Impact of the method of exposure in total hip arthroplasty on balancing ability in response to sudden unidirectional perturbation in the first six months of the postoperative period

Abstract

Introduction and objectiveTotal hip arthroplasty affects 3–5% of the elderly population. Therefore, the effectiveness of surgery and the ensuing rehabilitation is of great significance. This study investigated balancing ability in response to sudden unidirectional perturbation changes during the first 6months of the postoperative period with respect to different methods of joint exposure during the operation (antero-lateral, direct-lateral and posterior to preserve the joint capsule). Our hypothesis is that the results may provide a tool to improve the rehabilitation procedures. Materials and methodsThe dynamic balancing ability of 25 patients with direct-lateral exposure, 22 with antero-lateral exposure and 25 with posterior exposure during a total hip arthroplasty was examined using ultrasound-based provocation tests prior to and at 6weeks, 12weeks and 6months after total hip arthroplasty. The control group was represented by 45 healthy subjects of identical age. The dynamic balancing ability after unidirectional perturbation was characterised by Lehr’s damping ratio calculated from the results of tests performed with the patient standing on both limbs, standing on the affected limb and standing on the non-affected limb. ResultsIn the case of direct-lateral and antero-lateral exposure, Lehr’s damping ratio significantly decreased compared to the preoperative values at 6weeks postoperatively, but it increased steadily afterwards. Lehr’s damping ratio while standing on the affected limb was significantly lower – even at 6months postoperatively – than that of the control group. In the case of posterior exposure, Lehr’s damping ratio continuously increased in the postoperative period and corresponded to that of the control group at 6months after total hip arthroplasty. Discussion and conclusionFor patients operated on using direct-lateral and antero-lateral exposure methods, the dynamic balancing ability continuously improved in the first 6months of the postoperative period, but the dynamic balancing ability of the affected limb differed from that of the control group. In the case of posterior exposure to preserve the joint capsule the dynamic balancing ability evaluated a more rapidly compared to the other two exposure methods. There was no significant difference in the balancing ability of the control group at 6months after total hip arthroplasty with posterior exposure. The increasing range of joint motion, muscle development, and the development of the dynamic balancing ability should be taken into account when compiling rehabilitation protocols. Differences related to the method of exposure should be considered when developing the dynamic balancing ability and abandoning therapeutic aids.