Gait Training Using a Hip-Wearable Robotic Exoskeleton After Total Knee Arthroplasty: A Case Report

Abstract

The Honda Walking Assist® (HWA) is a light and easy wearable robot device for gait training, which assists patients’ hip flexion and extension movements to guide hip joint movements during gait. However, the safety and feasibility of gait training with HWA after total knee arthroplasty (TKA) remains unclear. Thus, we aimed to evaluate the safety and feasibility of this gait training intervention using HWA for a patient who underwent TKA. The patient was a 76-year-old female who underwent a left TKA. Gait training using HWA was conducted for 18 sessions in total, from 1 to 5 weeks after TKA. To verify the recovery process after TKA surgery, knee function parameters and walking ability were measured at pre-TKA and 1, 2, 4, and 8 weeks after TKA. The gait patterns at self-selected walking speed (SWS) without HWA at pre- and 5 weeks after TKA were measured by using 3-dimensional (3D) gait analysis. The patient completed a total of 18 gait training interventions with HWA without any adverse complications such as knee pain and skin injury. The postoperative knee extension range of motion (ROM), knee extension torque, SWS, and maximum walking speed were remarkably improved. Regarding gait kinematic parameters, though this patient had a characteristic gait pattern with decreased knee ROM (called stiff knee gait) preoperatively, the knee flexion angle at 5 weeks after TKA showed knee flexion movement at loading response phase (LR; called double knee action), increased knee ROM during gait, and increased knee flexion angle at swing phase. In this case, the gait training using HWA was safe and feasible, and could be effective for the early improvement of gait ability, hip function, and gait pattern after TKA.

Gait Training after Stroke with a Wearable Robotic Device: A Case Report of Further Improvements in Walking Ability after a Recovery Plateau

“…41 , 42 ) HWAT has been reported to lead to the appearance of knee flexion during the loading response phase in a patient undergoing total knee arthroplasty. 16 ) These facts support the possibility that our patient acquired a more efficient gait as a result of HWAT, and this subsequently led to the improvement of gait endurance.…”

“…HWA is applicable to patients with diseases related to the central nerve system 11 , 12 , 13 , 14 , 15 ) and with orthopedic diseases. 16 , 17 , 18 ) Randomized controlled trials with stroke patients have shown that gait training with HWA (HWAT) can increase the walking speed, the step length of the affected side, the cadence, and the walking capacity and improve symmetry. 11 , 12 , 13 ) These results raise the possibility that HWAT may lead to further improvements in walking ability on top of the recovery achieved by conventional rehabilitation.…”

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

“…In our previous reports, we demonstrated that HWA assistance promotes knee flexion by lifting the thigh during the swing phase, and HWA intervention is effective in improving stiff knee gait whereby knee flexion is reduced during walking. 21 Although gait kinematic parameters were not measured in this study, HWA intervention could contribute to the early improvement of walking ability with such a mechanism.…”

“…The surgical procedure was similar to that described in previous reports. 19 , 21 With the patients under general anesthesia, we made a midline skin incision and reached the joint using a medial parapatellar approach. The patella was not replaced, and the posterior cruciate ligament was retained.…”

“…We previously used the HWA for gait training and observed improved lower limb kinematic parameters (e.g., stiff knee gait pattern), as well as early improvement of walking ability after surgery in a patient who underwent TKA. 21 In addition to the aforementioned improvement of gait symmetry, we hypothesized that walking practice using a hip-driven exoskeleton-type robot can promote early recovery of walking and knee function in patients with knee joint diseases, since hip assist with the HWA can influence lower extremity kinematics during gait ( Figure 1B ). For this reason, we conducted a comparative study with a control group that received conventional physical therapy.…”