Original article
The Difference Between Actual and Prescribed Weight Bearing of Total Hip Patients With a Trochanteric Osteotomy: Long-Term Vertical Force Measurements Inside and Outside the Hospital

https://doi.org/10.1016/j.apmr.2006.11.005Get rights and content

Abstract

Hurkmans HL, Bussmann JB, Selles RW, Benda E, Stam HJ, Verhaar JA. The difference between actual and prescribed weight bearing of total hip patients with a trochanteric osteotomy: long-term vertical force measurements inside and outside the hospital.

Objective

To determine whether patients load the operated leg at a prescribed weight-bearing target load during postoperative recovery.

Design

A descriptive prospective study.

Setting

Orthopedic clinic and patients’ homes.

Participants

Fifty patients who had undergone total hip arthroplasty (THA) with trochanteric osteotomy.

Intervention

Patients were verbally instructed by a physical therapist to perform partial weight bearing at a 10% body weight (BW) target load (n=33) or at a 50% BW target load (n=17).

Main Outcome Measures

Mean peak load (%BW) and percentage of patients and mean percentage of steps below, equal to, and above the target load. Weight bearing was measured when patients walked with (condition 1) and without (condition 2) a physical therapist in the hospital and walked at home (condition 3).

Results

The mean peak load was significantly higher than the target in the 10% BW group for all 3 conditions (condition 1, 19.2% BW; condition 2, 20.0% BW; condition 3, 26.8% BW). In the 50% BW group, the mean peak load was significantly lower than the target in conditions 1 (28.1% BW) and 2 (32.5% BW). No significant difference in weight bearing was found when walking with or without a physical therapist (change in 10% BW, −0.1% BW; change in 50% BW, −3.17% BW). At home, the mean peak load was significantly larger compared with walking without a physical therapist in the hospital (change in 10% BW, −7.0% BW; change in 50% BW, −11.5% BW).

Conclusions

Partial weight bearing at a specific target load was not achieved by patients with a THA when given verbal instructions. Especially when using a low target load and when walking at home with no supervision of a physical therapist, patients loaded the operated leg higher and more frequently above the target load. Other training methods (eg, biofeedback) have to be evaluated to use as training tools for partial weight bearing at specific target loads.

Section snippets

Patient Population

Between August 2002 and October 2004, 145 consecutive patients received a primary unilateral THA with trochanteric osteotomy for the treatment of osteoarthritis of the hip at the orthopedic departments of 2 hospitals participating in this study. All patients between the age of 40 and 80 years and from whom a written informed consent was obtained were included in the study. Exclusion criteria were: medical conditions or social problems whereby patients could not perform or could not be

Patient Characteristics

Fifty patients participated in the study of which 33 patients performed PWB with a target load of 10% BW and 17 patients with a target load of 50% BW (fig 2). Patient characteristics are presented in table 1. Age was significantly higher (t48=2.3, P=.026) and body weight was significantly lower (t48=−1.2, P=.023) in the 10% target group compared with the 50% target group. When looking at men and women separately, these factors did not differ significantly between the 2 target groups. The 10%

Discussion

The present study evaluated PWB of patients with a THA and trochanteric osteotomy during their postoperative recovery by measuring the actual load during walking with a validated insole pressure system over a 5-hour period in the hospital and at home and comparing it with 2 instructed target loads in 3 conditions.

In this study, we found that 55% of the patients did not load their operated leg at the prescribed target load during their recovery when walking with (condition 1) or without

Conclusions

PWB at a specific target load was not achieved by patients with a THA when given verbal instructions. Especially when using a low target load and when walking at home with no supervision of a physical therapist, patients loaded the operated leg higher and more frequently above the target load. When a 50% target load is prescribed, verbal instructions for 10% target load training could be used to avoid high weight-bearing loads at the patient’s home. However, other training methods (eg,

References (32)

  • W.E. Siebert

    Partial weight bearing after total hip arthroplastyWhat does the patient really do? A prospective randomized gait analysis

    Hip Int

    (1994)
  • M. Tveit et al.

    Low effectiveness of prescribed partial weight bearingContinuous recording of vertical loads using a new pressure-sensitive insole

    J Rehabil Med

    (2001)
  • J.K. Weaver

    Total hip replacement: a comparison between the transtrochanteric and posterior surgical approaches

    Clin Orthop Relat Res

    (1975)
  • D.C. Wirtz et al.

    [Biomechanical aspects of load-bearing capacity after total endoprosthesis replacement of the hip jointAn evaluation of current knowledge and review of the literature]

    Z Orthop Ihre Grenzgeb

    (1998)
  • D.N. Teanby et al.

    Failure of trochanteric osteotomy in total hip replacement: a comparison of two methods of reattachment

    Ann R Coll Surg Engl

    (1996)
  • A. Frankel et al.

    Complications of trochanteric osteotomyLong-term implications

    Clin Orthop Relat Res

    (1993)
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