Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jul 3;13(1):163.
doi: 10.1186/s13018-018-0875-1.

Training with Hybrid Assistive Limb for walking function after total knee arthroplasty

Kenichi Yoshikawa  1 , Hirotaka Mutsuzaki  2 , Ayumu Sano  1 , Kazunori Koseki  1 , Takashi Fukaya  3 , Masafumi Mizukami  4 , Masashi Yamazaki  5
Affiliations

Training with Hybrid Assistive Limb for walking function after total knee arthroplasty

Kenichi Yoshikawa et al. J Orthop Surg Res. .

Abstract

Background: The Hybrid Assistive Limb (HAL, CYBERDYNE) is a wearable robot that provides assistance to patients while walking, standing, and performing leg movements based on the intended movement of the wearer. We aimed to assess the effect of HAL training on the walking ability, range of motion (ROM), and muscle strength of patients after total knee arthroplasty (TKA) for osteoarthritis and rheumatoid arthritis, and to compare the functional status after HAL training to the conventional training methods after surgery.

Methods: Nine patients (10 knees) underwent HAL training (mean age 74.1 ± 5.7 years; height 150.4 ± 6.5 cm; weight 61.2 ± 8.9 kg), whereas 10 patients (11 knees) underwent conventional rehabilitation (mean age 78.4 ± 8.0 years; height 150.5 ± 10.0 cm; weight 59.1 ± 9.8 kg). Patients underwent HAL training during 10 to 12 (average 14.4 min a session) sessions over a 4-week period, 1 week after TKA. There was no significant difference in the total physical therapy time including HAL training between the HAL and control groups. Gait speed, step length, ROM, and muscle strength were evaluated.

Results: The nine patients completed the HAL training sessions without adverse events. The walking speed and step length in the self-selected walking speed condition, and the walking speed in the maximum walking speed condition were greater in the HAL group than in the control group at 4 and 8 weeks (P < 0.05). The step length in the maximum walking speed condition was greater in the HAL group than in the control group at 2, 4, and 8 weeks (P < 0.05). The extension lag and knee pain were lower in the HAL group than in the control group at 2 weeks (P < 0.05). The muscle strength of knee extension in the HAL group was greater than that in the control group at 8 weeks (P < 0.05).

Conclusion: HAL training after TKA can improve the walking ability, ROM, and muscle strength compared to conventional physical therapy for up to 8 weeks after TKA. Since the recovery of walking ability was earlier in the HAL group than in the control group and adverse events were not observed in this pilot study, HAL training after TKA can be considered a safe and effective rehabilitation intervention.

Trial registration: UMIN, UMIN000017623 . Registered 19 May 2015.

Keywords: Hybrid assistive limb; Osteoarthritis; Rheumatoid arthritis; Robot assisted training; Total knee arthroplasty.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The ethics committee of Ibaraki Prefectural University of Health Sciences approved the study (nos. 637 and e146). Informed consent was obtained from the patients.

Consent for publication

Written informed consent for the publication of Fig. 1 was obtained from the patient.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Hybrid Assistive Limb (HAL) training. Knee extension and flexion exercise while sitting, with HAL on the sagittal plane (a). Gait training, with HAL on the sagittal plane (b)
Fig. 2
Fig. 2
A flowchart of this study
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Sanna M, Sanna C, Caputo F, Piu G, Salvi M. Surgical approaches in total knee arthroplasty. Joints. 2013;1:34. - PMC - PubMed
    1. Gøthesen Ø, Espehaug B, Havelin L, Petursson G, Lygre S, Ellison P, et al. Survival rates and causes of revision in cemented primary total knee replacement: a report from the Norwegian arthroplasty register 1994–2009. Bone Joint J. 2013;95:636–642. doi: 10.1302/0301-620X.95B5.30271. - DOI - PubMed
    1. Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster J-Y. Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. JBJS. 2004;86:963–974. doi: 10.2106/00004623-200405000-00012. - DOI - PubMed
    1. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005;35:424–436. doi: 10.2519/jospt.2005.35.7.424. - DOI - PubMed
    1. Turcot K, Sagawa Y, Jr, Fritschy D, Hoffmeyer P, Suva D, Armand S. How gait and clinical outcomes contribute to patients’ satisfaction three months following a total knee arthroplasty. J Arthroplast. 2013;28:1297–1300. doi: 10.1016/j.arth.2013.01.031. - DOI - PubMed
-