Early Recovery of Walking Ability in Patients After Total Knee Arthroplasty Using a Hip-Wearable Exoskeleton Robot: A Case-Controlled Clinical Trial

Abstract

Introduction: The Honda Walking Assist (HWA) is a hip-wearable exoskeleton robot for gait training that assists in hip flexion and extension movements to guide hip joint movements during gait. This study aimed to evaluate the effects of walking exercises with HWA in patients who underwent total knee arthroplasty (TKA). Materials and Methods: This study involved 10 patients (11 knees) in the HWA group and 11 patients (11 knees) in the control group who underwent conventional physical therapy. The patients assigned to the HWA group underwent a total of 17-20 gait training sessions, each lasting approximately 20 min from week 1 to 5 following TKA. Self-selected walking speed (SWS), maximum walking speed (MWS), range of motion (ROM), knee extension and flexion torque, and Western Ontario and McMaster Universities Osteoarthritis Index subscales of pain (WOMAC-p) and physical function (WOMAC-f) scores were measured preoperatively, at 2, 4, and 8 weeks following TKA. Results: Interventions were successfully completed in all patients, with no severe adverse events. A significant difference was noted in the time × group interaction effect between preoperative and week 2 SWS and MWS. Regarding knee function, there was a significant difference in the time × group interaction between preoperative and week 2 active ROM extension; however, no significant difference in knee torque, WOMAC-p, and WOMAC-f scores were observed. In the between-group post hoc analysis, WOMAC-f in the HWA group was higher than that in the control group at week 8. Discussion: Although the control group showed a temporary reduction in SWS and MWS 2 weeks after TKA, the HWA group did not. These results suggest that HWA intervention promotes early improvement in walking ability after TKA. Conclusions: The gait training using HWA was safe and feasible and could be effective for the early improvement of walking ability in TKA patients.

Robotic exoskeletons and total knee arthroplasty: The future of knee rehabilitation and replacement – A meta-analysis

“…[23] Several studies have shown that RAR improves knee ROM post-TKA. [12,13,24] The study results also support the finding that RAR produces this clinical benefit, as this study showed that both AROM and PROM improved through activeassistive joint support. In this study, RAR improved both AROM and PROM.…”

Powered Hip Exoskeletons for Gait Rehabilitation: A Systematic Review and Meta-analysis

“…Koseki et al conducted three studies on Honda Walking Assistive device® (HWA) and showed increased gait parameters (speed, step length and cadence) in one subject with hip osteoarthritis and two subjects with transfemoral amputation [11,33]. They also noted early gait improvement when waring HWA during a clinical trial and a case report on total knee arthroplasty patients [34,35]. HWA outcomes were similar on one patient with spinal cord injury [36].…”

A State-of-the-Art of Exoskeletons in Line with the WHO’s Vision on Healthy Aging: From Rehabilitation of Intrinsic Capacities to Augmentation of Functional Abilities

“…A total of 22.2% of the included studies had a poor quality [32][33][34][35][36][37][38][39], 55.5% had a fair quality [24,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] and 22.2% had a good quality [59][60][61][62][63][64][65][66] [Appendix B].…”

“…The included studies consisted of retrospective, prospective interventional, or observational research conducted in single or multi-center settings [Supplementary Materials (Tables S1-S3)]. A total of 17 studies investigated functional abilities [33,34,36,42,46,47,49,51,53,54,56,57,[59][60][61]63,65] [Table S1 in Supplementary Material], 23 investigated IC [32][33][34][35][36][37]42,45,47,49,50,52,53,[55][56][57][58][59][60][61][62][63]65] [Table S2 in Supplementary Material], and 26 investigated performance indicators [24,33,[35][36][37][38]…”