A Prospective Randomized Controlled Trial Assessing the Impact of Preoperative Combined with Postoperative Progressive Resistance Training on Muscle Strength, Gait, Balance and Function in Patients Undergoing Total Hip Arthroplasty.

Purpose: The aim of this study is to investigate the effects of a preoperative combined with postoperative moderate-intensity progressive resistance training (PRT) of the operative side in patients with hip osteoarthritis (HOA) who are undergoing total hip arthroplasty (THA). The study seeks to evaluate the impact of this combined intervention on muscle strength, gait, balance, and hip joint function in a controlled, measurable, and objective manner. Additionally, the study aims to compare the outcomes of this combined intervention with those of preoperative or postoperative muscle strength training conducted in isolation. Methods: A total of 90 patients with HOA scheduled for unilateral primary THA were randomly assigned to three groups: Pre group (preoperative PRT), Post group (postoperative PRT), and Pre& Post group (preoperative combined with postoperative PRT) focusing on hip flexion, extension, adduction, and abduction of operated side. Muscle strength, gait parameters, balance, and hip function were assessed at specific time points during a 12-month follow-up period. Results: All three groups showed significant improvements in muscle strength, with the Pre& Post group demonstrating the most pronounced and sustained gains. Gait velocity and cadence were significantly improved in the Pre& Post group at 1-month and 3-month postoperative follow-ups compared to the other groups. Similarly, the Pre& Post group exhibited superior balance performance at 3-month and 12-month postoperative follow-ups. The Harris Hip Score also showed better outcomes in the Pre& Post group at all follow-up intervals. Conclusion: Preoperative combined with postoperative moderate-intensity PRT in HOA patients undergoing THA led to superior improvements in muscle strength, gait, balance, and hip joint function compared to preoperative or postoperative PRT alone. This intervention shows significant promise in optimizing postoperative rehabilitation and enhancing patient outcomes following THA.

A complementary analytical tool for hip prosthesis dislocation: Thermal imaging in rehabilitation.

The use of routine ionizing imaging in identify and classify patients with dislocation or infection after surgery has some medical contraindication, in addition to risks associated with the ionizing load and elevated costs. A novel, less expensive and non-ionizing imaging technique, called infrared thermal imaging, can be proposed as a complementary method to routinely evaluate hip prosthesis patients and track their inflammation response following serious complications. Here we report a case of a total hip prosthesis which was dislocated during inpatient rehabilitation, and ultimately reduced without surgical procedure. During the process, routine clinical and radiographic diagnosis was complemented with an infrared examination. The infrared images were easy to take bedside, without direct contact with the area of surgery, and well tolerated. After the dislocation reduction, the thermal imaging procedure provided important feedbacks on the local inflammation, helping to exclude other complications such as the infections.

A Digital Health Intervention Platform (Active and Independent Management System) to Enhance the Rehabilitation Experience for Orthopedic Joint Replacement Patients: Usability Evaluation Study.

