title: Immediate weight bearing after uncemented total hip arthroplasty with an anteverted stem: A prospective randomized comparison using radiostereometry Early Migration Pattern of the Uncemented CLS Stem in Total Hip Arthroplasties Full weight-bearing after cementless total hip arthroplasty Early migration and late aseptic failure of proximal femoral prostheses. Unrestricted Weight Bearing and Intensive Physiotherapy after Uncemented Total Hip Arthroplasty Gait with and without forearm crutches in patients with total hip arthroplasty The effect of early weight bearing on migration pattern of the uncemented CLS stem in total hip arthroplasty. Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial. Early inpatient rehabilitation after elective hip and knee arthroplasty. Muscular recovery around the hip joint after total hip arthroplasty. No adverse effects of early weight bearing after uncemented total hip arthroplastyA randomized study of 20 patients
abstract: Background In uncemented total hip arthroplasty with hydroxyapatite coating , early weight bearing is frequently practice d but there is still not much evidence to support this recommendation . Method In a prospect i ve r and omized study we evaluated the effect of partial and full weight bearing after  cementless total hip arthroplasty ( ABG ; Stryker-Howmedica ) using radiostereometric analysis ( RSA ) . Between February 1996 and February 2000 , 43 consecutive patients ( mean age 53 ( 41–63 ) years , 23 women ) with hip osteoarthrosis received an uncemented and hydroxyapatite-coated prosthesis with an anteverted stem . All patients were operated in a st and ardized way by three experienced surgeons and they were r and omized to partial ( P ) or full ( F ) weight bearing during the first 6 weeks after surgery . The patients in the partial weight bearing group were equipped with a pressuresensitive insole signaling when their load exceeded the prescribed weight limit . Results At 3-month follow-up , the mean proximal (+)/ distal ( - ) migration of the stem was -0.14 mm ( -1.93– 0.11 ) in group P and -0.31 mm ( -4.30–0.16 ) in group F ( p = 0.6 ) . At 1-year follow-up , the mean migration was –0.17 mm ( -2.18–0.21 ) and -0.28 mm ( -4.31–0.11 ) , respectively ( p = 0.9 ) . There was no significant difference in stem rotations either ( p < 0.2 ) . The cup translations , rotations , and femoral head penetration were similar in the two groups ( p < 0.1 ) . There were no re-operations during the first year . Interpretation We did not find any adverse effect of full weight bearing immediately after operation , which justifies use of this regimen after uncemented total hip arthroplasty of the ABG type We performed this investigation to determine the possible migration starting immediately after surgery and the effect of different weightbearing regimens on the migration pattern of an uncemented hip stem ( CLS ) . Stem migration was determined with radiostereometry analysis with baseline when the patients still were anesthetized . Subsequent examinations were done up to 1 year . Twenty-nine patients ( mean age , 55 years ; range , 26 - 63 years ) were r and omized to either unrestricted weightbearing combined with intensive physiotherapy  from the first day after surgery or to partial weightbearing and a conservative training regimen for the first 3 months after surgery . At 1 week , subsidence was −0.03 mm in the unrestricted weightbearing group and 0.01 mm in the partial weightbearing group . At 1 year , subsidence was 1.01 mm in the unrestricted weightbearing group and 0.51 mm in the partial weightbearing group . One patient in the unrestricted weightbearing group had revision surgery because of aseptic loosening at 1.5 years after surgery . The CLS stem did not have any migration from the end the surgery until 1 week , but there was small migration from 1 week to 3 months after which the stem remained stable . The degree of early weightbearing did not affect the migration pattern . Level of Evidence : Level I , therapeutic study ( r and omized study ) . See the Guidelines for Authors for a complete description of levels of evidence Abstract . In a prospect i ve study of cementless total hip arthroplasty , 19 hips in 17 patients ( Group A ) were allowed full weight-bearing immediately after the operation while 18 hips in 16 patients ( Group B ) were first allowed weight-bearing after 6 weeks . Patients were matched for sex , age at surgery , height , weight , and follow-up period and there were no significant differences in hip scores between the two groups . Rehabilitation to gain walking ability with a cane lasted 5.8 days for Group A and 44.8 days for Group B ( P=0.0001 ) . The hospital stay after surgery was 30.1 days for Group A and 46.7 days for Group B ( P=0.006 ) . All patients showed bone ingrowth radiographically . There were no complications in either group . Résumé . Dans une étude prospect i ve d'arthroplastie totale de la hanche non-cimentée , z 17 malades ( 19 hanches ) ( Groupe A ) ont eu l'autorisation de pratiquer un appui complet immédiatement après l'intervention t and is que 16 malades ( 18 hanches ) ( Groupe B ) l'ont fait après 6 semaines . Les malades ont été appariés en regard du sexe , de l'âge à la chirurgie , de la taille , du poids , et de la durée du suivi . Il n'y avait pas de différence significative en ce qui concerne les scores du fonctionnement de la hanche entre les deux groupes . La durée de rééducation nécessaire pour obtenir la capacité de marche à l'aide d'une canne était de 5,8 jours pour le Groupe A et de 44,8 jours pour Groupe B ( P=0.0001 ) . La durée de séjour à l'hôpital après l'intervention était de 30,1 jours pour le Groupe A et de 46,7 jours pour le Groupe B ( P=0.006 ) . Nous avons constaté chez tous les patients une fixation osseuse à la radiographie . Il n'y avait aucune complication dans les deux groupes The  vertical migration of four configurations of a proximal femoral prosthesis , followed for up to nine years , was measured on st and ard radiographs . The same implant was used without cement ( group 1 ) and with cement ( group 2 ) . The migration of both groups was linear from six months onwards . The mean migration rate and the incidence of late aseptic loosening were both greater in group 1 . Survival analysis of the two groups , however , showed no statistically significant difference . In both groups , hips later destined for revision migrated more rapidly from the initial postoperative period onwards , than did the remainder . A threshold migration of 1.2 mm/year during the first two years after implantation detected hips likely to fail with a specificity of 86 % and a sensitivity of 78 % . This ' migration test ' was applied to the results in two further groups of patients in which a modified femoral prosthesis had been implanted without hydroxyapatite coating ( group 3 ) and with hydroxyapatite coating  ( group 4 ) . The test distinguished between the four groups and suggested that at least two fixation procedures should be ab and oned . We conclude that vertical migration measured on st and ard radiographs in the first two years after implantation can be used to predict late aseptic loosening . New prosthetic configurations should be evaluated by migration measurements before their general release . Our observations support the view that one cause of late aseptic loosening is imperfect initial fixation Background and Aims : The effectiveness of partial weightbearing after hip surgery has been question ed as well as the need of intensive physiotherapy . Material and Methods : 36 patients ( average age 54.4 , 19 women ) operated with uncemented hip arthroplasty were r and omized either to unrestricted weightbearing ( UWB ) combined with intensive physiotherapy or to partial weightbearing ( PWB ) for 3 months combined with a short self-training program . The load during walking and the muscle strength ( MS ) in abduction was measured preoperative and subsequent up to 12 months . Results : The average peak load on the operated leg at one week was 39.0 kg for the UWB and 25.8 for the PWB group ( P = 0.009 ) while at three months 70.0 and 31.7 ( P = 0.001 ) respectively . At 6 and 12 months there were no differences between the groups . The muscle strength increased in both groups up to six months but there were no differences between the groups . Conclusions : Even though patients applied more load than the recommended 15 kg most patients were able to comply with partial weightbearing fairly well . The effect of intensive physiotherapy on the muscle strength after hip arthroplasty is question able & NA ; There is considerable variation between centres in the use of forearm crutches in the rehabilitation of patients with total hip arthroplasty who are capable of full weight bearing . This study aim ed to compare the gait of patients with total hip arthroplasty walking with and without crutches .  The gait analysis in 19 patients included the assessment of kinematics , kinetics and the kinesiological electromyographic activity of lower limb and trunk muscles . With the forearm crutches patients walked with a reduced cadence , a longer stride length and more symmetrically ( P < 0.05 ) . The activity of the gluteus medius , vastus medialis and lateralis , and erector spinae muscles of the affected and of the vastus medialis muscle of the unaffected side decreased significantly ( P < 0.05 ) . Furthermore , seven subjects displayed an abnormal activation pattern of the affected hip abductor when walking with forearm crutches , characterized by a second burst during swing ( n = 5 ) or a tonic pattern ( n = 2 ) . It is concluded