participants at 6–12 weeks post-THA, except for ipsilateral loading during walking (p < 0.05) at the initial and terminal double-leg support period of the stance phase. Taken together, insole measurements allow for the quantification of ipsilateral loading and WBS deficits during ADLs, identifying differences between pre- and postoperative periods, and differentiating THA patients from healthy participants. However, post-THA measurements that lack pre-surgery assessments may not be sensitive to identifying patient-specific improvements in ipsilateral loading and WBS. Moreover, StS transitions and earlier follow-up time points should be considered an important clinical metric of biomechanical recovery after THA.
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Affiliation(s)
- Sónia A. Alves
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
- *Correspondence: Sónia A. Alves,
| | - Marco Preuße
- Klinik für Orthopädie und Traumatologie, Krankenhaus Märkisch-Oderland, Wriezen, Germany
| | - Hagen Hommel
- Klinik für Orthopädie und Traumatologie, Krankenhaus Märkisch-Oderland, Wriezen, Germany
| | - Georg N. Duda
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Alison N. Agres
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
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Sarac DC, Yalcinkaya G, Unver B. Validity and reliability of a smartphone goniometer application for measuring hip range of motions. Work 2022; 71:275-280. [PMID: 34924431 DOI: 10.3233/wor-213626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mobile applications which are designed to assess the range of motion (ROM) are widely used. OBJECTIVE The aim of this cross-sectional observational study was to determine the inter-observer and intra-observer reliability of a smartphone application "PT Goniometer" (PTG) and determine the correlation between PTG and universal goniometer (UG) regarding active ROMs of the hip in healthy participants. METHODS Thirty-four healthy young participants were included in the study. Two physiotherapists performed active hip flexion, abduction, internal rotation and external rotation ROM measurements of dominant legs of the participants by using PTG and UG. Intraclass correlation coefficients (ICC) were calculated to determine the intra-observer and inter-observer reliability. Level of correlations between PTG and UG were used to establish concurrent validity of PTG. RESULTS The PTG demonstrated excellent inter-observer and intra-observer reliability (ICC > 0.90) for all measured hip movements. The minimum detectable change (MDC95) was ranged from 3.29° to 5.1° for the intra-observer reliability, and from 2.55° to 3.21° for the inter-observer reliability. Additionally, the concurrent validity was found excellent (r = 0.91-0.93). CONCLUSION The results of the present study suggest that PTG is a valid and reliable mobile technology for measuring hip ROMs.
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Affiliation(s)
- Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Gamze Yalcinkaya
- Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Bayram Unver
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey
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Effect of 4 Weeks of Anti-Gravity Treadmill Training on Isokinetic Muscle Strength and Muscle Activity in Adults Patients with a Femoral Fracture: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228572. [PMID: 33227913 PMCID: PMC7699176 DOI: 10.3390/ijerph17228572] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 11/17/2022]
Abstract
This study aimed to identify the effect of anti-gravity treadmill training on isokinetic lower-limb muscle strength and muscle activities in patients surgically treated for a hip fracture. A total of 34 participants were randomly assigned into two groups: anti-gravity treadmill training group (n = 17) and control group (n = 17). The isokinetic muscle strength and endurance of hip flexor and extensor and the activities of the vastus lateralis (VL), vastus medialis (VM), gluteus maximus (GM), and gluteus medialis (Gm) muscles were measured before and after 4 weeks of the interventions. Significant improvements were observed in isokinetic muscle strength and endurance of hip flexors and extensors in both groups (p < 0.05); however, no significant differences were observed between the groups (p > 0.05) except for muscle strength of the hip extensor (d = 0.78, p = 0029). Statistically significant increases in the muscle activity of VL, VM, GM, and Gm were found before and after the intervention (p < 0.05), and significant differences in muscle activities of GM (d = 2.64, p < 0.001) and Gm (d = 2.59, p < 0.001) were observed between the groups. Our results indicate that both groups showed improvement in muscle strength, endurance, and activities after the intervention. Additionally, anti-gravity treadmill training improved significantly more muscle strength at 60°/s of the hip extensor and gluteus muscle activities than conventional therapy, which may be appropriate for patients with hip fracture surgery.
