Hip replacement rehab with HumanTrak (Use Case)

Using HumanTrak to improve the recovery pathway following total hip replacement.

Problem

Joan, a 72-year-old woman, enjoyed regular evening walks around her neighbourhood and gardening as ways to keep fit and active. However, steadily degenerating cartilage in her left hip made these activities too painful to continue. She was referred to an Orthopaedic surgeon by her General Practitioner when the pain became too much, who scheduled a total hip replacement after reviewing her medical images. While she knew her mobility would be severely limited following the surgery, she hoped to regain the ability to painlessly complete daily tasks following rehabilitation.

Rehabilitation

Joan’s physiotherapist scheduled a visit one week prior to the surgery to gather pre-surgery baseline data on Joan’s movement.

12-month rehabilitation program

Following a successful left hip replacement Joan began a 12-month rehabilitation program aimed at regaining her hip mobility (Lowe et al., 2009). Her program included weekly appointments with her physiotherapist where her progress was assessed using HumanTrak. Following each appointment, she was emailed a PDF showing the key metrics for the HumanTrak tests she performed that week, and by which she could gauge her recovery using objective measurements.

Weeks 1-3

Core and hip strengthening exercises in a seated and prone position.

Week 6-12

The HumanTrak Single Leg Stand test was used from 6 weeks onward to test Joan’s balance and her hip abductor strength. This test allowed Joan’s physiotherapist to monitor her for hip drop, which would be dangerous when she returned to her evening walks. Balancing on her left leg was taxing for Joan, but she was motivated by the HumanTrak reports that showed how her weak left hip abductors were causing moving impairments in comparison to her right.

From 6 weeks onwards Joan’s physiotherapist also began slowly adding progressively more difficult variations of HumanTrak’s Sit to Stand test to the weekly appointment. This simple test was a good gauge of the strength of Joan’s hip and knee extensor muscles. At first, a tall chair was used to ensure that Joan did not flex her hip too far and damage the replacement.

 12 weeks onwards

At 12 weeks post-operation Joan began the 30 Second Sit to Stand test where she had to perform as many repetitions as possible in 30 seconds while monitoring her form on the screen. After 12 weeks of physical rehab Joan was cleared to resume evening walks again and continued to visit for her weekly appointments. Both Joan and her physiotherapist were confident that she could safely walk without falling because they had seen the HumanTrak reports showing that she was able to maintain balance on one leg, had ample strength in her hip and knees, and had regained her baseline range of motion in her hip.

Solutions/advantages

One key advantage of using HumanTrak over manual measurement tools is the consistency with which the analyses are performed. Hip abductor weakness, as measured by hip drop and excessive pelvic lateral tilt, can cause dangerous falls if left untreated (Porto et al., 2019).

However, it is a subtle metric which is difficult to measure consistently. With the HumanTrak system, when Joan performed the Standing Posture and Single Leg Stand tests each week her physiotherapist could have confidence the metrics being reported could be directly compared to those same metrics from last week or last month.

“Each week her physiotherapist could have confidence the metrics being reported could be directly compared to those same metrics from last week or last month.”

As a result, her physiotherapist knew that the improvements in pelvic lateral tilt during Joan’s Single Leg Stand tests were due to strength increases in her hip abductors, not a change in measurement technique. In addition, the ready-made PDF reports allowed Joan’s physiotherapist to easily inform Joan of her progress. The easy-to-read format and longitudinal comparisons allowed Joan to monitor her performance over time without her physiotherapist needing to manually generate custom reports just for Joan.

Using PROMs to guide decision-making for hip replacement

Hip osteoarthritis is a chronic condition where symptoms may worsen, improve, or very commonly remain static over time. Overlaying this it is common to experience flares which are often the trigger for seeking medical attention and not necessarily indicative of deterioration.

Like in Joan’s case, many of the symptoms that bother clients with hip osteoarthritis include pain, stiffness, inability to participate in their usual activities, sleep impairment, and overall reduced quality of life.

These symptoms can only be understood by asking the patient themselves. Therefore, the use of patient-reported outcome measures (PROMs) was helpful in quantifying and tracking Joan’s subjective experiences.

Some of the PROMs Joan’s practitioner used to track her hip osteoarthritis progression included:

• Hip Disability and Osteoarthritis Outcome Score (HOOS)
• Copenhagen Hip and Groin Outcome Score (HAGOS)
• Western and McMaster Universities Arthritis Index (WOMAC)

These PROMs assisted in tracking Joan’s progress, understanding the severity of her symptoms, and guiding the decision-making for the timing of her hip replacement surgery (using HAGOS).

Conclusion

HumanTrak’s consistent longitudinal tracking gave Joan confidence that she was going to make it through her rehabilitation program. Each week she was able to see objective progress right in front of her on the HumanTrak screen. The objective metrics reported by HumanTrak gave Joan and her physiotherapist confidence that she could safely start her evening walks again. After one year, she had objective evidence of full recovery from her hip replacement surgery and gained a level of mobility that she would not have thought possible a year prior.

If you would like more information on HumanTraks, please feel free to contact us on our social media or fill out this contact form.

References:

1. Lowe, C. J. M., Barker, K. L., Dewey, M. E., & Sackley, C. M. (2009). Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials. BMC musculoskeletal disorders, 10(1), 98.

2. Porto, J. M., Júnior, R. C. F., Bocarde, L., Fernandes, J. A., Marques, N. R., Rodrigues, N. C., & de Abreu, D. C. C. (2019). Contribution of hip abductor– adductor muscles on static and dynamic balance of community-dwelling older adults. Aging clinical and experimental research, 31(5), 621-627.