A simple 10-meter walk test before surgery can help doctors and patients identify the optimal timing for hip replacement and set realistic expectations for recovery.
Study: Preoperative gait speed as a predictor of patient-reported outcomes after total hip arthroplasty: information on patient acceptable symptom status and K-means clustering analysis. Image Credit: DmyTo/Shutterstock.com
A recent study published in The Journal of Bone and Joint Surgery identifies preoperative gait speed as an important predictor of postoperative outcomes in patients undergoing total hip arthroplasty for hip osteoarthritis.
Variability in patient recovery.
Total hip arthroplasty, commonly known as hip replacement, is a surgical procedure performed to improve mobility in people with severe hip injuries, many of which are due to osteoarthritis. This surgery is associated with excellent long-term results; however, postoperative recovery and clinical responses vary among individuals.
The currently proposed indication criteria for total hip arthroplasty are based on limited evidence, emphasizing the need to identify preoperative predictors of postoperative outcomes and recovery.
Information provided by the patient about health status, symptoms, or quality of life is often used to determine the effectiveness of treatment. In the current study, researchers from Kyushu University in Japan examined whether health information collected from patients with hip osteoarthritis before surgery can predict clinical outcomes after total hip arthroplasty.
About the study
The current study included a total of 274 patients with hip osteoarthritis who underwent total hip arthroplasty. Preoperative information on duration of symptoms, pain intensity, hip range of motion, lower extremity muscle strength, and 10-meter free walking speed was collected using appropriate methods.
Patient-reported postoperative clinical outcomes were assessed using the Oxford Hip Score (OHS) and the Forgotten Joint Score-12 (FJS-12). OHS is a patient-reported questionnaire to assess hip pain and function, while FJS-12 is a patient-reported outcomes tool used to assess knowledge of artificial prosthesis during daily activities after total hip arthroplasty.
Key findings
Preoperative gait speed was identified as an important predictor of postoperative clinical outcomes. Furthermore, both hip flexion range of motion and hip flexion strength were significantly associated with preoperative gait speed.
Gait speed cutoff values of 0.7 and 1.0 meters/second were set to achieve clinically meaningful outcomes for hip pain and awareness of artificial prostheses, respectively. The study findings suggest that a gait speed cutoff value of 1.0 meters/second is the only significant predictor of excellent outcomes after total hip arthroplasty.
Importance of the study
Preoperative gait speed, defined as walking speed, was identified as a clinically relevant parameter for predicting outcomes in patients with hip osteoarthritis after total hip arthroplasty.
In particular, the researchers established a gait speed threshold of 1.0 meters/second as the only independent predictor of excellent postoperative outcomes. This threshold aligns with established sarcopenia criteria and is supported by previous studies reporting that the typical walking speed of people aged 60 to 69 years is 1.2 to 1.4 meters/second.
Based on these observations, a preoperative walking speed of less than 1.0 meters/second can be considered a clinically meaningful benchmark for determining the appropriate timing for total hip arthroplasty.
Gait speed, which reflects the integrated performance of the cardiovascular, neurological, and musculoskeletal systems, is considered an important predictor of adverse outcomes, including postoperative complications, falls, institutionalization, disability, and mortality. A reduction in walking speed of 0.1 meters/second has been associated with decreased survival among community-dwelling older adults.
Measuring gait speed requires minimal equipment, facilitating broad applicability in diverse resource settings. The reproducibility and clinical relevance of gait speed make it a practical preoperative indicator of recovery and rehabilitation goals, helping patients understand their functional status.
Age, hip flexion range of motion, hip flexion muscle strength, and pain intensity all contribute to preoperative gait speed. Existing evidence suggests that reduced hip range of motion and decreased muscle strength may influence walking speed in patients with hip osteoarthritis. Therefore, preoperative rehabilitation focusing on hip range of motion, hip flexion muscle strength, and general physical activity is recommended for patients of all ages to achieve favorable results after surgery.
Overall, the study findings underscore the importance of maintaining lower extremity function and walking speed, regardless of age, to achieve favorable postoperative clinical outcomes. These insights can serve as valuable decision-making tools for preoperative evaluation and determination of optimal timing of surgery.
During the gait speed measurement, the researchers allowed patients who usually use a cane to use it, which may overestimate their walking ability. Patients with arthritis in the spine or other lower joints were also included in the study, which may have influenced walking speed.
