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John S, Weizel D, Heumann AS, Fischer A, Orlowski K, Mrkor KU, Edelmann-Nusser J, Witte K. Persisting inter-limb differences in patients following total hip arthroplasty four to five years after surgery? A preliminary cross-sectional study. BMC Musculoskelet Disord 2021; 22:230. [PMID: 33639901 PMCID: PMC7916281 DOI: 10.1186/s12891-021-04099-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is an effective procedure for patients with end-stage hip osteoarthritis. However, whether or not pre-operatively existing functional deficits are persisting several years post-surgery in the affected limb has not been thoroughly researched. Therefore, the primary aim of this preliminary study was to include patients four to five years after undergoing THA and to investigate potential differences between the operated and non-operated leg in hip strength, range of motion (ROM), balance, and gait. The secondary aim was to compare these values from the operated leg of the patients to those of the legs of healthy subjects. METHODS Sixteen patients (age: 65.20 ± 5.32 years) following unilateral THA (post-operation time: 4.7 ± 0.7 years) and ten, healthy, age-matched control subjects (age: 60.85 ± 7.57 years) were examined for maximum isometric hip muscle strength, active ROM of the hip joint, balance and gait on both limbs. Paired t-tests were used to assess the inter-limb differences in the THA group. Analyses of covariance (ANCOVA) were performed to compare groups, using age as a covariate. RESULTS The analysis of inter-limb differences in patients following THA revealed significant deficits on the operated side for hip abduction strength (p = 0.02), for hip flexion ROM (p < 0.01) and for balance in terms of the length of center of pressure (COP) (p = 0.04). Compared to values of the control subjects, the patients demonstrated significantly reduced hip strength in flexion, extension and abduction (p < 0.05) on the operated leg as well as reduced ROM measures in hip flexion, extension and abduction (p < 0.05). CONCLUSIONS The first results of this explorative study indicated that inter-limb differences as well as reduced hip strength and hip ROM compared with control subjects were still present four to five years after THA. These persisting asymmetries and deficits in patients following THA may be one explanation for the decrease in health-related quality of life (HRQoL) seen in patients over the years after surgery. Further studies are required to replicate these findings with a larger sample size. TRIAL REGISTRATION DRKS, DRKS00016945. Registered 12 March 2019 - Retrospectively registered.
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Affiliation(s)
- Stefanie John
- Sports Science, Faculty of Humanities, Otto-von-Guericke-University, Zschokkestraße 32, 39104, Magdeburg, Germany.
| | - David Weizel
- Sports Science, Faculty of Humanities, Otto-von-Guericke-University, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Anna S Heumann
- Sports Science, Faculty of Humanities, Otto-von-Guericke-University, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Anja Fischer
- Sports Science, Faculty of Humanities, Otto-von-Guericke-University, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Katja Orlowski
- Department of Computer Science and Media, Brandenburg University of Applied Sciences, Magdeburger Straße 50, 14770, Brandenburg an der Havel, Germany
| | - Kai-Uwe Mrkor
- Department of Computer Science and Media, Brandenburg University of Applied Sciences, Magdeburger Straße 50, 14770, Brandenburg an der Havel, Germany
| | - Jürgen Edelmann-Nusser
- Sports Science, Faculty of Humanities, Otto-von-Guericke-University, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Kerstin Witte
- Sports Science, Faculty of Humanities, Otto-von-Guericke-University, Zschokkestraße 32, 39104, Magdeburg, Germany
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Du Z, Tang S, Yang R, Tang X, Ji T, Guo W. Use of an Artificial Ligament Decreases Hip Dislocation and Improves Limb Function After Total Femoral Prosthetic Replacement Following Femoral Tumor Resection. J Arthroplasty 2018; 33:1507-1514. [PMID: 29366726 DOI: 10.1016/j.arth.2017.12.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hip dislocation is a major complication of total femoral prosthetic reconstruction (TFR) after femoral tumor resection. Hip dislocation can occur because of inadequate functional abductor musculature, inadequate hip capsule repair, or a long lever arm after total femur replacement. To eliminate the negative effects of these factors on the risk of hip dislocation, the use of artificial ligaments may help to increase the stability of the hip joint. We aimed to determine whether application of an artificial ligament would improve limb function and active range of movement (ROM) after TFR. METHODS Fifty-eight patients who underwent femoral tumor resection and TFR were included. A band-shaped artificial ligament was wrapped spirally around the proximal site of the total femur prosthesis for periacetabular soft tissue reconstruction in 12 patients. The other 46 patients did not consent to receiving the artificial ligament. Complications including hip dislocation and infection, limb function, and active hip ROM were compared between patients who did and did not receive the artificial ligament. RESULTS The hip dislocation rate was lower in the patients who received the artificial ligament. The risk of deep infection did not differ between groups. The group that received the ligament also achieved better limb function and active ROM on flexion and abduction. CONCLUSION Patients treated with total femur resection and endoprosthetic replacement with an artificial ligament for periacetabular soft tissue reconstruction had a more stable hip joint, better limb function, and greater active hip ROM than did patients who did not receive an artificial ligament.
