Abstract
BackgroundOsteoarthritis and subsequent total hip arthroplasty (THA) lead to damages to hip joint mechanoceptors, which in turns lead to impairments in proprioception. One of the abilities mainly affected by an altered joint proprioception is balance. The aim of this work was to investigate the balance and proprioception impairments, current assessment tools, and rehabilitation training after THA.MethodsA systematic literature revision was conducted on PubMed, Web of Science and Cochrane databases. Articles reporting balance and proprioception impairments, current assessment tools, or rehabilitation interventions were included. Methodological quality was assessed using the Downs and Black checklist. A total of 41 articles were included, 33 discussing balance and proprioception assessment, and 8 dealing with training. Data related to type of surgical approach, type and timing of assessment protocols, assessment instrumentation, and type, volume and duration of the rehabilitation training were extracted from each study.ResultsThirty-one studies were of high quality, 2 of moderate quality and 8 of low-quality. Literature review showed an improvement in balance following THA in comparison with the pre-operative performance, although balance abnormalities persist up to 5 years after surgery, with THA patients showing an increased risk for falls. Balance training is effective in all the rehabilitation phases if specifically structured for balance enhancement and consistent in training volume. It remains unclear which assessments are more appropriate for the different rehabilitation phases, and if differences exist between the different surgical procedures used for THA. Only two studies assessed proprioception.ConclusionBalance and proprioception show impairments up to 5 years after THA, increasing the risk of falls. However, patients with THA may benefit of an adequate balance training. Further research is needed to investigate the gaps in balance and proprioception assessment and training following THA surgery.
Highlights
Osteoarthritis and subsequent total hip arthroplasty (THA) lead to damages to hip joint mechanoceptors, which in turns lead to impairments in proprioception
Search results According to the PRISMA flow-chart (Fig. 1), a total of 1780 articles were retrieved from the initial literature search
Five articles [27, 28, 29,30,31,32] were excluded because the results from patients with THA were mixed to results of patients operated on for other orthopaedic conditions
Summary
Osteoarthritis and subsequent total hip arthroplasty (THA) lead to damages to hip joint mechanoceptors, which in turns lead to impairments in proprioception. Labanca et al BMC Musculoskeletal Disorders (2021) 22:1055 interventions for joints replacement may compromise part of the joint structures and surrounding components, with joint mechanoceptors being the most affected structure by THA surgery. The damages to these mechanoceptors lead to impairments in proprioception, i.e., to a lack or to abnormal afferent signals informing the brain of joints’ position and movement. Abnormal proprioceptive signals do affect sensory function, and motor control, since sensory information is essential for movement programming [4] For these reasons, patients undergoing joint replacement surgery show both sensitive and motor abnormalities [2, 5, 6]. In THA patients, balance deficits may be persistent after surgery [11, 12], leading to an increase in the risk of falls [13], especially in the first year after surgery [14]
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