Perioperative Exercise Improve Early Return Of Ambulatory Function For End-stage Hip Osteoarthritis Underwent Total Hip Arthroplasty

Objective:To determine if a customized perioperative exercise program for the treatment of elderly patients with end-stage osteoarthritis(OA) underwent total hip arthroplasty(THA) can achieve an earlier recovery of normal ambulatory function and evaluate clinical effect and safety of perioperative exercise programs.Methods:This is a clinical experimental study.From December 2005 to March 2007,forty patients with end-stage osteoarthritis(OA) underwent total hip arthroplasty(THA) according to strict inclusion and exclusion criteria enrolled in our study and were divided into either the intervention group which received a perioperative customized exercise program from the time before surgery to 12 weeks after surgery or the control group which received the routine perioperative care in random.Ambulatory function was assessed by measurement of gait parameters during a 25-m walk test at 3 weeks and 12 weeks postoperatively,and walking endurance was assessed by a 6-minute walk test at 12 weeks postoperatively.Gait parameters including step frequency,step length,gait velocity and 6-minitue maximal walking distance were calculated and compared between two groups.Results:Twenty patients in the intervention group attended all scheduled exercise sessions with no training injuries.Eighteen patients in the control group completed last follow-up.There were no significant difference of preoperative demography data including average age,sex proportion, heighth,weighth,body mass index(BMI),operational extremity,admitting diagnosis,average step frequency,average step length and average gait velocity between two groups(p＞0.05).At 3 weeks postoperatively,the average step frequency between intervention group and control group were 66.40±0.36 and 62.00±6.02 steps/min(p=0.036 p＜0.05),the average step length were 0.48±0.51 and 0.45±0.56 meter/step(p=0.235 p＞0.05),the average gait velocity were 0.53±0.71 and 0.47±0.88m/s(p=0.044 p＜0.05).At 12 weeks postoperatively,the average step frequency between intervention group and control group were 91.30±5.08 and 79.89±5.91 steps/min(p=0.000 p＜0.01),the average step length were 0.57±0.44 and 0.49±0.51 meter/step(p=0.000 p＜0.01),the average gait velocity were 0.86±0.77 and 0.66±0.10m/s(p=0.000 p＜0.01),the average 6-minitue maximal walking distance were 372.16±33.32 and 283.58±43.32 meters(p=0.000 p＜0.01).Intervention group subjects demonstrated greater step frequency and gait velocity at 3 weeks postoperatively.At 12 weeks postoperatively,all gait parameters in intervention group were greater than control group,and the 6-min maximal walking distance was significantly greater than control group.Conclusion:The study indicates that our perioperative customized exercise programs are well tolerated in the elderly patient with end-stage hip osteoarthritis.In one side,the perioperative customized exercise programs can improve effectively step frequency and average gait velocity in 3 weeks after total hip arthroplasty.In the other side,the perioperative customized exercise programs can improve effectively step frequency,step length,average gait velocity and 6-minitue maximal walking distance in 12 weeks after total hip arthroplasty.