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Affiliation(s)
- Zhiye Du
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Shun Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Tao Ji
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, People's Republic of China; Key Laboratory for Musculoskeletal Tumor of Beijing, Peking University People's Hospital, Beijing, People's Republic of China
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Bennett D, Ryan P, O'Brien S, Beverland DE. Gait kinetics of total hip replacement patients-A large scale, long-term follow-up study. Gait Posture 2017; 53:173-178. [PMID: 28171843 DOI: 10.1016/j.gaitpost.2017.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/05/2017] [Accepted: 01/18/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is not known if lower limb gait kinetics of total hip replacement (THR) patients reach normal levels at long term follow-up post-operatively. METHODS Three-dimensional gait analysis was performed on 134 THR patients with identical implants 10-years post-operatively. Lower limb moments and powers were compared between different age strata (54-64 years, 65-69 years, 70-74 years, 75-79 years and over 80 years) and a normal elderly control group. RESULTS Hip extensor moment and hip power generation were significantly reduced in all age groups compared to normal. External hip rotation moment was significantly reduced in all age groups, apart from the youngest group, compared to normal. However, in contrast to previous short term follow-up studies there was no significant difference in hip abduction moment between any of the age groups and the normal group. CONCLUSION This large cohort study shows that, at long term follow-up following THR, some hip joint kinetics (hip extensor and external rotation moments and hip power generation) do not reach normal levels, but that peak abduction moment is preserved. THR patients recovery could potentially benefit from intensive rehabilitation focusing on hip extension and external rotation in the post-operative, and perhaps preoperative, period.
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Affiliation(s)
- Damien Bennett
- Outcome Assessment Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom.
| | - Paul Ryan
- School of Medicine, Queens University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Seamus O'Brien
- Outcome Assessment Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
| | - David E Beverland
- Outcome Assessment Unit, Musgrave Park Hospital, Belfast, Northern Ireland, United Kingdom
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Arai M, Shiratani T. Comparison of the effects of remote after-effects of static contractions for different upper-extremity positions and pinch-force strengths in patients with restricted wrist flexion range of motion. J Bodyw Mov Ther 2015; 19:624-8. [PMID: 26592219 DOI: 10.1016/j.jbmt.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/22/2014] [Accepted: 11/02/2014] [Indexed: 11/19/2022]
Abstract
The objective of the study was to examine the after-effects of static contractions of upper extremity muscles in different shoulder joint positions and at different pinch-force strengths on the maximal active range of motion (MAROM) and wrist agonist/antagonist IEMG activities for patients with restricted wrist flexion range of motion (ROM) due to upper limb pain and dysfunction. The subjects were 10 outpatients (3 males, 7 females) with restricted wrist joints. These subjects performed four static contractions of upper extremity muscles in neutral and diagonal shoulder joint positions and with weak and strong pinch-force strengths in random order. Two-way repeated measures analysis of variance showed that the change in MAROM was significantly larger (P < 0.05) after diagonal-strong static contractions than after neutral-weak static contractions. There were no significant correlations between changes in MAROM and IEMG activities. These results indicate that shoulder joint position and pinch-force strength should be considered for effective induction of remote after-effects of static contractions for increasing MAROM for restricted wrist flexion ROM.
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Affiliation(s)
- Mitsuo Arai
- Division of Physical Therapy, Tokyo Metropolitan University, Japan.
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Arai M, Shiratani T. Effect of remote after-effects of resistive static contraction of the pelvic depressors on improvement of restricted wrist flexion range of motion in patients with restricted wrist flexion range of motion. J Bodyw Mov Ther 2015; 19:442-6. [PMID: 26118515 DOI: 10.1016/j.jbmt.2014.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/22/2014] [Accepted: 11/02/2014] [Indexed: 10/24/2022]
Abstract
The objective of the study was to compare the effects of remote after-effects of resistive static contraction of the pelvic depressors (RSCPD) with after-effects of static contraction of upper extremity muscles (SCUE) on improvement of the maximal active range of motion (MAROM) for patients with restricted wrist flexion range of motion (ROM) due to upper limb pain and dysfunction. The participants were 10 outpatients with restricted wrist joints. The mean (SD) age was 53.7 (4.4) years (range, 34-81). The subjects performed two exercise protocols (SCUE and RSCPD) in random order. One-way repeated measures ANOVA showed significant main effects in evaluation of the change in MAROM and IEMG activities for different conditions (after rest, after SCUE, and after RSCPD). The remote after-effects of RSCPD, but not those of SCUE, caused significant improvement in MAROM for restricted wrist flexion ROM.