BACKGROUND: Optimal rehabilitation programs for orthopedic joint replacement patients ensure faster return to function, earlier discharge from hospital, and improved patient satisfaction. Digital health interventions show promise as a supporting tool for re-enablement. OBJECTIVE: The main goal of this mixed methods study was to examine the usability of the AIMS platform from the perspectives of both patients and clinicians. The aim of this study was to evaluate a re-enablement platform that we have developed that uses a holistic systems approach to address the de-enablement that occurs in hospitalized inpatients, with the older adult population most at risk. The Active and Independent Management System (AIMS) platform is anticipated to deliver improved patient participation in recovery and self-management through education and the ability to track rehabilitation progression in hospital and after patient discharge. METHODS: Two well-known instruments were used to measure usability: the System Usability Scale (SUS) with 10 items and, for finer granularity, the User Experience Questionnaire (UEQ) with 26 items. In all, 26 physiotherapists and health care professionals evaluated the AIMS clinical portal; and 44 patients in hospital for total knee replacement, total hip replacement, or dynamic hip screw implant evaluated the AIMS app. RESULTS: For the AIMS clinical portal, the mean SUS score obtained was 82.88 (SD 13.07, median 86.25), which would be considered good/excellent according to a validated adjective rating scale. For the UEQ, the means of the normalized scores (range -3 to +3) were as follows: attractiveness=2.683 (SD 0.100), perspicuity=2.775 (SD 0.150), efficiency=2.775 (SD 0.130), dependability=2.300 (SD 0.080), stimulation=1.950 (SD 0.120), and novelty=1.625 (SD 0.090). All dimensions were thus classed as excellent against the benchmarks, confirming the results from the SUS questionnaire. For the AIMS app, the mean SUS score obtained was 74.41 (SD 10.26), with a median of 77.50, which would be considered good according to the aforementioned adjective rating scale. For the UEQ, the means of the normalized scores were as follows: attractiveness=2.733 (SD 0.070), perspicuity=2.900 (SD 0.060), efficiency=2.800 (SD 0.090), dependability=2.425 (SD 0.060), stimulation=2.200 (SD 0.010), and novelty=1.450 (0.260). All dimensions were thus classed as excellent against the benchmarks (with the exception of novelty, which was classed as good), providing slightly better results than the SUS questionnaire. CONCLUSIONS: The study has shown that both the AIMS clinical portal and the AIMS app have good to excellent usability scores, and the platform provides a solid foundation for the next phase of research, which will involve evaluating the effectiveness of the platform in improving patient outcomes after total knee replacement, total hip replacement, or dynamic hip screw.

Patients' perspective of fast-track total joint arthroplasty: a systematic review.

The introduction of fast-track protocols decreased length of hospital stay and improved rehabilitation and outcomes in total joint arthroplasty. Despite improved clinical results published in many papers, the patient perspective of these protocols is less investigated. Purpose of this study was to explore the patient perspective of fast-track protocols in arthroplasty. A systematic search for articles of patient experiences in total hip, knee, and shoulder arthroplasty was conducted using EMBASE, MEDLINE, Cochrane, and Web-of-Science for articles published from inception to February 14, 2023. In total 12 studies were included involving 672 patients. Most patients were satisfied with short length of hospital stay and preferred rehabilitation at home with relatives for support. Various experiences were reported regarding pain and postoperative out of hospital physical therapy. Frequently, feelings of insecurity were reported because of lack of personalized information. Based on current qualitative literature, patients are satisfied with short length of hospital stay in fast-track total joint arthroplasty. Improvements in personalized information and physical therapy protocols is needed.

The Needs and Experiences of Patients Returning to Work After Total Knee Arthroplasty and Total Hip Arthroplasty: A Systematic Review and Meta-Synthesis.

OBJECTIVE: The objective of this study was to conduct a systematic and comprehensive review of qualitative research to examine the physical and psychological needs, as well as work experiences, of patients undergoing total knee replacement and total hip replacement surgeries during their process of returning to work. METHODS: A systematic review and meta-synthesis of qualitative literature was conducted. A systematic search was conducted across 8 databases to identify qualitative or mixed-methods research on the needs and experiences of individuals with total knee replacement and total hip replacement who have returned to work. The search period extended from the inception of each database to March 2023. Two researchers independently utilized a predetermined search strategy to retrieve relevant English-language studies published in any year. The included studies were assessed for quality using the Critical Appraisal Skills Program appraisal tool. Findings from the studies were then summarized and integrated using the pooled integration method. RESULTS: There were 10 studies in total. Three key themes were identified from the original research: needs during the return to work process and rehabilitation training, faith and support to return to work, and constraints and challenges at work. CONCLUSION: Health care professionals and employers should conscientiously consider the physical and psychological requirements of patients who have undergone total knee replacement and total hip replacement when they are resuming work, taking into account the specific constraints and challenges that may arise in the workplace. To ensure a seamless transition back to work, it is essential to develop tailored occupational interventions, implement comprehensive return to work programs, and offer patients sufficient understanding and support. IMPACT: The findings of this study offer valuable insights into the physical and psychological needs, as well as the work experiences, of patients who have undergone total knee replacement and total hip replacement during their reintegration into the workforce. These findings have the potential to assist health care professionals and employers in providing enhanced support to facilitate successful return-to-work outcomes for patients.