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Marchisio AE, Ribeiro TA, Umpierres CSA, GalvÃo LÍ, Rosito R, Macedo CADES, Galia CR. Accelerated rehabilitation versus conventional rehabilitation in total hip arthroplasty (ARTHA): a randomized double blinded clinical trial. ACTA ACUST UNITED AC 2020; 47:e20202548. [PMID: 32844909 DOI: 10.1590/0100-6991e-20202548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES compare an accelerated physiotherapeutic protocol to a conventional physiotherapeutic protocol in total hip arthroplasty patients. METHODS a randomized double blinded clinical trial performed from August 2013 to November 2014. Forty-eight patients diagnosed with hip osteoarthritis submitted to a total hip arthroplasty surgery. An accelerated rehabilitation physiotherapy applied three times a day and start gait training on the first day or standard physiotherapy applied once a day and start gait training on the second or third day of hospitalization. The Merle dAubigné and Postel score (mobility, pain and gait), muscle strength force, range of motion, in hospital stay and time to start of gait training, were the outcomes. RESULTS the mean age was 64.46 years (10.37 years standard deviation). No differences were observed in age in different genders, and the two randomization groups were homogeneous. In hospital stay was lower in the intervention group compared to the control group, 3 (3-4) days [median (interquartile range)] versus 4 (4-5) days. Time to the start of gait training was early in the intervention group compared to the control group, 1 (1-1) days versus 2 (2-2) days. Higher muscle strength values were observed in the postoperative results in the intervention group compared to the control group for internal rotation, external rotation and abduction. CONCLUSIONS an accelerated physiotherapeutic protocol should be encouraged, because it shows favourable results in gait, muscle strength and length of hospital stay, even upon hospital discharge.
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Affiliation(s)
- Angela Elizabeth Marchisio
- Postgraduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tiango Aguiar Ribeiro
- Postgraduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Carolina Sant Anna Umpierres
- Postgraduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - LÍvia GalvÃo
- Postgraduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ricardo Rosito
- Hip Surgery of the Department of Orthopedic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | | | - Carlos Roberto Galia
- Postgraduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Tian P, Li ZJ, Xu GJ, Sun XL, Ma XL. Partial versus early full weight bearing after uncemented total hip arthroplasty: a meta-analysis. J Orthop Surg Res 2017; 12:31. [PMID: 28212661 PMCID: PMC5316222 DOI: 10.1186/s13018-017-0527-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This meta-analysis aimed to investigate the efficacy and safety of partial weight bearing (PWB) versus early full weight bearing (FWB) after uncemented total hip arthroplasty (THA). METHODS We conducted a search in PubMed, EMBASE, The Cochrane Library, and Web of Science for randomized controlled trials (RCTs) and non-RCTs comparing PWB and early FWB after uncemented THA. Two authors conducted the selection of studies, data extraction, and assessment of risk of bias independently. A pooled meta-analysis was performed using the RevMan 5.3 software. RESULTS Six RCTs and three non-RCTs met the inclusion criteria. The meta-analysis indicated that compared with PWB, the FWB group showed greater femoral subsidence at 3-month follow-up (MD = -0.12, 95% CI -0.22 to -0.01, P = 0.03). There were no significant differences in the hip Harris score at 1-year and 2-year follow-up (MD = 1.54, 95% CI -0.83 to 3.90, P = 0.20; MD = 0.08, 95% CI -1.19 to 1.34, P = 0.90, respectively), in femoral subsidence at 2-year follow-up and at two additional years of follow-up (MD = -0.03, 95% CI -0.31 to 0.25, P = 0.84; (MD = -0.02, 95% CI -0.37 to 0.33, P = 0.91, respectively). There were no significant differences in the incidences of bone ingrowth fixation, spot welds, and radiolucent lines. CONCLUSIONS This meta-analysis shows that early FWB in patients with uncemented THA could be safe and could not increase the incidence of postoperative complications.
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Affiliation(s)
- Peng Tian
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China
| | - Zhi-Jun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Gui-Jun Xu
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China
| | - Xiao-Lei Sun
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China
| | - Xin-Long Ma
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China.