that the use of forearm crutches result ed in a symmetrical gait pattern . The reduced activity of relevant pelvi‐trochanteric muscles and the disturbed activation pattern of the affected hip abductor when walking with crutches might indicate that patients should walk unaided as soon as possible to provide a more efficient muscular training under dynamic conditions . Gang mit und ohne Unterarmkrücken bei Patienten mit Hüft‐TEP Es gibt erhebliche Unterschiede zwischen den Zentren bei der Verwendung von Unterarmkrücken bei der Rehabilitation von Patienten mit Hüft‐TEP , die voll belastbar sind . Diese Studie hat das Ziel , den Gang von Patienten mit Hüft‐TEP , die mit und ohne Krücken gehen , zu vergleichen . Die Gangauswertung bei 19 Patienten umfa&bgr;t die Beurteilung der Kinematik , Kinetik und der kinesiologischen elektromyeolographischen Aktivität der Muskeln von Rumpf und unteren Extremitäten . Mit den Unterarmkrücken gingen die Patienten mit einem verlangsamten Rhythmus , einer grö&bgr;eren Schrittlänge und symmetrischer ( P < 0.05 ) , die Aktivität der Mm gluteus , vastus medialis und laterialis sowie erector spinae der betroffenen und des M. vastus medialis der nichtbetroffenen Seite nahmen erheblich ab ( P < 0.05 ) . Au&bgr;erdem hatten sieben Patienten beim Gehen mit Unterarmkrücken ein abnormes Aktivierungsmuster des betroffenen Hüftabduktors , das sich in einem zweiten Impuls beim Schwung ( n = 5 ) oder einem tonischen Muster ( n = 2 ) äu&bgr;erte . Schlu&bgr;folgerung : Die Verwendung von Unterarmstützen führte zu einem symmetrischen Gangmuster . Die verringerte Aktivität von relevanten Muskeln von Becken und Trochanter und das gestörte Aktivierungsmuster des betroffenen Hüftabduktors beim Gehen mit Krücken lassen ein alsbaldiges Gehen ohne Hilfsmittel als sinnvoll erscheinen , um ein effizienteres Muskeltraining unter dynamischen Bedingungen zu ermöglichen . Déambulation avec et sans Béquilles après une Arthroplastie Totale de Hanche Il existe une variation considérable selon les centres concernant l'utilisation de béquilles pour la rééducation des patients ayant bénéficié d'une arthroplastie totale de hanche capables de supporter totalement leur poids . Cette étude était destinée à comparer la déambulation des patients après une arthroplastie totale de hanche marchant avec ou sans béquilles . L'analyse de la déambulation effectuée chez 19 patients incluait une évaluation cinématique , cinétique et une étude de l'activité électromyographique kinésiologique des muscles des membres inférieures et des muscles du tronc . Avec des béquilles , les patients ont marché plus lentement , à plus petits pas et plus symétriquement ( P < 0.05 ) . L'activité des muscles moyen fessier , vastes intérne et externe du membre inférieur et celle des muscles spinaux du côté atteint ont diminué significativement ( P < 0.05 ) , tout comme celle du muscle vaste interne du membre inférieur du côté non atteint . En outre , sept sujets ont présenté une activation anormale des abducteurs de hanche du côté atteint lors de la déambulation avec béquilles , se caractérisant par une deuxième salve d'activité électrique lors du balancement ( n = 5 ) ou un tracé tonique ( n = 2 ) . Conclusion : L'utilisation de béquilles a permis une déambulation symétrique . Toutefois , pour une rééducation musculaire plus efficace , en conditions dynamiques , il est recomm and é de recourir le plus rapidement possible après l'intervention à une déambulation sans aide en raison de la diminution de l'activité des muscles pelvi‐trochantériens concernés et de l'activation paradoxale des abducteurs de hanche du côté atteint lors de la déambulation avec béquilles . Deambulación con o sin Muletas de Apoyo en El Antebrazo en Pacientes Sometidos a Artroplastia de Cadera Completa Existe una gran variabilidad entre los centros en cuanto al uso de muletas de apoyo en el antebrazo en la rehabilitación de los pacientes sometidos a artoplastia de cadera completa que pueden soportar todo el peso . El objetivo de este estudio fue comparar la marcha de los pacientes con artoplastia de cadera completa que caminaban con y sin muletas . El análisis de la marcha en 19 pacientes incluyó la valoración de la cinemática , de la cinética y de la actividad cinesiológica en el electromiograma de los músculos de las extremidades inferiores y del tronco . Con las muletas de apoyo en el antebrazo , los pacientes caminaron con una cadencia menor , con una mayor zancada y de forma más simétrica ( P < 0.05 ) ; la actividad de los músculos glúteo medio , vasto medial y lateral y erector de la espina dorsal del lado afectado , y del músculo vasto medial contralateral disminuyó de forma significativa ( P < 0.05 ) . Además , siete sujetos desarrollaron una patrón de activación anormal del abductor de la cadera afectada al caminar con muletas