Abstract
Introduction
The current standard of care for postoperative support during ambulation is a walker and accompanying gait belt. The use of a walker necessitates awkward body positioning, adequate upper body strength, and prohibits natural foot over foot progression during gait. Additionally, use of a gait belt necessitates that the therapist remains immediately beside or behind the patient, limiting the view of the patient's gait pattern and placing the therapist and patient at risk should the patient fall. The Secure Tracks™ (Fig 1) is a patient support device which runs in an overhead track and supports the patient in the periaxillary region, providing a more natural body position and foot progression while limiting the risk of falls. This prospective randomized study compares the rate of ambulation and other clinical outcomes measures in a population of total knee replacement recipients postoperatively.
Methods
A total of 31 unilateral total knee recipients were enrolled in this prospective randomized comparison between the standard of care gait training and the Secure Tracks device. IRB approval was obtained from the relevant oversight board. Patients were permitted to weight-bear as tolerated starting the evening of their surgical procedure. Patients were instructed to walk until they felt fatigued or unsafe and were not encouraged or discouraged to stop. The therapists tracked the distance each patient walked during each of their ambulation sessions and also recorded any incidence of falls or other adverse events. A timed up and go test (TUG) and Visual Analogue Scale for pain (VAS) were also administered at the time of consent, at discharge from the hospital, and at the 2 week clinic followup appointment.
Results
The mean distance walked by each rehabilitation group at all time points can be found In Table 1. On average, Secure Tracks patients walk between 52% and 152% further in each ambulation session. This amounted to a statistically significant increase on the day of surgery (p=0.021) and the second evening postop (p=0.018). The total distance walked while in the hospital was 96% greater in the Secure Tracks group (2,174 ft), compared to the standard rehabilitation group (1,170 ft) p = 0.035.
The results of the timed up and go test are contained In Table 2. Patients in the Secure Tracks group experienced significantly less pain during the TUG test at 2 weeks postoperatively (p = 0.049) and showed a trend to complete the task 3 seconds faster (p = 0.11). There was no statistically significant difference between the time required to complete the task, or the pain level experienced during the task, preoperatively or at discharge.
Discussion and Conclusion
The Secure Tracks proved to be a safe and effective patient support device that significantly increased the distance that patients walked during the postoperative period. The increased ambulation immediately following surgery likely contributed to the increased speed and decreased pain during the timed up and go test two weeks postoperatively.