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Unver B, Kahraman T, Kalkan S, Yuksel E, Karatosun V, Gunal I. Test-retest reliability of the stair test in patients with total hip arthroplasty. Hip Int 2015; 25:160-3. [PMID: 25633756 DOI: 10.5301/hipint.5000217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE Stair climbing is one of the important functional activities of daily living to maintain mobility and independence. Walking and stair climbing have been identified by clinicians and patients as critical functional activities before and after total hip arthroplasty (THA). Testing the ability to manage steps has been commonly used in clinical and research settings because it is an inexpensive and simple way to measure functional status after THA. The frequent use of this test supports studies seeking evidence to validate stair test (ST) as a measure of physical performance in subjects with THA. The aim of this study is to determine the test-retest reliability of the 9-step ST in patients with THA. METHODS Patients performed twice trials for the ST on the same day with one hour interval. To assess test-retest reliability, the intra-class correlation coefficient--ICC (2,1), standard error of measurement (SEM), minimal detectable change at the 90% confidence level (MDC90) were calculated. RESULTS A total of 37 patients with THA participated in this study. The ST showed very high reliability (ICC = 0.98 (95% CI, 0.96 to 0.99)). The SEM was 0.3 seconds and the MDC90 was 0.7 seconds. CONCLUSIONS Test-retest reliability of the ST was very high for the patients with THA, and the SEM and MDC90 were adequate for clinical use. The ST is less time consuming and has very high reliability to measure the functional level after THA in the clinical setting.
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Affiliation(s)
- Bayram Unver
- 1 School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir - Turkey
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Sengul YS, Unver B, Karatosun V, Gunal I. Assessment of pain-related fear in patients with the thrust plate prosthesis (TPP): due to hip fracture and hip osteoarthritis. Arch Gerontol Geriatr 2011; 53:e249-52. [PMID: 21680032 DOI: 10.1016/j.archger.2011.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 05/05/2011] [Indexed: 02/08/2023]
Abstract
The aim of this study is to determine the differences between hip fracture and hip arthrosis groups and to assess pain related fear of injury in patients who were operated using the TPP following hip fracture or hip arthrosis. Fifty-eight patients (mean age = 63.9 ± 10.3 years) who were operated using the TPP, following hip fracture (hip fracture group; n = 25) or coxarthrosis (coxarthrosis group; n = 33) were recruited. All of the measurements were performed after a follow-up time of at least 2 years. Functional level by Harris Hip Scoring System (HHS), pain related fear by Tampa Scale for Kinesiophobia (TSK) and pain intensity by numerical rating scale (NRS) was evaluated. There were no significant differences between demographic and clinical characteristics of two groups. However, pain intensity was higher in coxarthrosis group than hip fracture group. There was no correlation between the TSK scores and either Harris scores or NRS scores (p > 0.05) in the hip fracture group. No correlation between NRS and TSK was found in coxarthrosis group but there was a significant correlation between TSK and HHS. TSK scores were high in both groups. High TSK scores proved us that the patients with TPP had fear of movement even they had enough physical performance. The coxarthrosis group had higher pain intensity. Rehabilitation clinicians should consider pain-related belief which is more important than pain intensity and functional level in coxarthrosis patients.
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Affiliation(s)
- Yesim Salik Sengul
- Dokuz Eylul University, School of Physical Therapy and Rehabilitation, Inciralti, 35340 Izmir, Turkey.
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12
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Recovery of physical functioning after total hip arthroplasty: systematic review and meta-analysis of the literature. Phys Ther 2011; 91:615-29. [PMID: 21393418 DOI: 10.2522/ptj.20100201] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND After total hip arthroplasty (THA), patients today (who tend to be younger and more active than those who previously underwent this surgical procedure) have high expectations regarding functional outcome. Therefore, patients need to be well informed about recovery of physical functioning after THA. PURPOSE The purpose of this study was to review publications on recovery of physical functioning after THA and examine the degree of recovery with regard to 3 aspects of functioning (ie, perceived physical functioning, functional capacity to perform activities, and actual daily activity in the home situation). DATA SOURCES Data were obtained from the MEDLINE and EMBASE databases from inception to July 2009, and references in identified articles were tracked. STUDY SELECTION Prospective studies with a before-after design were included. Patients included in the analysis had to have primary THA for osteoarthritis. DATA EXTRACTION AND SYNTHESIS Two reviewers independently checked the inclusion criteria, conducted the risk of bias assessment, and extracted the results. Data were pooled in a meta-analysis using a random-effects model. RESULTS A total of 31 studies were included. For perceived physical functioning, patients recovered from less than 50% preoperatively to about 80% of that of controls (individuals who were healthy) 6 to 8 months postsurgery. On functional capacity, patients recovered from 70% preoperatively to about 80% of that of controls 6 to 8 months postsurgery. For actual daily activity, patients recovered from 80% preoperatively to 84% of that of controls at 6 months postsurgery. LIMITATIONS Only a few studies were retrieved that investigated the recovery of physical functioning longer than 8 months after surgery. CONCLUSIONS Compared with the preoperative situation, the 3 aspects of physical functioning showed varying degrees of recovery after surgery. At 6 to 8 months postoperatively, physical functioning had generally recovered to about 80% of that of controls.
