Cemil YILDIZ, İbrahim YANMIŞ, Servet TUNAY, Akif ÇUHADAR, A. Sabri ATEŞALP, Ethem GÜR

Tek taraflı total kalça artroplastisinin kantitatif yürüme analizi ile değerlendirilmesi

Amaç: Bu prospektif çalışmada, tek taraflı total kalça artroplastisi sonrası yürüyüş parametrelerindeki değişikliklerin belirlenmesi ve objektif olarak gözlenen değişikliklerle sübjektif analizlerin karşılaştırılması amaçlandı. Çalışma planı: Tek taraflı dejeneratif kalça hastalığı olan 38 olgu (21 kadın, 17 erkek; ortalama yaş 61) yürüyüş değerlendirme bandı (Gait Rite, A.B.D.) kullanılarak, ameliyat öncesi ve sonrasında yürüyüş karakteristikleri açısından değerlendirildi. Her hastada, cerrahiden sonra 6. ve 12. aylarda olmak üzere en az iki yürüme değerlendirmesi yapıldı. Nöromuskuler veya iskelet hastalığı olmayan 50 kişiden kontrol grubu oluşturuldu. Ayrıca, hastalar klinik olarak Harris kalça skorlamasına göre değerlendirildi. Sonuçlar: Ameliyat öncesi tüm hastalarda sübjektif değerlendirme sonuçları kötüydü (Harris kalça skoru

Anahtar Kelimeler:

Artroplasti, replasman, kalça, Ağrı, Ortopedik işlemler, Değerlendirme çalışmaları, Kalça protezi, Osteoartrit, Yürüyüş şekli

Evaluation of unilateral total hip arthroplasty by a quantiative analysis of gait

Objectives: The purpose of this prospective study was to assess changes in gait parameters after unilateral total hip arthroplasty and to correlate these objective changes with the results of subjective analyses. Methods: Thirty-eight patients (21 women, 17 men; mean age 61 years) with unilateral degenerative hip disease were evaluated in order to investigate preoperative and postoperative gait characteristics with the use of a gait evaluation mat (Gait Rite, USA). Each patient underwent at least two postoperative gait evaluations in the sixth and twelfth months, respectively. Gait evaluations were also made in a control group of 50 individuals without any neuromuscular and skeletal disease. Clinical evaluations were made using the Harris hip scoring system. Results: All patients exhibited poor subjective evaluations preoperatively (Harris hip score <70). Compared to controls, patients had decreased step length and velocity, but increased stance, step, double support and swing times. Postoperatively, gait characteristics did not differ from those elicited prior to surgery in the first six months; however, patients attained near-normal velocity in the twelfth month. The recorded values for step length, step time, and double support time were similar to those of controls in both extremities. Conclusion: This study showed that total hip arthroplasty considerably improved the gait characteristics of patients with degenerative arthritis, and that this improvement could be measured and recorded quantitatively with the use of a walking band.

Keywords:

Arthroplasty, Replacement, Hip, Pain, Orthopedic Procedures, Evaluation Studies, Hip Prosthesis, Osteoarthritis, Gait,

PDF

___

1. Herberts P, Malchau H. Long-term registration has improved the quality of hip replacement: a review of the Swedish THR Register comparing 160,000 cases. Acta Orthop Scand 2000;71:111-21.
2. Gage JR. An overview of normal walking. Inst Course Lect 1990;39:291-303.
3. Wadsworth JB, Smidt GL, Johnston RC. Gait characteristics of subjects with hip disease. Phys Ther 1972;52:829-39.
4. Murray MP, Gore DR, Clarkson BH. Walking patterns of patients with unilateral hip pain due to osteo-arthritis and avascular necrosis. J Bone Joint Surg [Am] 1971;53:259-74.
5. Tümer ST, Güler HC. Yürüyüş analizinin temel verileri ve klinik uygulaması. Artroplasti Artroskopik Cerrahi Dergisi 1998;9:158-63.
6. Wykman A, Olsson E. Walking ability after total hip replacement. A comparison of gait analysis in unilateral and bilateral cases. J Bone Joint Surg [Br] 1992;74:53-6.
7. Soderman P, Malchau H. Is the Harris hip score system useful to study the outcome of total hip replacement? Clin Orthop 2001;(384):189-97.
8. Harris WH. A new approach to total hip replacement without osteotomy of the greater trochanter. Clin Orthop 1975;(106):19-26.
9. Wertsch JJ, Webster JG, Tompkins WJ. A portable insole plantar pressure measurement system. J Rehabil Res Dev 1992;29:13-8.
10.Olsson E, Goldie I, Wykman A. Total hip replacement. A comparison between cemented (Charnley) and noncemented (HP Garches) fixation by clinical assessment and objective gait analysis. Scand J Rehabil Med 1986;18:107-16
11. Berman AT, Zarro VJ, Bosacco SJ, Israelite C. Quantitative gait analysis after unilateral or bilateral total knee replacement. J Bone Joint Surg [Am] 1987;69:1340-5.
12. Berman AT, Quinn RH, Zarro VJ. Quantitative gait analysis in unilateral and bilateral total hip replacements. Arch Phys Med Rehabil 1991;72:190-4.