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Published on: March 23, 2019
Objective evaluation of walking distance improvement in patients undergoing total hip replacement
Benoit Rigolot1, Shirin Monadjemi1, Hubert Petit1
1Université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.
Background:
Patients undergoing total hip replacement (THR) frequently question the extent to which the procedure will improve their walking abilities. As self-reported questionnaires commonly used to assess recovery are subjective, this study aimed: (1) to quantify changes in daily-step count from the preoperative period to three years after THR, withing patients' natural living environment, using an accelerometer-integrated pedometer, (2) to determine whether some patients demonstrated faster improvements in walking ability and, if so, to identify the patients' characteristics associated with this pattern.
Hypothesis:
We hypothesized that average daily-step-counts would increase following surgery.
Patients And Methods:
This prospective observational study included 60 patients undergoing primary THR. Assessments were performed preoperatively and at 3, 12 and 36 months postoperation. Walking performance was evaluated by measuring daily-step-count using an accelerometer-based pedometer worn for seven consecutive days for each timepoint. Demographic data and functional outcomes including PMA, HHS, SF-12 and WOMAC scores were collected throughout follow-up.
Results:
The mean daily-step-counts increased significantly from 2428 ± 1622 preoperatively to 3747 ± 2264 at M12 (p = 0.013), and to 3611 ± 2207 at M36 (p = 0.023). Walking improvement occurred withing the first 12 months. Patients with sedentary occupations had lower daily-step-counts than those with a Devane level 5, suggesting that walking activity may be influenced by habitual lifestyle.
Conclusion:
On average, patients undergoing THR gained approximately 1,382 steps/day by one-year post-surgery, although final walking capacity appears to be associated with patient's habitual activity. Pedometers can help estimating postoperative improvements according to Devane score and may provide useful information for estimating implant wear, which is influenced by the number of walking cycles rather than time.
Level Of Evidence:
IV; prospective observational study.
