| Summary: | 碩士 === 長庚大學 === 臨床行為科學研究所 === 97 === Total hip replacement (THR) is a widely accepted strategy to resolve the pain and functional limitation caused by end phase of hip arthritis and/or hip joint necrosis. Previous studies showed that THR was able to relief the hip pain, change static standing stability, improve gait pattern, increase functional independence and quality of life. But there is a lack of studies investigated the continuous functional recovery for patients underwent the THR. The aim of this study is to compare the functional status of the patients between one week before surgery and 3 months after surgery to understand the recovery process. The results of this study were expected to be able to help clinicians develop the rehabilitation plan for optimal functional recovery, fall prevention after surgery and thus, fastening the patients return to independent life and increase the quality of life.
20 THR patients agreed to participate in this study. All patients were evaluated both in laboratory and in rehabilitation clinics. In laboratory, the static and dynamic postural stability were measured using RS-scan foot pressure measurement system, Vicon 512 motion analysis system and 2 AMTI force plates. The static postural stability was measured while the patients maintaining four stance posture; the dynamic postural stability was measured while the patients walking on a 10-meter walkway and crossing obstacle of 3 different heights. In rehabilitation clinics, subjective and objective functional status were measured by Self-administered Hip-Rating Questionnaire, Visual Analog Pain Scale, Berg Balance Scale, Functional Independence Measure, and Frenchay Activities Index. There were four repeated measures for all of the measurements for each subject: one week before operation, two weeks/ six weeks/ three months after operation.
The result showed that the static postural stability decreased as the difficulty of the standing posture increased. Besides, the CoP traveling path excursion increased continuously during the four phases of measurements. It was also found that the patients prefer to bear their weight over the leg in behind while standing heel-to-toe. Furthermore, the gait pattern improved after the surgery, as observed by decreased antalgic gait and increased walking speed three months after surgery. The toe clearing distance decreased and CoM-CoP inclination angles increased while crossing obstacle when the patients used the affected leg as leading limb. The anterior CoM-CoP inclination angle decreased and clearing distance increased when the patients used the affected leg as trailing limb.
The results of subjective and objective functional performance measures showed that surgery was very effective in decreased the hip pain and increased the functional independence. Although the functional independence and functional balance decreased at 2 weeks after surgery, they were improved significantly at 3 months after surgery and were much better than before surgery. But the level of participation in daily activities was at best the same as before surgery at 3 months after surgery.
According to above results, the following recommendations were appropriate for patients education after surgery: (1) avoid tandem stance posture with the affected leg in behind within four weeks after surgery; (2) the safe stragtegy is to use the affected leg as leading limb for obstacle crossing; (3) encourage patients participating in daily activities at 3 months after surgery.
This was the first study to investigate the continuous functional recovery process for THR patients. For future study, the sample size and the duration of follow up should be extended. Besides, measurement at 4 weeks after surgery should be able to provide more information regarding to the recovery speed.
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