Development and testing of a system to improve gait after joint replacement

In the UK, success of total hip replacement (THR) or total knee replacement (TKR) is measured using questionnaires. Patient Reported Outcome Measures (PROMs) which show an improvement of 96.5% for THR and 93.6% for TKR. However, only 67.5% of THR patients and 58.9% of TKR patients reported an improvement in Quality of Life (QoL) (EQ-VAS) at 6 months after surgery. This latter value is broadly similar to published data that shows approximately 50% of hip and knee patients have some gait abnormalities at one year post operatively, associated with poorer reported quality of life.
People adapt their gait to avoid pain in the arthritic joint thereby creating abnormalities in their gait over time. Once the joint pain is relieved by surgery, patients need retraining to walk correctly and to strengthen weakened muscles. Because patients are generally unaware of how their walking pattern has adapted over time, many continue unaware to load joints and use muscles incorrectly. This can lead to falls, reduced activity, osteoarthritis or further joint replacement surgery.
This project aims to improve patients gait after hospital discharge through objective analysis and recommended bespoke exercises with the expectation this will improve walking and movement and through this improvement in QoL as well as future reductions in musculoskeletal and other related health conditions.
Studies using GaitSmart on older people who have fallen have already confirmed that an assessment and intervention programme can help patients improve their gait and QoL.
The study will produce data to objectively assess physical outcomes in THR patients post-operatively. GaitSmart provides a standardized digital gait analysis to enable better rehabilitation and hip functionality and aims to optimize the impact of the initial surgery in the long-term. The study aims to assess the effectiveness of the intervention on gait, movement and Quality of Life (on five dimensions and one overall score) and will also compare the resource costs of using the new care pathway against the existing the existing costs in the standard of care (SoC) pathway. The clinical efficacy of the new care pathway will be determined by comparing patient data up to 15 weeks post-operatively between the control and intervention groups. In this way, an economic evaluation will be carried out concurrently with the trial to determine the cost-effectiveness of GaitSmart versus current SoC and will be compared to current thresholds for adoption used by NICE.
Currently no objective assessment is carried out either pre- or post-operatively. In addition to improving individual patient care, comparisons between types of TKR or THR procedures, implants, healthcare providers, care protocols etc. could be made in the future using GaitSmart.