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Affiliation(s)
- Mitsuo Arai
- Division of Physical Therapy, Tokyo Metropolitan University, Japan.
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Nankaku M, Akiyama H, Kakinoki R, Nishikawa T, Tanaka Y, Matsuda S. Factors associated with ambulatory status 6 months after total hip arthroplasty. Physiotherapy 2014; 100:263-7. [DOI: 10.1016/j.physio.2013.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
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Rathod PA, Orishimo KF, Kremenic IJ, Deshmukh AJ, Rodriguez JA. Similar improvement in gait parameters following direct anterior & posterior approach total hip arthroplasty. J Arthroplasty 2014; 29:1261-4. [PMID: 24405621 DOI: 10.1016/j.arth.2013.11.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/05/2013] [Accepted: 11/26/2013] [Indexed: 02/01/2023] Open
Abstract
We compared gait parameters prior to, at 6 months and 1 year following total hip arthroplasty (THA) performed via direct anterior approach (DAA) and posterior approach (PA) by a single surgeon in 22 patients. A gait analysis system involving reflective markers, infrared cameras and a multicomponent force plate was utilized. Postoperatively, the study cohort demonstrated improvement in flexion/extension range of motion (ROM) (P = 0.001), peak flexion (P = 0.005) and extension (P = 0.002) moments with no differences between groups. Internal/external ROM improved significantly in the DAA group (P = 0.04) with no change in the PA group. THA performed via DAA and PA offers similar improvement in gait parameters with the exception of internal/external ROM which might be related to the release and repair of external rotators during PA THA.
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Affiliation(s)
- Parthiv A Rathod
- Center For Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, New York, New York
| | - Karl F Orishimo
- Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), North Shore LIJ/Lenox Hill Hospital, New York, New York
| | - Ian J Kremenic
- Nicholas Institute of Sports Medicine and Athletic Trauma (NISMAT), North Shore LIJ/Lenox Hill Hospital, New York, New York
| | - Ajit J Deshmukh
- Center For Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, New York, New York
| | - José A Rodriguez
- Center For Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, New York, New York
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Gait and gait-related activities of daily living after total hip arthroplasty: a systematic review. Clin Biomech (Bristol, Avon) 2014; 29:705-18. [PMID: 24951319 DOI: 10.1016/j.clinbiomech.2014.05.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/23/2014] [Accepted: 05/27/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Differences in the performance of gait and gait-related activities of daily living are known to persist after total hip arthroplasty compared to healthy controls, but the specific underlying deficits (spatiotemporal, kinematics and kinetics) are not completely understood. This review aimed to map the differences between patients and controls, and between the operated and non-operated limbs during various activities of daily living. METHODS A computerized search with broad search terms was performed in the MEDLINE database. Primary inclusion criteria were: primary osteoarthritis as indication, comparison with healthy controls or comparison between the operated and the non-operated limbs, and follow-up period at least six months after surgery. FINDINGS The literature search yielded 2177 citations, of which 35 articles were included. Compared to controls, reductions were identified in the operated hip in sagittal range of motion, peak extension, sagittal power generation, abduction moment and external rotation moment. During stair ascent, these reductions did not become more apparent, although deficits in hip kinetics in all three planes were found. Walking speed and step length were reduced compared to controls at longer-term follow-up, but not at short-term follow-up. INTERPRETATION The hip abduction moment deficit was present both in level walking and in stair ascent in total hip arthroplasty patients compared to controls. Reduced sagittal hip power generation and external rotation moment were also found, of which the clinical relevance remains to be established. Due to a low number of studies, many of the longer-term effects of THA on gait and gait-related ADL are not yet accurately known.