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Klöpfer-Krämer I, Augat P. [Partial weight-bearing in rehabilitation. Strategies for instruction and limitations]. Unfallchirurg 2010; 113:14-20. [PMID: 20012428 DOI: 10.1007/s00113-009-1717-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Following trauma or surgery on the musculoskeletal system the primary aim is always as complete a restitution of mobility as possible. By mobilization with partial weight-bearing this is possible. The preferred way of teaching partial weight-bearing is the use of conventional bathroom scales. This method proves to be simple as well as time and cost-saving, but the transferability to the patient's daily life is questionable. Training and control of partial weight-bearing under dynamic conditions, such as normal walking, and walking up and down stairs seem to be very important. Different investigations have shown that the minority of subjects recruited could manage to maintain the given load of partial weight-bearing. Furthermore, the actual resulting moments within the joints, caused by muscles, fascia and tendons, are not considered in presets of partial weight-bearing, as only external forces (ground reaction forces) are measured. However, the problems in teaching partial weight-bearing have to be contrasted with the as yet unexplained issue of postoperative partial versus full weight-bearing.
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Affiliation(s)
- I Klöpfer-Krämer
- Institut für Biomechanik, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418 Murnau am Staffelsee.
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14
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Corner JA, Rawoot A, Parmar HV. The thrust plate prosthesis in the treatment of osteoarthritis of the hip. Clinical and radiological outcome with minimum 5-year follow-up. Hip Int 2009; 18:88-94. [PMID: 18645981 DOI: 10.1177/112070000801800204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The thrust plate prosthesis (TPP) is a neck preserving femoral component in total hip arthroplasty (THA). We present our mid-term results from using the thrust plate prosthesis in young patients with hip arthritis. We conducted a retrospective review of a consecutive series of patients with a minimum of 5 years follow-up after total hip arthroplasty using the thrust plate prosthesis. Harris Hip Score (HHS) and Oxford Hip Score (OHS) were recorded preoperatively and at the last clinical review. Radiographic analysis was performed and patient satisfaction levels and complications were recorded. Between 1996 and 2000 we implanted 41 prostheses in 38 consecutive patients (3 bilateral). The mean age at time of surgery was 56 years (41-67) and the mean length of follow-up was 71 months. The HHS improved from a mean of 42 points preoperatively to 88 points at the last clinical review and the mean OHS also improved from 40 points to 18 points. Eighty-three percent of patients expressed that they were 'very satisfied' with the procedure. Implant survivorship was 95% at 5 years follow-up with revision surgery being the end point. Eight patients suffer discomfort when lying on the operated side. Many patients treated with the TPP show excellent improvement in clinical outcome scores and a high level of patient satisfaction but the complication rate gives some concern. We support the selective use of the TPP to treat young patients with hip osteoarthritis.
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Affiliation(s)
- J A Corner
- Department of Orthopaedic Surgery, Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire, UK
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Karatosun V, Unver B, Gunal I. Hip arthroplasty with the thrust plate prosthesis in patients of 65 years of age or older: 67 patients followed 2-7 years. Arch Orthop Trauma Surg 2008; 128:377-81. [PMID: 17985151 DOI: 10.1007/s00402-007-0487-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Thrust plate prosthesis (TPP) is a relatively new concept in total hip arthroplasty and advocated to be used in young patients. We retrospectively evaluated the results of 67 patients (71 hips) who were older than 65 years of age and underwent hip arthroplasty using the TPP. PATIENTS AND METHODS There were 50 female and 17 male patients with a mean age 71 (range 65-89) years. All patients received accelerated rehabilitation program either with full weight bearing in the second postoperative day or at 6 weeks. All patients were followed-up for at least 2 years (range 28-87 months). RESULTS The average Harris hip score improved from 43 (range 8-72) to 93 (range 64-100) at the latest follow-up (p < 0.001). The overall revision rate was 8.4%. However, when the patients with definitive history of trauma were excluded the rate for loosening and technical errors decreased to 4.2%. There was no significant difference between the Harris hip score of patients with full weight bearing in the second postoperative day or 6 weeks (p = 0.57). CONCLUSION We conclude that the TPP could be indicated for older patients without age limit and that an accelerated rehabilitation program with early weight bearing can be applied to these patients.
