Treadmill Rehabilitation Study for Total Hip Arthroplasty

One Patients Story to Treatment and Recovery

““The AlterG is a vital piece of equipment when assisting in the rehabilitation of those with a weight bearing restriction or joint pain from arthritis. We are able to help our patients walk in a safe, controlled, and pain-free environment.””

Stephanie Frager, Therapy Director, Southlake Village Rehabilitation and Care Center

Treadmill Rehabilitation Study for Total Hip Arthroplasty

David Nissenbaum, MPT, MA, LAT

Introduction

72-year-old active female with long history of DJD to lumbar spine and most recently to her right hip. She underwent elective right total hip arthroplasty.

  • A posterior approach was used in the procedure
  • The patient is active, walking 2 miles daily for exercise and also walks her dog at least 30 min per day

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Goals

  • Start total hip arthroplasty rehabilitation
  • Initiate early activity with respect for THA post-operative precautions
  • Develop a normal gait pattern
  • Progressively improve hip and core strength
  • Return to a normal walking program and be able to walk her dog on even and uneven surfaces without difficulty

History / Progression

I.  Plan

  • Patient had long history of back pain which was getting worse with increased activity
  • Developed increased R hip pain after returning from vacation
  • Consulted with MD and elected to undergo R total hip arthroplasty with posterior approach
  • Underwent 4 days of inpatient care, followed by 10 days of inpatient rehabilitation, then started outpatient rehabilitation
  • Patient initially had significant anterior and anteromedial hip pain. X-rays were cleared by MD.  Had significant lower leg swelling issues, cleared also for any vascular issues
  • 2 weeks post-op, the patient initiated a walking program on the AlterG Anti-Gravity physical therapy equipment at 30% of her body weight at 1.5 mph and no incline. We did reduce her to 25% of her body weight secondary to mild groin pain
  • The protocol included gait training (on the AlterG), soft tissue mobilization, hip stability drills, and proprioceptive drills
  • Program duration was 4 months

II.  Considerations

  • Pain and soreness were considered when progressing ambulation on the AlterG
  • Speed and incline were increased as patient’s pain level improved

III. Progression

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Results

The patient was seen 3x/wk x 3 weeks, then 2x/wk x 3 weeks, then 1x/wk x 4 weeks, then once every 2-3 weeks until 4 months post op.  The patient started with increased anterior/medial hip pain which we needed to keep an eye on. She also had bilateral lower leg swelling issues that we were watching. She did have follow up x-rays and Doppler to rule out any medical issues. The patient did achieve all of her goals and has returned back to an exercise program and walking her dog.

The AlterG Anti-Gravity Treadmill was incorporated early in the physical therapy rehabilitation program as a way to restore her normal gait. In addition to allowing for normal gait patterns, the limited hip flexion ROM needed in walking in the AlterG versus cycling provided a safe exercise alternative while respecting standard THA post-operative precautions. The patient walked on the AlterG daily and progressed her speed and increased her incline to make it more of an endurance program.

The patient was discharged after 4 months post op and able to walk her dog without problems. She is able to ambulate on stable and unstable surfaces without difficulty.

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