System for Tracking and Evaluating Performance (Step-App®): validation and clinical application of a mobile telemonitoring system in patients with knee and hip total arthroplasty. A prospective cohort study.

BACKGROUND: Technological advances and digital solutions have been proposed to overcome barriers to sustainable rehabilitation programs in patients with musculoskeletal disorders. However, to date, standardized telemonitoring systems able to precisely assess physical performance and functioning are still lacking. AIM: To validate a new mobile telemonitoring system, named System for Tracking and Evaluating Performance (Step-App®), to evaluate physical performance in patients undergone knee and hip total arthroplasty. DESIGN: Prospective cohort study. METHODS: A consecutive series of older adults with knee and hip total arthroplasty participated in a comprehensive rehabilitation program. The Step-App®, a mobile telemonitoring system, was used to remotely monitor the effects of rehabilitation, and the outcomes were assessed before (T0) and after the rehabilitation treatment (T1). The primary outcomes were the 6-Minute Walk Test (6MWT), the 10-Meter Walk Test (10MWT), and the 30-Second Sit-To-Stand Test (30SST). RESULTS: Out of 42 patients assessed, 25 older patients were included in the present study. The correlation analysis between the Step-App® measurements and the traditional in-person assessments demonstrated a strong positive correlation for the 6MWT (T0: r2=0.9981, P<0.0001; T1: r2=0.9981, P<0.0001), 10MWT (T0: r2=0.9423, P<0.0001; T1: r2=0.8634, P<0.0001), and 30SST (T0: r2=1, P<0.0001; T1: r2=1, P<0.0001). The agreement analysis, using Bland-Altman plots, showed a good agreement between the Step-App® measurements and the in-person assessments. CONCLUSIONS: Therefore, we might conclude that Step-App® could be considered as a validated mobile telemonitoring system for remote assessment that might have a role in telemonitoring personalized rehabilitation programs for knee and hip replacement patients. CLINICAL REHABILITATION IMPACT: Our findings might guide clinicians in remote monitoring of physical performance in patients with musculoskeletal conditions, providing new insight into tailored telerehabilitation programs.

Mobile Application Use and Patient Engagement in Total Hip and Knee Arthroplasty.

¼ Mobile applications (MAs) are widely available for use during the perioperative period and are associated with increased adherence to rehabilitation plans, increased satisfaction with care, and considerable cost savings when used appropriately.¼ MAs offer surgeons and health care stakeholders the ability to collect clinical data and quality metrics that are important to value-based reimbursement models and clinical research.¼ Patients are willing to use wearable technology to assist with data collection as part of MAs but prefer it to be comfortable, easy to apply, and discreet.¼ Smart implants have been developed as the next step in MA use and data collection, but concerns exist pertaining to patient privacy and cost.¼ The ongoing challenge of MA standardization, validation, equity, and cost has persisted as concerns regarding widespread use.

Do increasingly unstable balance devices provide a graded challenge to bipedal stance in total hip arthroplasty patients?

BACKGROUND: Progressive balance exercises are critical to early functional rehabilitation after total hip arthroplasty (THA) but little is known regarding the challenge imposed by common balance devices. RESEARCH QUESTION: Do progressively unstable balance devices provide a graded challenge to bipedal stance during early functional rehabilitation in THA patients? METHODS: Postural control was evaluated in 42 patients (age, 63.7 ± 9.6 years; height, 1.72 ± 0.08 m and body mass, 78.9 ± 14.6 kg) approximately 3 weeks (23 ± 6 days) following unilateral primary THA. Patients were divided into two groups, based on their ability to complete a 20-second unipedal stance test (UPST) on the operated limb. A lumbar mounted inertial sensor monitored center of mass (COM) displacement during bipedal balance conditions involving three balance pads of progressive stiffness and an oscillatory platform, used in isolation and in combination with the most stable balance pad. COM displacement was normalised to bipedal stance on a hard surface. Differences between conditions and patient groups were assessed using a mixed-model analysis of variance. RESULTS: Twenty patients (48%) were able to complete the UPST on their operated limb. There was a significant effect of balance condition on COM displacement during bipedal stance (F4,160 = 82.6, p < .01). COM displacement was lowest for the oscillatory platform but increased non-linearly across the three balance pads (p < .05). There was no significant difference in COM displacement between THA patients able and unable to complete the UPST. SIGNIFICANCE: Increasingly compliant balance pads provided a progressive, though nonlinear, challenge to bipedal balance control in THA patients that was greater than that of an oscillating platform and independent of the ability to stand independently on the operated limb. These findings serve as a guide for the design of progressive training programs that enhance balance in THA patients.

