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The Impact of Total Hip Arthroplasty on Daily Ambulatory Function: A Prospective Study
Kevin A Wu1, Eric S Dilbone1, David N Kugelman1
1Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Background:
Total hip arthroplasty (THA) significantly improves pain and function in patients who have end-stage hip osteoarthritis. However, patient expectations regarding recovery and functional outcomes are often unclear. This study aimed to describe the trajectory of daily physical activity in the first year following primary THA, using wearable technology to collect objective data on gait speed, step count, standing duration, and estimated performance on the 6-minute walk test. Understanding postoperative recovery patterns can help manage patient expectations and improve counseling effectiveness.
Methods:
A prospective cohort study was conducted on 57 patients undergoing THA. Patients were provided with a device to track daily physical activity. Daily metrics, including gait speed, step count, standing duration, steadiness, and estimated 6-minute walk test performance, were collected and averaged weekly for analysis. Device adherence was monitored by tracking days without data output. Days without recorded data were excluded from analysis to account for nonwear time and ensure accuracy of the activity metrics.
Results:
Postoperatively, there was a significant increase in average daily step count compared to preoperative levels at 6 weeks (P < 0.001), 6 months (P < 0.001), and 12 months (P < 0.001) after surgery. Steadiness showed improvement at 12 months postoperative (P < 0.001). Standing duration increased significantly at 6 weeks postoperative (P = 0.002), but decreased at 6 and 12 months postoperative. Gait speed decreased at 6 weeks (P = 0.003), but increased at 6 and 12 months postoperative (P = 0.032, P = 0.021). The estimated 6-minute walk test distance improved significantly at 6 and 12 months postoperative (P = 0.038, P = 0.039).
Conclusions:
The study offers valuable insights into the trajectory of daily physical activity following THA. There were significant improvements in various objective measures of physical activity postoperatively, which highlights the effectiveness of THA in enhancing functional outcomes and quality of life for patients who have end-stage hip osteoarthritis. Effective counseling regarding expected recovery and rehabilitation strategies is crucial to optimize postoperative outcomes and improve patient satisfaction, particularly as these improvements do not occur immediately following surgery. These findings can help guide clinical decision-making and patient counseling.