de apoyo en el antebrazo , que se caracterizó por una segunda descarga durante el balanceo ( n = 5 ) o un patrón tónico ( n = 2 ) . Conclusión : el uso de muletas de apoyo en el antebrazo produjo un patrón de la marcha simétrico . La disminución de la actividad de los principales músculos de la pelvis y del trocánter y la alteración del patrón de activación del abductor de la cadera afectada producida al caminar con muletas hacen recomendable la deambulación sin ayuda tan pronto como sea posible para conseguir un entrenamiento muscular más eficaz en condiciones dinámicas . International Journal of Rehabilitation Research Forty-two patients ( younger than 65 years ) with osteoarthritis were operated on with an uncemented CLS stem and r and omized to early unrestricted weight bearing combined with intensive physiotherapy or to partial weight bearing combined with self-training . Radiostereometric analysis showed 1.2 ( + 0.11 to -6.76 ) mm subsidence of the stem at 24 months in both groups . There was no significant difference in the migration pattern between the unrestricted and partial weight bearing groups . Actual loading on the operated leg , measured with the F-scan system , did not influence the migration of the stem . There was a strong correlation between the average subsidence at 3 and 24 months ( r = 0.96 ) . Early full weight bearing and active rehabilitation can be used for the uncemented CLS stem without increased risk of early loosening OBJECTIVE To investigate the effects of a late-phase exercise program for patients who underwent total hip arthroplasty ( THA ) 4 to 12 months earlier . DESIGN A single-blind , r and omized controlled trial . SETTING Exercises were performed in subjects ' homes . Exercise instruction and measurements taken before and after the trial were performed in an outpatient research and treatment center . PARTICIPANTS Convenience sample of 34 adults 4 to 12 months post-THA r and omly allocated to experimental or control groups . Twenty-eight subjects completed the study . INTERVENTION An 8-week , hip-exercise intervention , during which the control group received basic isometric and active range of motion exercises ; the experimental group received strength and postural stability exercises . MAIN OUTCOME MEASURES Score on the 12-Item Hip Question naire ; fear of falling ; hip flexor , extensor , abductor , and knee extensor muscle torque ; and postural stability in single stance . RESULTS There was a statistically significant improvement in all measures of self-perceived function , muscle strength ( hip flexors , 24.4 % ; hip extensors , 47.8 % ; hip abductors , 41.2 % ; knee extensors , 23.4 % ) , and postural stability ( 36.8 % ) in the experimental group and no significant change in the control group . Neither group had statistically significant changes in fear of falling measures . CONCLUSIONS An exercise program emphasizing weight bearing and postural stability significantly improved muscle strength , postural stability , and self-perceived function in patients 4 to 12 months after THA CONTEXT Inpatient rehabilitation after elective hip and knee arthroplasty is often necessary for patients who can not function at home soon after surgery , but how soon after surgery inpatient rehabilitation can be initiated has not been studied . OBJECTIVE To test the hypothesis that high-risk patients undergoing elective hip and knee arthroplasty  would incur less total cost and experience more rapid functional improvement if inpatient rehabilitation began on postoperative day 3 rather than day 7 , without adverse consequences to the patients . DESIGN R and omized controlled trial conducted from 1994 to 1996 . SETTING Tertiary care center . PARTICIPANTS A total of 86 patients undergoing elective hip or knee arthroplasty and who met the following criteria for being high risk : 70 years of age or older and living alone , 70 years of age or older with 2 or more comorbid conditions , or any age with 3 or more comorbid conditions . Of the 86 patients , 71 completed the study . INTERVENTIONS R and om assignment to begin inpatient rehabilitation on postoperative day 3 vs postoperative day 7 . MAIN OUTCOME MEASURES Total length of stay and cost from orthopedic and rehabilitation hospital admissions , functional performance in hospitals using a subset of the functional independence measure , and 4-month follow-up assessment using the R AND 36-item health survey I and the functional status index . RESULTS Patients who completed the study and began inpatient rehabilitation on postoperative day 3 exhibited shorter mean ( + /-SD ) total length of stay ( 11.7+/-2.3 days vs 14.5+/-1.9 , P<.001 ) , lower mean ( + /-SD ) total cost ( $ 25891+/-$3648 vs $ 27762+/-$3626 , P<.03 ) , more rapid attainment of short-term functional milestones between days 6 and 10 ( 36.2+/-14.4 m ambulated vs 21.4+/-13.3 m , P<.001 ; 4.8+/-0.8 mean transfer functional independence measure score vs 4.3+/-0.7 , P<.01 ) , and equivalent functional outcome at 4-month follow-up . CONCLUSION These data showed that high-risk individuals were able to tolerate early intensive rehabilitation , and this intervention yielded faster attainment of short-term functional milestones in fewer days using less total cost A prospect i ve study was conducted to quantitatively measure the relative muscle torque strengths in 20 consecutive women with unilateral osteoarthritic hips and 20 consecutive men with unilateral osteonecrotic hips before and after primary cementless total hip arthroplasty .  