The organizers contacted 96 patients monitored by the Hip Group of Santa Casa de
Misericórdia de São Paulo. Forty-five patients of both sexes, residing in
Greater São Paulo, and submitted to uni- or bilateral Total Hip Arthroplasty (THA),
were included in the study. The patients submitted to bilateral THA had only the side with
longer follow-up time evaluated. Patients with less than 6 months of THA postoperative (PO)
time were excluded. Of the 96 patients, 46 were not willing to take part in the study, and
five had less than six months of PO time.
All the patients received explanations regarding the goals and procedures of this survey
and in agreeing to take part in the study signed a consent form. The project of this study
was approved by the Institutional Review Board under no. 495/07.
The patients were evaluated by the Modified Merle d'Aubigné and Postel
Method9 (link) (Appendix 1 ), which evaluates pain, gait and mobility, on a scale of 1
to 6 for each item, where 1 indicates the worst and 6, the best state of the patient. The
total minimum score reached is 3, and the maximum is 18. In this modified method, the
patients are categorized by the alphabetical prefixes: Prefix A: patient with one hip
involved; B: patient with two hips involved; C: patient with systemic disease that
interferes in normal gait (polyarthritis in rheumatoid arthritis, senility, hemiplegia,
cardiovascular and pulmonary dysfunction), which are classified according to the clinical
and radiographic diagnosis.
The study used parameters to standardize the gait options. Option 6: indicated patient with
normal gait; 5: limping gait without use of crutches; 4: patient who walks long distances
with cane (parameterized as the individual who walks in the park without difficulties); 3:
limited with cane, tolerates prolonged orthostatism (patient goes to the supermarket,
manages to accomplish activities of daily living (ADL); 2: limited in time and distance,
with or without cane (patient who goes for a quick walk and returns, covering no more than
two blocks); 1: few meters or bedridden, uses cane or crutches (goes to the bathroom and
returns, ambulatory in the home).
Passive movements of the hip were made and measured using the universal goniometer to
evaluate mobility or range of motion (ROM). The supine position was chosen for the
measurement using Lea and Gerhardt as a reference.18 (link) Hip flexion and extension were tested with the hip at 0º
of abduction, adduction and rotation. In flexion the pelvis was stabilized to prevent
rotation and posterior tilt. Extension was measured with lower limbs in the Thomas test
position, measuring the angle between the femur and the stretcher of the extended limb.
Abduction and adduction were tested with the hip at 0º of flexion, extension and
rotation. To measure the adduction, the contralateral hip was flexed to allow the evaluation
throughout the ROM. For internal and external rotation the hip was positioned at 0º
of abduction, adduction with the knee and hip flexed at 90º.
With the purpose of establishing parameters for the evaluation criteria, the three
physiotherapist researchers received training in the instrument, carried out according to
the evaluation of the Hip Group of Santa Casa de Misericórdia de São
Paulo.
The evaluation occurred on the same day, and the patient evaluation order was determined at
random. The researchers did not communicate during the evaluation periods. Each patient was
evaluated by the three researchers, with an interval of 30 minutes between each evaluator.
Cronbach's Alpha Statistic Test was applied for the statistical analysis through version
13.0 of the SPSS (Statistical Package for Social Sciences) program. A significance level of
p≤0.05 and high reliability with α between 0.7 and 1.0 were considered.
Misericórdia de São Paulo. Forty-five patients of both sexes, residing in
Greater São Paulo, and submitted to uni- or bilateral Total Hip Arthroplasty (THA),
were included in the study. The patients submitted to bilateral THA had only the side with
longer follow-up time evaluated. Patients with less than 6 months of THA postoperative (PO)
time were excluded. Of the 96 patients, 46 were not willing to take part in the study, and
five had less than six months of PO time.
All the patients received explanations regarding the goals and procedures of this survey
and in agreeing to take part in the study signed a consent form. The project of this study
was approved by the Institutional Review Board under no. 495/07.
The patients were evaluated by the Modified Merle d'Aubigné and Postel
Method9 (link) (
to 6 for each item, where 1 indicates the worst and 6, the best state of the patient. The
total minimum score reached is 3, and the maximum is 18. In this modified method, the
patients are categorized by the alphabetical prefixes: Prefix A: patient with one hip
involved; B: patient with two hips involved; C: patient with systemic disease that
interferes in normal gait (polyarthritis in rheumatoid arthritis, senility, hemiplegia,
cardiovascular and pulmonary dysfunction), which are classified according to the clinical
and radiographic diagnosis.
The study used parameters to standardize the gait options. Option 6: indicated patient with
normal gait; 5: limping gait without use of crutches; 4: patient who walks long distances
with cane (parameterized as the individual who walks in the park without difficulties); 3:
limited with cane, tolerates prolonged orthostatism (patient goes to the supermarket,
manages to accomplish activities of daily living (ADL); 2: limited in time and distance,
with or without cane (patient who goes for a quick walk and returns, covering no more than
two blocks); 1: few meters or bedridden, uses cane or crutches (goes to the bathroom and
returns, ambulatory in the home).
Passive movements of the hip were made and measured using the universal goniometer to
evaluate mobility or range of motion (ROM). The supine position was chosen for the
measurement using Lea and Gerhardt as a reference.18 (link) Hip flexion and extension were tested with the hip at 0º
of abduction, adduction and rotation. In flexion the pelvis was stabilized to prevent
rotation and posterior tilt. Extension was measured with lower limbs in the Thomas test
position, measuring the angle between the femur and the stretcher of the extended limb.
Abduction and adduction were tested with the hip at 0º of flexion, extension and
rotation. To measure the adduction, the contralateral hip was flexed to allow the evaluation
throughout the ROM. For internal and external rotation the hip was positioned at 0º
of abduction, adduction with the knee and hip flexed at 90º.
With the purpose of establishing parameters for the evaluation criteria, the three
physiotherapist researchers received training in the instrument, carried out according to
the evaluation of the Hip Group of Santa Casa de Misericórdia de São
Paulo.
The evaluation occurred on the same day, and the patient evaluation order was determined at
random. The researchers did not communicate during the evaluation periods. Each patient was
evaluated by the three researchers, with an interval of 30 minutes between each evaluator.
Cronbach's Alpha Statistic Test was applied for the statistical analysis through version
13.0 of the SPSS (Statistical Package for Social Sciences) program. A significance level of
p≤0.05 and high reliability with α between 0.7 and 1.0 were considered.
