Rehab on the Treadmill after Hip Replacement SurgeryThe mission after total hip replacement (THR) surgery is to get up and walking. Physical therapists and doctors are always looking for ways to help THR patients get back on their feet as soon as possible. Walking is the best way to build strength in the legs and hips. But walking is difficult after THR. Patients can't put full weight on their new hip for some time.
Which is where this study comes in. Treadmill training with body support has helped patients with certain types of hip fractures. These authors tested whether treadmill training would help THR patients.
The authors looked at pain, strength, and walking ability in 80 THR patients. All of them could walk using two crutches. The patients were divided into two groups. Each person in the control group got 45 minutes of physical therapy every day for 10 days.
The test group also got 45 minutes of therapy. However, they spent about 30 minutes of that time walking on a treadmill. They wore a special body harness that supported much of their weight. The rest of the session was spent doing physical therapy exercises. Both groups also got 30 minutes of occupational therapy, massage, heat, or ultrasound each day. And both groups spent 25 minutes a day doing exercises in the pool.
All the patients were followed for one year. They were regularly checked for pain levels, hip and leg strength, and walking ability. Both groups improved over time. But the treadmill group did significantly better than the control group over the whole year. The treadmill group had less pain and stronger hip muscles. They had better range of motion and a more even walking gait. They got off crutches five weeks earlier. The only measurement that wasn't any different was walking speed.
And there was even a surprise bonus. No one in the treadmill group had loosening of the hip implant, compared to four patients in the control group. This might not mean anything. But the authors say stronger muscles may have helped prevent loosening.
Why such a big difference? The authors point out that patients in the treadmill group took between 1,000 and 1,500 steps in each training session. This compares to only 100 to 150 steps for the control group. That means the treadmill group walked 10 times as much in the 10 days of therapy. All this walking helped the hip muscles get stronger much faster. And stronger muscles let the treadmill group walk even more outside of therapy sessions.
The authors note one potential problem with the program. One of the treadmill patients died of a blood clot. The patient had earlier problems with blood clots. It is possible that the harness or the exercise made blood clots more likely to loosen and travel to the lungs. They now put all patients on blood thinners during the treadmill program after THR.
Stefan Hesse, MD, et al. Treadmill Training with Partial Body-Weight Support after Total Hip Arthroplasty: A Randomized Controlled Trial. In Archives of Physical Medicine and Rehabilitation. December 2003. Vol. 84. No. 12. Pp. 1767-1773.
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