Assessing the Prognostic Value of Gait Speed to Functional Milestones Status Post Total Hip and Knee Arthroplasty

Summative patient outcome education is consistently presented to patients following total joint replacement on set and distant timelines away from the date of surgery to better manage their expectations. However, these distant timelines may not accurately reflect the individuals who can regain functional abilities at earlier time frames. It would be insightful to explore if gait speed assessment, following total joint replacement, correlates with the specified timelines patients need to achieve functional milestones status post total hip and knee arthroplasty. The primary aim of this study is to explore if a postoperative three-meter walk test provides prognostic value for the time participants take to achieve functional milestones status post total hip or knee replacement.

This study was an observational cohort study with target accrual set to 100 participants. Inclusion criteria were patients who underwent total hip or knee arthroplasty and attended inpatient and outpatient physical therapy at a surgical institution. Exclusion criteria were patients who lacked the ability to provide informed consent, patients with postoperative complications following total joint replacement, revision surgeries, or non-compliance with scheduled physical therapy. Gait speed was assessed within one to three days following total hip or knee replacement and participants were provided a survey where they recorded the date of when they achieved the specified milestones. Continuous variables were summarized as median (range) while categorical variables were reported as frequency (percentage). Patients were divided into two groups based on their gait speed with the median value of gait speed as the cutoff point. Wilcoxon rank sum test was used to compare continuous variables between groups with higher and lower gait speed and Fisher's exact test was used to compare the categorical variables. All tests were two-sided with a p value of <0.05 considered statistically significant.

No statistically significant correlations were found between gait speed and days to achieving functional milestones in this sample.  Conclusion: There were multiple limitations contributing to the results of this study. Poor retention rate, which led to a small sample size limiting the power of the study, was the primary limitation. Further exploration is warranted to better understand if gait speed assessment provides prognostic value for functional milestones following total hip or knee replacement.