Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial

Abstract

Objective: To compare treadmill training with partial body-weight support (TT-BWS) and conventional physical therapy (PT) in ambulatory patients with hip arthroplasty.

Design: Randomized controlled trial.

Setting: Rehabilitation center.

Participants: Eighty patients with a fully loadable implant who could walk independently with crutches after unilateral total hip arthroplasty were randomized to receive either TT-BWS (treatment group) or conventional PT (controls), for 10 working days.

Interventions: Each patient received 45 minutes of individualized PT, either treadmill training plus PT in the experimental or PT alone in the control group.

Main outcome measures: The Harris score, recorded by blind assessors, served as the primary outcome measure. Secondary outcome measures were the hip extension deficit, gait velocity, gait symmetry, affected hip abductor power; hip abductor amplitude of electromyographic activation; and the interval from surgery to abandoning crutches.

Results: At the end of training, the treatment group's Harris score was 13.6 points higher (P<.0001) than the control group's score. Further, hip extension deficit was 6.8 degrees less (P<.0001), gait symmetry was 10% greater (P=.001), affected hip abductor was stronger (Medical Research Council grades 4.24 vs 3.73; P<.0001), and the amplitude of gluteus medius activity was 41.5% greater (P=.001) than those measures for controls. Gait velocity did not differ in the 2 groups. These significant differences in favor of the treatment group persisted at 3 and 12 months. The treatment group abandoned crutches sooner than the control group (3 vs 8wk). In the treatment group, 39 patients finished treatment, 35 appeared at 3, and 26 at 12 months for follow-up. In the control group, the corresponding numbers were 40, 35, and 24 patients, respectively.

Conclusion: TT-BWS is more effective than conventional PT at restoring symmetrical independent walking after hip replacement.