Abstract
Introduction: Total hip arthroplasty is a common procedure in end-stage hip osteoarthritis. Yet, following hip arthroplasty, deficits in functional performance, possibly due to movement compensations, persist. The purposes of this study are to provide conceptual basis for improving functional performance following hip arthroplasty by addressing movement compensation, present a unique rehabilitation protocol developed from this conceptual framework, and present findings from a preliminary investigation. Methods: This study was a prospective, randomized, controlled preliminary trial with concealed allocation and intention-to-treat analysis. Twenty participants undergoing primary, posterior approach THA were randomized into a neuromuscular reeducation and a control group. The neuromuscular reeducation group completed an 8-week, outpatient rehabilitation program after total hip arthroplasty utilizing neuromuscular reeducation techniques to promote pelvic stability and strength to improve movement quality. The control group was supervised by the study therapist weekly for 8 weeks after surgery but did not attend outpatient rehabilitation. Outcomes, assessed before and after surgery, included stair climb test, gait speed, 6-minute walk test, assessments of postural control and pelvic stability, muscle strength, and self-reported function. Results: Following the intervention, the neuromuscular reeducation group demonstrated statistically and clinically significant improvements in the stair climb test, 4-meter walk, 6-minute walk, postural control, and in some patient-reported outcomes. Further, there were trends toward improvement in pelvic stability during functional tasks and muscle strength, but these improvements were not statistically significant. Conclusions: Findings of this preliminary investigation support the use of neuromuscular reeducation techniques to improve functional performance after total hip arthroplasty, yet more information may be needed to determine efficacy. Therefore, this preliminary work has set the stage for future investigations to explore whether neuromuscular reeducation training after total hip arthroplasty should be considered in clinical practice.
Highlights
Total hip arthroplasty is a common procedure in end-stage hip osteoarthritis
There were trends toward improvement in pelvic stability during functional tasks and muscle strength, but these improvements were not statistically significant. Findings of this preliminary investigation support the use of neuromuscular reeducation techniques to improve functional performance after total hip arthroplasty, yet more information may be needed to determine efficacy. This preliminary work has set the stage for future investigations to explore whether neuromuscular reeducation training after total hip arthroplasty should be considered in clinical practice
Similar movement pattern training has improved strength, function, and hip mechanics in young people with hip pain [21]. Considering this conceptual framework, we propose that a potential strategy to improve functional performance after Total hip arthroplasty (THA) could include utilizing neuromuscular reeducation techniques to improve stability and control during movement
Summary
Total hip arthroplasty is a common procedure in end-stage hip osteoarthritis. Yet, following hip arthroplasty, deficits in functional performance, possibly due to movement compensations, persist. The neuromuscular reeducation group completed an 8-week, outpatient rehabilitation program after total hip arthroplasty utilizing neuromuscular reeducation techniques to promote pelvic stability and strength to improve movement quality. Results: Following the intervention, the neuromuscular reeducation group demonstrated statistically and clinically significant improvements in the stair climb test, 4-meter walk, 6-minute walk, postural control, and in some patient-reported outcomes. Conclusions: Findings of this preliminary investigation support the use of neuromuscular reeducation techniques to improve functional performance after total hip arthroplasty, yet more information may be needed to determine efficacy. Strength training alone may not address the poor movement quality seen during activities of daily living such as transfers, walking, and stairs Performing these activities without movement compensation depends on the ability of the body to produce stable, coordinated movements during functional tasks, which is referred to as neuromuscular control [13].
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