Effects of aquatic exercises in patients after total hip arthroplasty: A systematic review.

BACKGROUND: Total hip arthroplasty (THA) is a surgical procedure that can alter physical function and quality of life. OBJECTIVES: The aim was to verify the effects of aquatic exercises compared with exercises on land, control or other modalities, in patients undergoing THA on the primary outcomes: self-reported physical function, quality of life and pain; and secondary outcomes: muscle strength, functional capacity and gait. DESIGN: Systematic review that followed the PRISMA Statement and PROSPERO registered. The search was performed in the following databases: Web of Science, Embase, Medline, Cinahl, Lilacs, SPORTDiscus, Cochrane Library, Scopus, SciELO, and PEDro, from 1945 to 2022. The risk of bias assessment was performed using the Risk of Bias 2 (RoB2) from the Cochrane Collaboration. RESULTS: Three randomized controlled trials (RCTs) were included, with a total of 364 participants. In the selection process, two publications from the same study were found. The RoB2 assessment classified one RCT as "high risk of bias" and the others as "low risk of bias". Therefore, the analysis of the results considered only studies with a low risk of bias. For the self-reported physical function outcome, evaluated by WOMAC, improvement was observed in favor of aquatic exercises, when started on the 14th postoperative day. Pain improved after 24th week postoperative, in favor of exercise (effect size between 0.2 and 0.4). Quality of life, verified only by one RCT, improved at each time point evaluated (effect size between 0.01 and 0.10). The functional capacity showed no difference between the groups. This was the first systematic review to assess the benefits of aquatic exercises specifically in THA and it was possible to infer that the exercises initiated after 14 days of postoperative are safer. The protocol should include proprioceptive, coordination, and resistance exercises. The session can last around 30 min and is held three times a week. CONCLUSION: Decision making for treatment in the postoperative of THA may include aquatic exercises as a safe and efficacious alternative to improve self-reported physical function, pain, quality of life, and muscle resistance.

Incorporating Functional Strength Integration Techniques During Total Hip Arthroplasty Rehabilitation: A Randomized Controlled Trial.

OBJECTIVE: Total hip arthroplasty (THA) is a common orthopedic procedure that alleviates pain for millions of individuals. Yet, persistent physical function deficits, perhaps associated with movement compensations, are observed after THA. These deficits negatively affect quality of life and health for many individuals. Functional strength integration (FSI) techniques combine muscle strength training with specific movement retraining to improve physical function. This study aimed to determine if FSI would improve functional performance through remediation of movement compensations for individuals after THA. METHODS: A double-blind randomized controlled trial was conducted. Ninety-five participants were randomized to either the FSI or control (CON) group for an 8-week intervention. The FSI protocol included exercise to improve muscular control and stability around the hip to minimize movement compensation during daily activity. The CON protocol included low-load resistance exercise, range-of-motion activities, and patient education. Functional performance, muscle strength, and self-reported outcomes were measured preoperatively, midway and after intervention, and 6 months after THA. Change from preoperative assessment to each time point was measured, and between-group differences were assessed. RESULTS: There were minimal differences in outcomes between groups at the first postoperative assessment. There were no statistically significant between-group differences in the later assessments, including the primary endpoint. Both groups improved functional outcomes throughout the study period. CONCLUSION: The FSI intervention did not result in greater improvements in function after THA compared to the CON intervention. Future work should further investigate additional biomechanical outcomes, timing of the FSI protocol, effective dosing, and patient characteristics predictive of success with FSI. IMPACT: Recovery after THA is complex, and individuals after THA are affected by persistent movement deficits that affect morbidity and quality of life. The present study suggests that either approach to THA rehabilitation could improve outcomes for patients, and that structured rehabilitation programs may benefit individuals after THA.

