Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY.
J Arthroplasty. 2021 Aug;36(8):2817-2822. doi: 10.1016/j.arth.2021.03.038. Epub 2021 Mar 18.
Recent data suggest that a modified, more lenient set of precautions after total hip arthroplasty (THA) performed through the posterolateral approach may safely allow more patient movement and exercise in the immediate postoperative period. We hypothesize that 1) patients undergoing THA given modified precautions will demonstrate a fast-track return to functional activity and 2) wrist-based activity trackers will provide valuable information on postoperative activity levels.
We prospectively enrolled patients undergoing THA. Patients were given a wrist-based, commercially available activity tracker to wear 1 week preoperatively and 6 weeks postoperatively. Postoperative hip precautions included only the avoidance of the "leg-shaving" position of combined hip flexion, adduction, and internal rotation. Linear mixed models were used to analyze the change in steps and Hip Disability and Osteoarthritis Outcome Score-Junior (HOOS)-JR data. Pearson correlation coefficients were used to describe the relationship between average steps and HOOS-JR scores over time.
Eighty-two patients were enrolled. Seventy-four percent returned to work by week 4. Seventy-six percent of left THA patients returned to driving by week 4. At 6 weeks, 23% of survey respondents were taking pain medication and 26% were using assistive devices. Average daily steps were 1098 at week 1, 2491 at week 2, 4130 at week 3, 4850 at week 4, 5712 at week 5, and 6069 at week 6. A significant correlation (R: -0.981) was found between increased weekly steps and improved HOOS-JR scores after THA (P < .001).
Defining expected recovery timelines for patients undergoing THA helps surgeons counsel their patients preoperatively. Our study demonstrates an expected pathway for recovery after THA by using modified precautions that will be more clearly outlined with ongoing clinical data analysis.
最近的数据表明，对于通过后外侧入路进行的全髋关节置换术（THA），采用改良的、更宽松的预防措施，可在术后即刻安全地允许患者进行更多的活动和运动。我们假设：1）接受改良预防措施的 THA 患者将快速恢复功能活动，2）腕部活动追踪器将提供术后活动水平的有价值信息。
我们前瞻性地招募了接受 THA 的患者。患者在术前 1 周和术后 6 周佩戴腕部、市售的活动追踪器。术后髋关节预防措施仅包括避免髋关节屈曲、内收和内旋的“剃腿”位置。采用线性混合模型分析步数和髋关节残疾和骨关节炎结果评分-少年版（HOOS-JR）数据的变化。采用 Pearson 相关系数描述平均步数与随时间变化的 HOOS-JR 评分之间的关系。
共纳入 82 例患者。74%的患者在第 4 周恢复工作。76%的左侧 THA 患者在第 4 周恢复驾驶。在第 6 周时，23%的调查受访者仍在服用止痛药，26%的人在使用辅助器具。第 1 周平均每天步数为 1098 步，第 2 周为 2491 步，第 3 周为 4130 步，第 4 周为 4850 步，第 5 周为 5712 步，第 6 周为 6069 步。THA 后，每周步数的增加与 HOOS-JR 评分的改善之间存在显著相关性（R：-0.981，P<0.001）。
确定接受 THA 的患者的预期康复时间线有助于外科医生在术前为患者提供咨询。我们的研究通过使用改良的预防措施，展示了 THA 后康复的预期途径，随着对临床数据的进一步分析，这种途径将更加清晰。