Maximal isometric torque strengths in the muscles of flexion , extension , and abduction around the hip joint were measured preoperatively and postoperatively at six months and one year , using a Cybex 340 dynamometer . The results showed improved muscle function after total hip arthroplasty in both diseased and healthy hips . In the diseased hips , all muscle groups improved significantly , from 150 to 250 % of the preoperative levels , at six months and one year postoperatively , except in the osteoarthritic women , in whom the improvement at six months was minimal . Preoperatively , all muscle groups in the diseased hips were weaker than those in the uninvolved hips , especially in the osteonecrotic men ( 51 - 79 % of healthy side ) . In both groups , however , the torques strengths of the diseased hips had not caught up to the healthy hips in the one-year follow-up period ( 84 - 89 % in the osteonecrotic male group , and 79 - 81 % in the osteoarthritic female group ) . The authors recommended that muscle strengthening exercises for the hip should be continued for at least one year , and perhaps longer , after total hip arthroplasty BACKGROUND Few guidelines are available whether early weight-bearing after an  uncemented total hip arthroplasty ( THA ) can be recommended or not . Stability and ingrowth may be jeopardized by immediate loading of the implant while functional recovery may be promoted and periprosthetic demineralization reduced . PATIENTS AND METHODS We did a prospect i ve study of 20 patients who were operated on with a hydroxyapatite-coated ( HA ) , uncemented total hip arthroplasty with a tapered stem because of unilateral arthrosis , and r and omized the patients to the immediate ( I ) or late ( L ) weight-bearing ( after 3 months ) group . The shoe on the operated side was equipped with an auditory device signaling when the patient placed a load on the extremity . The clinical assessment was done with the Harris hip score at the time of the operation and after 12 and 24 months . Radiographs and dual-energy x-ray absorptiometry ( DEXA ) were evaluated for migration , femoral remodeling and bone mineral density ( BMD ) after 3 , 6 , 12 and 24 months .  Tc-scintigraphy  was done after 6 , 12 and 24 months . RESULTS Postoperatively , the Harris hip score showed no group difference . After 3 months , we noted a large reduction in BMD around the stem prosthesis . This was most marked in the proximal regions and the bone loss was significantly larger in zone 1 , 4 and 5 in the L group . Distally , the BMD normalized with time , but the loss of bone persisted in the proximal zones after 24 months . An initial increase in the scintigraphic uptake ratio in all zones in both groups declined with time , but it was still increased on the operated side after 24 months . Several radiographic signs of bone remodeling were seen , but the patterns were similar in both groups . INTERPRETATION We found no adverse effect of immediate weight bearing with this prosthesis
target: We found moderate to strong evidence that no adverse effects on subsidence and osseous integration of the femoral stem after uncemented THA occur after immediate UWB .
background: The aim of this systematic review was to find evidence -based support in the literature to allow immediate unrestricted weight bearing after  primary uncemented total hip arthroplasty ( THA ) .
  Accelerated rehabilitation programs for THA are becoming increasingly popular to shorten hospital stay and to facilitate rapid restoration of function .
  The goals of these rehabilitation programs could be more easily achieved if immediate unrestricted weight bearing ( UWB ) could be allowed after a THA .
  So far , however , immediate weight bearing is frequently contraindicated in widely accepted protocol s for uncemented THA due to fear for subsidence and absence of osseous integration of the femoral stem .
  Thus , frequently protected weight bearing and restricted activities are still advocated for at least 6 weeks after surgery .
  In addition , we analyzed the literature to come to a recommendation on gait pattern and walking aid .