Patient-reported outcomes the first thirty days after fast-track primary total hip arthroplasty. A prospective cohort study using a web-based registration tool for postoperative follow-up.

INTRODUCTION: The documentation on patient reported outcomes the first weeks at home following total hip arthroplasty (THA) is sparse. Length of hospital stay after THA is substantially reduced. Therefore, knowledge on whether patients are managing their own postoperative rehabilitation early after discharge is important, in order to give the patients realistic preoperative information, to modify expectations and enable patients to monitor their own rehabilitation process. METHODS: Eighty-two THA patients were included in a prospective cohort study. Patient-reported outcomes were collected twice a week thirty days postoperatively using a web-based registration tool. Numeric rating scales (0-10) for pain, function, and quality of life, EQ-5D, and the use of opioids were registered. Four weeks postoperatively a telephone interview were conducted. Pain, EQ5D and hip specific physical function score (HOOS-PS) were recorded preoperatively, at three- and twelve-months follow-up. RESULTS: Pain was maintained the first days after hospital discharge. From day 0 to day 30, pain decreased from 4.0 (SD 2.23) to 2.3 (SD 1.75), function improved from 4.4 (SD 2.06) to 7 (SD 1.57), quality of life improved from 6.3 (SD 2.69) to 7.8 (SD 1.47), and EQ-5D improved from 0.4 to (SD 0.27) to 0.7 (SD 0.14). After 30 days, 32% still used opioids. All patients completed the web-registration. Pain, EQ-5D and HOOS-PS improved substantially from preoperatively to twelve months follow-up. CONCLUSION: Fast-track THA patients can expect continued postoperative pain and impaired quality of life the first week at home, before gradually improvement. After thirty days, 32 % of the patients still used opioids.

Better Before-Better After: A Qualitative Phenomenology Study of Older Adults' Experiences With Prehabilitation Before Total Hip Replacement.

Total hip replacement is considered a successful intervention for pain relief and improved function. However, poor presurgery physical function may increase the likelihood of delayed postsurgery recovery. The purpose of this study was to describe community-dwelling older adults' experiences with a prehabilitation program (preoperative exercise) before total hip replacement. Four participants were interviewed 13 and 15 weeks postsurgery. The interviews were recorded, transcribed, and analyzed with systematic text condensation. Physical, mental, and social limitations were, to a higher or lesser degree, part of the participants' life presurgery. The results indicate that tailored close supervised training presurgery increased the participants' amount of and adherence to exercise, confidence, and sense of control. The participants had a positive experience of increased strength during the training period and gained motivation to perform progressive training. The exercise program helped the participants be physically and mentally prepared. The results indicate that close supervised prehabilitation in community-dwelling older adults undergoing total hip replacement can contribute to improved function and increase the level of activity and self-efficacy postsurgery.

Identifying self-reported health-related problems in home-based rehabilitation of older patients after hip replacement in China: a machine learning study based on Omaha system theory.

BACKGROUND: With the aging of the population, the number of total hip replacement surgeries is increasing globally. Hip replacement has undergone revolutionary advancements in surgical methods and materials. Due to the short length of hospitalization, rehabilitation care is mainly home-based. The needs and concerns about such home-based rehabilitation are constantly changing, requiring continuous attention. OBJECTIVE: To explore effective methods for comprehensively identifying older patients' self-reported outcomes after home-based rehabilitation for hip replacement, in order to develop appropriate intervention strategies for patient rehabilitation care in the future. METHODS: This study constructed a corpus of patients' self-reported rehabilitation care problems after hip replacement, based on the Omaha classification system. This study used the Python development language and implemented artificial intelligence to match the corpus data on the cooperation platform, to identify the main health-related problems reported by the patients, and to perform statistical analyses. RESULTS: Most patients had physical health-related problems. More than 80% of these problems were related to neuromusculoskeletal function, interpersonal relationships, pain, health care supervision, physical activity, vision, nutrition, and residential environment. The most common period in which patients' self-reported problems arose was 6 months post-surgery. The relevant labels that were moderately related to these problems were: Physiology-Speech and Language and Physiology-Mind (r = 0.45), Health-Related Behaviors-Nutrition and Health-Related Behaviors-Compliance with Doctors' Prescription (r = 0.40). CONCLUSION: Physiological issues remain the main health-related issues for home-based rehabilitation after hip replacement in older patients. Precision care has become an important principle of rehabilitation care. This study used a machine learning method to obtain the largest quantitative network data possible. The artificial intelligence capture was fully automated, which greatly improved efficiency, as compared to manual data entering.

