Abstract
BackgroundBy measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits.Objective(s)Firstly, to quantify changes (compared to pre-operative values) in hip muscle strength, leg-press power, and functional performance in the first week after THA, and secondly, to explore relationships between the muscle strength changes, and changes in hip pain, systemic inflammation, and thigh swelling.DesignProspective, cohort study.SettingConvenience sample of patients receiving a THA at Copenhagen University Hospital, Hvidovre, Denmark, between March and December 2011.ParticipantsThirty-five patients (65.9±7.2 years) undergoing THA.Main outcome measuresHip muscle strength, leg-press power, performance-based function, and self-reported disability were determined prior to, and 2 and 8 days after, THA (Day 2 and 8, respectively). Hip pain, thigh swelling, and C-Reactive Protein were also determined.ResultsFive patients were lost to follow-up. Hip muscle strength and leg press power were substantially reduced at Day 2 (range of reductions: 41–58%, P<0.001), but less pronounced at Day 8 (range of reductions: 23–31%, P<0.017). Self-reported symptoms and function (HOOS: Pain, Symptoms, and ADL) improved at Day 8 (P<0.014). Changes in hip pain, C-Reactive Protein, and thigh swelling were not related to the muscle strength and power losses.Conclusion(s)Hip muscle strength and leg-press power decreased substantially in the first week after THA – especially at Day 2 – with some recovery at Day 8. The muscle strength loss and power loss were not related to changes in hip pain, systemic inflammation, or thigh swelling. In contrast, self-reported symptoms and function improved. These data on surgery-induced changes in muscle strength may help design impairment-directed, post-operative rehabilitation to be introduced soon after surgery.Trial RegistrationClinicalTrials.gov NCT01246674.
Highlights
Total hip arthroplasty (THA) is commonly performed to relieve pain and improve functional performance in patients with endstage hip osteoarthritis [1]
Hip muscle strength and leg press power were substantially reduced at Day 2, but less pronounced at Day 8
The main findings of the current study were (i) considerable loss of hip muscle strength and leg-press power postoperatively at Day 2, (ii) this loss was reduced but still lower at Day 8 compared with Pre-surgery, and (iii) changes in hip pain, thigh swelling or systemic inflammation were not associated with loss of hip muscle strength or leg-press power
Summary
Total hip arthroplasty (THA) is commonly performed to relieve pain and improve functional performance in patients with endstage hip osteoarthritis [1] In many places, it is followed by outpatient physical rehabilitation, with the rehabilitation components sometimes differing between programs [2,3]. In order to do so, early strength deficits induced by surgery need to be quantified, in order to design a specific, impairment-directed, postoperative rehabilitation program for implementation soon after surgery This approach is an important initial step in the fast-track/enhanced recovery program methodology [24,25], which combines evidence from different peri-operative uni-modal interventions, including post-operative physical rehabilitation [23]. By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to target identified deficits
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