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Evidence from gait analysis on total hip patients suggests that there are differences bewteen them and unaffected individuals, even after many years post-op. This means that those patients do not regain 'normal' gait. However, I am of the opinion that there comes a time when the gait patterns for the patient either no longer improves or that any further improvements are so minor as to be insignificant. It is this point that I call 'fully rehabilitated'. The problem now lies in defining when this point occurs. Although natural variabilities mean that this point will differ from person to person, I feel that there could be a post-op period in which most people could be said to have reached this 'fully rehabilitated' state.
I would like to thank everyone for their speedy and insightful responses and present a summary which may shed some light on this matter.
The consensus is that the later the final gait assessment takes place the better, but 12 months seems to be the standard.
Comments were made about other contributing clinical and social factors and implant type.
Others commented on the lack of knowledge about the timing of recovery and suggested pilot studies and studies with multiple gait assessments to track recovery.
"Your opinion based on the available evidence is going to be as good as anyone else's. My personal understanding on the matter is:1. Essentially at 6 months you have made most of the progress you are going to make2. Harris Hip Scores etc stabilise however at 12 to 18 months - and I personally believe this is where final assessment should be based."
"So if your choices are 9 or 12 months, I would chose 12. In my groups, PT was completed by 8-12 weeks, yet general improvement in gait continued when the patients increased their comfort levels and frequency for daily activities at home."
"We are doing a study here at University of Iowa,USA for the Hip replacement subjects and have them come into our Gait analysis lab pre-op, 6 weeks , 6 months and 1 year after surgery."
"My advice would to always try and time your assessments with clinical follow-up. If you want to explore as close to a stable gait as possible I would advise 12 months, which I would assume will also correspond to a clinical follow-up. I feel that these types of studies must generate evidence usable by surgeons and physios and unless they are time to coincide with clinical follow-up the usefulness of the data (in a clinical sense) is limited."
"12 month will be the standard way to go as it is when thesurgeon sees them as well for their final assessment. You can test them at 9 months and they may or may not be small changes between the two time points."
"I did find significant improvements between pre and 3 month post-op time points, in many hip sagittal and frontal plane kinetics and kinematics, along with changes in EMG results of the glut med and max. But I must add that there was continued improvement at 1 year in the THA group,..."
"- porous or cemented? Porous would have longer time to full implant stability (3-6 months for bone ingrowth) with perhaps closer to 'normal' gait."
"...the ability of patients to "return to" (regain) "normal" walking mechanics after total hip replacement, no matter the time post-op, is a highly dependent question with the variables including, among others: pre- and post-op limb length inequality, pre- and post-op analgesia (Rx, non-Rx and recreational) use, pre-op activity level and work status, surgical approach (and type/positioning of components), (possible) intra-op complications (such as fracture), type and duration of rehabilitation, disability (and replacement) status of other lower limb joints and co-morbidities, including post-polio syndrome, Parkinson's, poor general health status, etc." "I would select a small number (3-6) of otherwise healthy candidates for a single joint replacement, preferably for post traumatic OA, of one gender and perform a longitudinal pilot study, making measurements at 3-mo pre op, then at 1, 2, 3, 6, 9 and 12 mo post op. Even with comorbidity effects, this should yield enough data to permit you to plan your main experiment."
"I'm not sure what your analyses include, but if its daily function type of analyses I think an upon release analysis, 3, 6, 9, 12m to see progression to "normal" gait."
"I think that you would add valuable information to your study if you perform your first post-op gait analysis as soon as the patient is able to walk without much pain. That way you can see exactly how the surgery itself has affected their walking ability, as well as their recovery."
"I believe that you should perform at least 2 post-op assessments and you may want to look at immediately following, and then up to 9 and 12 months... As far as whether you will find any change between 9 and 12 months may be piloted with a couple of individuals to see if there is any greater improvement."
"...due to the obvious hole you have found in the literature - I think it would be fascinating to do both of the follow up assessments (9 and 12 months) and therefore produce some information about recovery rates."
"You may want to look at the following for very early gait analysis after THR.A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Mayr E, Nogler M, Benedetti MG, Kessler O, Reinthaler A,Krismer M, Leardini A. Clin Biomech (Bristol, Avon). 2009 Dec;24(10):812-8"
In summary, the consensus is that if the choice is between 9 and 12 months, then 12 months should be selected. Although for best clinical comparison, then testing should be timed to co-incide with the clinical follow-ups. However, there is a lack of knowledge regarding how recovery progresses.