Study on the Effect of Pain Programmed Care Based on the Concept of Prehabilitation on the Recovery of Joint Function and WHOQOL-BREF Score in Elderly Patients after Total Hip Arthroplasty.

Objective: To assess the impact of pain-programmed care, utilizing the concept of prehabilitation, on the postoperative recovery of joint function and WHOQOL-BREF score in elderly patients following total hip arthroplasty. Methods: Ninety cases of elderly patients with total hip arthroplasty admitted to our hospital from January to December 2022 were selected as the observation sample, and the 90 elderly patients with total hip arthroplasty were divided into 45 control groups and 45 control groups by random number table method. The pain assessment, functional exercise compliance, hip joint function and quality of life of the two groups were compared after the intervention. Results: The nursing intervention led to a significant reduction in pain scores and improvement in quality of life for elderly patients undergoing total hip joint replacement. The observation group showed a greater reduction in resting pain scores (6.20 ± 0.63 vs. 3.78 ± 0.67, P < .05) and activity pain scores (8.78 ± 0.64 vs. 4.89 ± 0.68, P < .05) compared to the control group. Additionally, the observation group demonstrated significant improvements in physiology (55.73 ± 2.14 vs. 71.87 ± 21.59, P < .05), psychology (55.71 ± 2.13 vs. 72.60 ± 2.20, P < .05), social relations (55.73 ± 2.13 vs. 71.96 ± 1.57, P < .05), and environmental effect (55.60 ± 2.15 vs. 68.62 ± 1.51, P < .05) after care, whereas the control group exhibited lesser improvements in these areas (physiology: 55.60 ± 2.24 vs. 64.53±2.02, P < .05; psychology: 55.60 ± 2.22 vs. 66.33±1.99, P < .05; social relations: 55.82 ± 2.09 vs. 67.84 ± 1.73, P < .05; environmental effect: 55.89 ± 2.18 vs. 62.09 ± 51.49, P < .05). These findings demonstrate the significant impact of nursing intervention on pain reduction and improved quality of life for elderly patients undergoing total hip joint replacement. Conclusion: Pain programmed care based on the concept of prehabilitation for elderly patients undergoing total hip arthroplasty has a significant positive impact on pain control, compliance with functional exercise, recovery of hip function, and improvement of quality of life. These findings highlight the benefits of implementing pain management strategies and rehabilitation programs in the field of total hip arthroplasty and elderly care.

Advantages of Total Hip Arthroplasty Using the Posterolateral Approach Combined with Phased Rehabilitation Management for Patients with Femoral Neck Fractures.

