This document discusses using home-based gait training following knee and hip arthroplasty. It notes that many joint replacement patients do not recover normal gait, reducing their quality of life. A pilot study used remote monitoring of gait data in patients' homes to provide personalized diagnosis and improve outcomes. Results showed gait data and targeted physiotherapy helped one patient resume normal gait after 9 months. Another patient in need of joint replacement was easily diagnosed. A third patient with no targeted physiotherapy after operations showed deteriorating mobility. The study demonstrated remote gait monitoring can improve joint replacement rehabilitation.

1. Home Based Gait Training Following Knee
and Hip Arthroplasty.
Graham Worsley, Dr Diana
Hodgins ETB Ltd

2. Poor gait is a significant factor in falls
Many THR and TKR patients do not recover a
“normal” gait
This reduces their QoL and incurs costs to the NHS:
Contralateral joint replacement, falls, revisions etc.
Is this due to poor rehab and if so can we improve it?
Note THR = Total Hip Replacement, TKR Total Knee Replacement

3. SBRI Pilot study (2015) to demonstrate remote access
to gait data in the home, and to indicate whether
objective, measured gait data:
can improve outcomes for joint replacement
(alongside supported physiotherapy)
can help provide personal diagnosis for
individuals with poor mobility

5. Hip Data from a healthy individual
Range of Motion Score % 100.0
Left Right
Range hip (°) 48.77 48.72
Range knee (°) 59.16 60.65
Range pelvis (°) 8.61 6.07
Range thigh (°) 47.55 48.03
Range calf (°) 80.75 82.79
Average Duration (s) 0.99
Quality of Gait Score % 92.9
Pelvis medial-lateral (°) 7.30 5.47
Thigh medial-lateral (%) 22.54 21.78
Calf medial-lateral (%) 17.44 23.12
Swing Time (%) 48.00 48.00
Stance Flexion (°) 23.23 22.09
Symmetry Score % 100.0
Hip (%) 0.10
Knee (%) -2.48
Pelvis (%) 34.63
Thigh (%) -0.99
Calf (%) -2.49
Stance (%) 4.90
Swing Difference (%) 0.00
Healthy person has
all the values as
green

6. Three volunteers:
Male, post unilateral hip replacement
– Monitored twice weekly over 9 month period
Female, living at home, poor mobility
– Monitored over a 2 week period
Male, previous hip and knee replacement
– Monitored twice

7. Volunteer with
one hip
replacement
Volunteer with
one hip and one
knee replacement

8. Results for THR patient over time
0
10
20
30
40
50
60
-100 0 100 200 300
Hipangle(deg)
Days from op
Hip angle
Affected hip Non affected hip
0
0.2
0.4
0.6
0.8
1
1.2
1.4
-100 0 100 200 300
Strideduration(s)
Days from op
Stride duration
9 months to resume
good range and
good symmetry
Stride duration
returns to
normal 9 weeks
post op

9. 9 months post op

10. At one week it was possible to provide a ‘Start Point’ for the
patient.
After 3 months range had improved significantly on the
operated side, but still outside normal limits.
Signed off by physio (no pain) and subsequent plateau from
3-6 months.
Focused rehab at 6 months to initiate further improvement.
After 9 months the range of motion on both hips has achieved
that of the good hip and symmetry has been resumed.
Monitoring and focused input enabled this person to resume a
normal gait after 9 months.

11. The right hip
(green line) has
poor range
Poor hip range
has affected all
other aspects
of the gait cycle
Hip symmetry
is very poor

12. When examined it was found that the right hip had
severe OA and a replacement hip was necessary
The person was scheduled for surgery later that year
Without surgery her risk of falling or becoming
immobile was very high

13. Right knee in 2005
Revision in 2006
Left hip in 2014
Clearly has not
recovered functionality
following either
operation

14. This person is not under any specialist care but
clearly has major mobility issues.
Without professional assistance his mobility will
continue to deteriorate.

15. Session with general hospital physiotherapists
Presentations to RNOH Stanmore
No interest from Chartered Society of
Physiotherapists

16. Project successfully combined the two systems and remote gait
data was sent via the telehealth system from the home to the
server. We also noted:
Patient with THR benefited from gait data plus targeted input
Frail person was easily diagnosed and needed surgery
Person with no targeted physio after knee and hip replacement
has very poor gait and is now suffering pain and mobility issues

17. SBRI Phase II rejected.
Successful bid for Smart Proof of Market.
SWOT analysis:
NHS, private sector, private purchase – not ready
Market is in running gait clinics.

18. Acknowledgements
Stephen Hope, Adrian Flowerday – Docobo Ltd
Roberta Bass - Weston General Hospital
Mr John Timperley – Exeter Hip Foundation
Professor Ian McCarthy - UCL

19. NICE Guidelines – Falls http://cks.nice.org.uk/falls-
risk-assessment#!scenario
Doyle F, Whitehouse S, Timperley J. Measurement of
Gait Abnormality One Year After THA Using A Portable
Six Sensor IMU System. Presented at International
Hip Society, Chicago, September 2015
Hodgins D, McCarthy I. How measuring an older
person’s walking pattern can help keep them mobile
‘Personalised healthcare for mobility’. ITAP 2015
Springer ISSN 1611-3349

20. Thank You
Questions?
graham.worsley195@btinternet.com; DMH@etb.co.uk (Diana Hodgins)