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Affiliation(s)
- Vasfi Karatosun
- Department of Orthopedics, Dokuz Eylül University Hospital, Balcova, 35340 Izmir, Turkey.
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Angin S, Karatosun V, Unver B, Gunal I. Gait assessment in patients with thrust plate prosthesis and intramedullary stemmed prosthesis implanted to each hip. Arch Orthop Trauma Surg 2007; 127:91-6. [PMID: 17216169 DOI: 10.1007/s00402-006-0281-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Indexed: 02/08/2023]
Abstract
INTRODUCTION There has not been any study regarding comparative gait analysis in patients with intramedullary stemmed prosthesis (ISP) and thrust plate prosthesis (TPP) implanted to each hip. PATIENTS AND METHODS Four patients (three females and one male) who had undergone operation due to coxarthrosis were selected. The mean age was 60.5 (37-78) years. TPP and ISP had been implanted to the left and right hip, respectively, in three patients, and one patient received TPP to the right and ISP to the left hip. Gait was analyzed with a BTS Elite System consisting six cameras and two Kistler force plates using Helen Hayes marker set to assess the gait parameters. The clinical outcome was also evaluated according to Harris hip score (HHS). RESULTS The average HHS was 95.0 (82-100) points after a mean follow-up of 45.0 (30-50) months for TPP and 94.5 (80-100) points after a follow-up of 60.0 (14-122) months for ISP. Neither of the HHS scores and follow-up time nor gait parameters obtained from the TPP-implanted side were statistically different when compared to those of the ISP-implanted side. CONCLUSION TPP and ISP as the implants with their own biomechanical specifications did not produce any remarkable difference in gait.
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Affiliation(s)
- Salih Angin
- School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Inciralti, 35340 Izmir, Turkey.
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Karatosun V, Gunal I, Unver B, Gultekin A. Thrust plate prosthesis for osteonecrosis of the femoral head: short-term results of 15 patients followed 2-6 years. J Orthop Sci 2006; 11:450-3. [PMID: 17013731 DOI: 10.1007/s00776-006-1053-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 06/16/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND The thrust plate prosthesis is an implant with a metaphyseal fixation at the proximal femur that transmits the load forces of the hip onto the femoral neck. METHODS In this prospective study, 15 patients (8 women, 7 men) with 19 cementless thrust plate prostheses because of femoral head necrosis were examined. A clinical and radiologic evaluation was performed preoperatively, at 3, 6, 12, 18, and 24 months postoperatively, and every year thereafter. The mean follow-up period was 44 (range, 24-72) months. The average age at the time of surgery was 49 (27-70) years. The pathogenesis of femoral head necrosis included alcoholism (6 joints of 3 cases), Gaucher disease (1 joint of 1 case), Sheehan syndrome (2 joints of 1 case), and idiopathic (10 joints of 10 cases). RESULTS The Harris hip score increased from 53 (range, 15-71) to 97 (92-100) points on the final evaluation. Although mean preoperative hip flexion and abduction were 78 degrees (45 degrees -110 degrees ) and 24 degrees (10 degrees -45 degrees ), respectively, these increased to 114 degrees (75 degrees -125 degrees ) and 47 degrees (45 degrees -50 degrees ) 12 months after surgery and remained stable up to the latest follow-up. None of the patients displayed mechanical problems, and revision was not necessary in any case. CONCLUSIONS The thrust plate prosthesis shows midterm results comparable to those of the cementless stemmed prosthesis and supplies advantages, especially for younger patients with femoral head necrosis, because of its metaphyseal bone-preserving fixation.
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Affiliation(s)
- Vasfi Karatosun
- Department of Orthopedics, Dokuz Eylul University Hospital, Balcova, TR-35340, Izmir, Turkey
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