Background: Total hip arthroplasty (THA) has emerged as a pivotal approach for addressing femoral neck fractures (FNFs), a prevalent type of fracture in older people. Restoring joint functionality following surgery significantly contributes to patients' overall well-being. Therefore, the implementation of rational and effective rehabilitation exercises is crucial. Objective: This study aims to investigate the impact of phased rehabilitation management on patients with FNFs who have undergone THA. Methods: In this prospective comparative study, a total of 89 patients were enrolled. Among them, 49 patients underwent phased rehabilitation management, while 40 patients received conventional postoperative rehabilitation. The evaluation encompassed a range of assessments, including the Harris Hip Score (HHS) for the evaluation of hip joint function, the Five-Times-Sit-to-Stand Test (FTSST) to quantify lower limb muscle strength, the Barthel Index to assess activities of daily living, and the Visual Analog Scale (VAS) to measure pain intensity. Furthermore, preoperative and postoperative serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were diligently measured to provide a comprehensive understanding of the patient's inflammatory responses. Results: Overall, the study group exhibited a significantly higher average HHS after surgery compared to the control group. Notably, the VAS scores at 1 day and 3 days post-surgery in both groups demonstrated a reduced trend compared to preoperative values. This trend was more significant in the study group compared to the control group. The time taken for the FTSST in patients undergoing phased rehabilitation management was less compared to the control group. Furthermore, phased rehabilitation management was associated with more significant improvements in activities of daily living. Notably, IL-6 levels were higher in both the study and control groups at 1 day postoperatively than before surgery, while they decreased at 3 days postoperatively compared to the 1-day mark. The study group exhibited significantly lower levels of CRP (mg/L) and ESR (mm/h) compared to the control group. Conclusions: Implementing phased rehabilitation management for patients with FNFs following THA improves hip joint function, lower limb muscle strength, daily living activities, pain intensity, and inflammatory response.

Does Hand Grip Strength (HGS) Predict Functional Independence Differently in Patients Post Hip Replacement Due to Osteoarthritis versus Patients Status Post Hip Replacement Due to a Fracture?

Purpose: The aim of the study was to determine whether hand grip strength (HGS) predicts functional independence in older patients who have undergone hip replacement due to osteoarthritis versus older patients who have undergone hip replacement surgery due to fracture. Patients and Methods: The study included 239 patients aged 65 and over in the first weeks after total hip replacement during rehabilitation treatment. Multivariate linear regression was used to determine HGS as a predictor of activities of daily living (ADL) and instrumental activities of daily living (IADL) in both groups: patients post hip replacement due to osteoarthritis and patients post hip replacement due to a fracture. Results: Analysis showed that pre-rehab HGS in the osteoarthritis group predicts improved activities of daily living after rehabilitation (ADL, OR = 1.098; CI 95% 1.052-1.147 and IADL, OR = 1.182; CI 95% 1.103-1.267) and 6 months after (ADL, OR = 1.191; CI 95% 1.066-1.329 and IADL, OR = 1.096; CI 95% 1.012-1.186). In the fracture group, HGS predicts the ADL (OR = 1.081; CI 95% 1.015-1.152) after rehabilitation, and IADL after rehabilitation (OR = 1.122; CI 95% 1.046-1.205) and 6 months after (OR = 1.090; 95% CI 1.021-1.64). Conclusion: HGS in patients after hip replacement surgery predicts functional independence in basic and complex activities of daily living. This can allow the identification of osteoarthritis patients with low hand grip - who can be considered as patients with a higher risk of an unsatisfying outcome of surgery. These patients should undergo pre-rehabilitation and should be monitored, and/or supported in terms of rehabilitation after discharge.

Inertial Sensors for Hip Arthroplasty Rehabilitation: A Scoping Review.

The objective of this scoping review is to characterize the current panorama of inertia sensors for the rehabilitation of hip arthroplasty. In this context, the most widely used sensors are IMUs, which combine accelerometers and gyroscopes to measure acceleration and angular velocity in three axes. We found that data collected by the IMU sensors are used to analyze and detect any deviation from the normal to measure the position and movement of the hip joint. The main functions of inertial sensors are to measure various aspects of training, such as speed, acceleration, and body orientation. The reviewers extracted the most relevant articles published between 2010 and 2023 in the ACM Digital Library, PubMed, ScienceDirect, Scopus, and Web of Science. In this scoping review, the PRISMA-ScR checklist was used, and a Cohen's kappa coefficient of 0.4866 was applied, implying moderate agreement between reviewers; 23 primary studies were extracted from a total of 681. In the future, it will be an excellent challenge for experts in inertial sensors with medical applications to provide access codes for other researchers, which will be one of the most critical trends in the advancement of applications of portable inertial sensors for biomechanics.

Randomized controlled trial to compare conventional physiotherapy with task-oriented exercises after total hip replacement.