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I would like to thank everyone for their speedy and insightful responses and present a summary which may shed some light on this matter.
The consensus is that the later the final gait assessment takes place the better, but 12 months seems to be the standard.
Comments were made about other contributing clinical and social factors and implant type.
Others commented on the lack of knowledge about the timing of recovery and suggested pilot studies and studies with multiple gait assessments to track recovery.
"Your opinion based on the available evidence is going to be as good as anyone else's. My personal understanding on the matter is:1. Essentially at 6 months you have made most of the progress you are going to make2. Harris Hip Scores etc stabilise however at 12 to 18 months - and I personally believe this is where final assessment should be based."
"So if your choices are 9 or 12 months, I would chose 12. In my groups, PT was completed by 8-12 weeks, yet general improvement in gait continued when the patients increased their comfort levels and frequency for daily activities at home."
"We are doing a study here at University of Iowa,USA for the Hip replacement subjects and have them come into our Gait analysis lab pre-op, 6 weeks , 6 months and 1 year after surgery."
"My advice would to always try and time your assessments with clinical follow-up. If you want to explore as close to a stable gait as possible I would advise 12 months, which I would assume will also correspond to a clinical follow-up. I feel that these types of studies must generate evidence usable by surgeons and physios and unless they are time to coincide with clinical follow-up the usefulness of the data (in a clinical sense) is limited."
"12 month will be the standard way to go as it is when thesurgeon sees them as well for their final assessment. You can test them at 9 months and they may or may not be small changes between the two time points."
"I did find significant improvements between pre and 3 month post-op time points, in many hip sagittal and frontal plane kinetics and kinematics, along with changes in EMG results of the glut med and max. But I must add that there was continued improvement at 1 year in the THA group,..."
"- porous or cemented? Porous would have longer time to full implant stability (3-6 months for bone ingrowth) with perhaps closer to 'normal' gait."
"...the ability of patients to "return to" (regain) "normal" walking mechanics after total hip replacement, no matter the time post-op, is a highly dependent question with the variables including, among others: pre- and post-op limb length inequality, pre- and post-op analgesia (Rx, non-Rx and recreational) use, pre-op activity level and work status, surgical approach (and type/positioning of components), (possible) intra-op complications (such as fracture), type and duration of rehabilitation, disability (and replacement) status of other lower limb joints and co-morbidities, including post-polio syndrome, Parkinson's, poor general health status, etc." "I would select a small number (3-6) of otherwise healthy candidates for a single joint replacement, preferably for post traumatic OA, of one gender and perform a longitudinal pilot study, making measurements at 3-mo pre op, then at 1, 2, 3, 6, 9 and 12 mo post op. Even with comorbidity effects, this should yield enough data to permit you to plan your main experiment."
"I'm not sure what your analyses include, but if its daily function type of analyses I think an upon release analysis, 3, 6, 9, 12m to see progression to "normal" gait."
"I think that you would add valuable information to your study if you perform your first post-op gait analysis as soon as the patient is able to walk without much pain. That way you can see exactly how the surgery itself has affected their walking ability, as well as their recovery."
"I believe that you should perform at least 2 post-op assessments and you may want to look at immediately following, and then up to 9 and 12 months... As far as whether you will find any change between 9 and 12 months may be piloted with a couple of individuals to see if there is any greater improvement."
"...due to the obvious hole you have found in the literature - I think it would be fascinating to do both of the follow up assessments (9 and 12 months) and therefore produce some information about recovery rates."
"You may want to look at the following for very early gait analysis after THR.A prospective randomized assessment of earlier functional recovery in THA patients treated by minimally invasive direct anterior approach: a gait analysis study. Mayr E, Nogler M, Benedetti MG, Kessler O, Reinthaler A,Krismer M, Leardini A. Clin Biomech (Bristol, Avon). 2009 Dec;24(10):812-8"
In summary, the consensus is that if the choice is between 9 and 12 months, then 12 months should be selected. Although for best clinical comparison, then testing should be timed to co-incide with the clinical follow-ups. However, there is a lack of knowledge regarding how recovery progresses.
__________________________________________________ _______________
Have more than one Hotmail account? Link them together to easily access both
http://clk.atdmt.com/UKM/go/186394591/direct/01/