BACKGROUND: Different interventions are used during rehabilitation after hip replacement surgery, but it is unclear if task-oriented exercise is more effective than conventional physiotherapy. OBJECTIVE: This study compared the effectiveness of conventional physiotherapy (CPT) programme with task-oriented exercise (TOE) on hip pain, function, static and dynamic balance during the early rehabilitation stage after total hip replacement. METHODS: This randomized controlled parallel-group trial was executed in an inpatient physical medicine and rehabilitation centre. The study included 40 patients who were randomly classified into CPT and TOE groups (n= 20 in each). Hip pain (assessed by visual analogue scale), function in the operated leg (assessed by modified Harris Hip Score, mHHS), static balance (assessed by Abili Balance analyser system) and dynamic balance (assessed by Berg Balance Scale) were evaluated at baseline and after 18 days of rehabilitation. Cohen's effect size (d) was calculated. RESULTS: Greater pain reduction (p< 0.05; d= 0.08) was observed after TOE (1.6 ± 0.68 scores) compared with the CPT programme (2.2 ± 0.83 scores). Hip function assessed by the modified mHHS improved more (p< 0.05; d= 0.30) in the TOE group (73.45 ± 6.23 scores) than in the CPT group (54.90 ± 6.28 scores). Static balance improved significantly in both groups after the interventions but did not differ significantly between the groups. The improvement in dynamic balance was significantly greater (p< 0.05; d= 0.45) after TOE (50.55 ± 1.57 scores) than after CPT (38.55 ± 3.43 scores). CONCLUSION: Both interventions reduced pain and improved function of the operated leg and static and dynamic balance. The effect on hip function was superior for TOE compared with CPT.

Weight-shifting-based robot control system improves the weight-bearing rate and balance ability of the static standing position in hip osteoarthritis patients: a randomized controlled trial focusing on outcomes after total hip arthroplasty.

Background: After a total hip arthroplasty (THA), standing and walking balance are greatly affected in the early stages of recovery, so it is important to increase the weight-bearing amount (WBA) on the operated side. Sometimes, traditional treatments may not be enough to improve WBA and weight-bearing ratio (WBR) on the operated side in a satisfactory way. To solve this problem, we came up with a new weight-shifting-based robot control system called LOCOBOT. This system can control a spherical robot on a floor by changing the center of pressure (COP) on a force-sensing board in rehabilitation after THA. The goal of this study was to find out how rehabilitation with the LOCOBOT affects the WBR and balance in a static standing position in patients with unilateral hip osteoarthritis (OA) who had a primary uncemented THA. Methods: This randomized controlled trial included 20 patients diagnosed with Kellgren-Lawrence (K-L) grade 3 or 4 hip OA on the operative side and K-L grade 0 normal hip on the nonoperative side. We used the minimization method for allocation and randomly assigned patients to either the LOCOBOT group or the control group. As a result, 10 patient seach were randomly assigned to the LOCOBOT and control groups. Both groups received 40 min of rehabilitation treatment. Out of the 40 min, the LOCOBOT group underwent treatment for 10 min with LOCOBOT. The control group performed COP-controlled exercises on a flat floor instead of using LOCOBOT for 10 of the 40 min. All theoutcome measures were performed pre-THA and 11.9 ± 1.6 days after THA (12 days after THA). The primary outcome measure included WBR in the static standing position. Results: After12 days of THA, the LOCOBOT group exhibited significantly higher mean WBR and WBA (operated side) values than the control group. Furthermore, the LOCOBOT group exhibited significantly lower mean WBA (non-operated side) and outer diameter area (ODA) values than the control group. From pre-THA to 12 days after THA, the LOCOBOT group exhibited a significant improvement in mean WBR and WBA (operated side). Moreover, the mean WBA (non-operated side) and ODA significantly decreased. From pre-THA to 12 days after THA, the control group showed a significant increase in total trajectory length and ODA. Conclusions: The most important finding of this study was that patients were able to perform the LOCOBOT exercise as early as the second day after THA, and that WBR and ODA significantly improved by the 12th day after THA. This result demonstrated that the LOCOBOT effectively improves WBR in a short period of time after THA and is a valuable system for enhancing balance ability. This expedites the acquisition of independence in activities of daily living after THA and may contribute to optimizing the effectiveness of medical care.