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10
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Brueilly KE, Schoenfeld BJ, Darbouze MR, Kolber MJ. Postrehabilitation Exercise Considerations Following Hip Arthroplasty. Strength Cond J 2013. [DOI: 10.1519/ssc.0b013e31828a0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Penny JØ, Ovesen O, Varmarken J, Overgaard S. Similar range of motion and function after resurfacing large-head or standard total hip arthroplasty. Acta Orthop 2013; 84:246-53. [PMID: 23530872 PMCID: PMC3715815 DOI: 10.3109/17453674.2013.788435] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Large-size hip articulations may improve range of motion (ROM) and function compared to a 28-mm THA, and the low risk of dislocation allows the patients more activity postoperatively. On the other hand, the greater extent of surgery for resurfacing hip arthroplasty (RHA) could impair rehabilitation. We investigated the effect of head size and surgical procedure on postoperative rehabilitation in a randomized clinical trial (RCT). Methods We followed randomized groups of RHAs, large-head THAs and standard THAs at 2 months, 6 months, 1 and 2 years postoperatively, recording clinical rehabilitation parameters. RESULTS Large articulations increased the mean total range of motion by 13° during the first 6 postoperative months. The increase was not statistically significant and was transient. The 2-year total ROM (SD) for RHA, standard THA, and large-head THA was 221° (35), 232° (36), and 225° (30) respectively, but the differences were not statistically significant. The 3 groups were similar regarding Harris hip score, UCLA activity score, step rate, and sick leave. INTERPRETATION Head size had no influence on range of motion. The lack of restriction allowed for large articulations did not improve the clinical and patient-perceived outcomes. The more extensive surgical procedure of RHA did not impair the rehabilitation. This project is registered at ClinicalTrials.gov under # NCT01113762.
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Affiliation(s)
- Jeannette Østergaard Penny
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense,Department of Orthopedic Surgery, Naestved Hospital, Naestved,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Ovesen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Barker KL, Newman MA, Hughes T, Sackley C, Pandit H, Kiran A, Murray DW. Recovery of function following hip resurfacing arthroplasty: a randomized controlled trial comparing an accelerated versus standard physiotherapy rehabilitation programme. Clin Rehabil 2013; 27:771-84. [DOI: 10.1177/0269215513478437] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: To identify if a tailored rehabilitation programme is more effective than standard practice at improving function in patients undergoing metal-on-metal hip resurfacing arthroplasty. Design: Randomized controlled trial. Setting: Specialist orthopaedic hospital. Subjects: 80 men with a median age of 56 years. Interventions: Tailored post-operative physiotherapy programme compared with standard physiotherapy. Main Outcomes: Primary outcome – Oxford Hip Score (OHS), Secondary outcomes: Hip disability and Osteoarthritis Outcome Score (HOOS), EuroQol (EQ-5D-3L) and UCLA activity score. Hip range of motion, hip muscle strength and patient selected goals were also assessed. Results: At one year the mean (SD) Oxford Hip Score of the intervention group was higher, 45.1 (5.3), than the control group, 39.6 (8.8). This was supported by a linear regression model, which detected a 5.8 unit change in Oxford Hip Score ( p < 0.001), effect size 0.76. There was a statistically significant increase in Hip disability and Osteoarthritis Outcome Score of 12.4% ( p < 0.0005), effect size 0.76; UCLA activity score differed by 0.66 points ( p < 0.019), effect size 0.43; EQ 5D showed an improvement of 0.85 ( p < 0.0005), effect size 0.76. A total of 80% (32 of 40) of the intervention group fully met their self-selected goal compared with 55% (22 of 40) of the control group. Hip range of motion increased significantly; hip flexion by a mean difference 17.9 degrees ( p < 0.0005), hip extension by 5.7 degrees ( p < 0.004) and abduction by 4 degrees ( p < 0.05). Muscle strength improved more in the intervention group but was not statistically significant. Conclusions: A tailored physiotherapy programme improved self-reported functional outcomes and hip range of motion in patients undergoing hip resurfacing.
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Affiliation(s)
- Karen L Barker
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
- NIHR – BRU, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Meredith A Newman
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Tamsin Hughes
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Cath Sackley
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Hemant Pandit
- NIHR – BRU, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amit Kiran
- NIHR – BRU, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David W Murray
- NIHR – BRU, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Siverling S, Felix I, Chow SB, Niedbala E, Su EP. Hip resurfacing: not your average hip replacement. Curr Rev Musculoskelet Med 2012; 5:32-8. [PMID: 22231958 DOI: 10.1007/s12178-011-9103-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hip resurfacing (HR) has become a widely used surgical intervention for younger patients requiring hip joint arthroplasty. While case reports have been published describing rehabilitation programs following HR, there has yet to be established rehabilitation guidelines. Through experience and clinical reasoning, the following guidelines have been developed based on the patients at the Hospital for Special Surgery. The demographics of the typical HR patient, along with the surgical process are described. Current published literature reporting rehabilitation for patients with arthritic hip pathologies has been incorporated into the guidelines and is presented. The guidelines are divided into three phases, with goals for each phase explained. A progression through phases by way of reaching certain milestones and goals is advocated.
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Affiliation(s)
- Scott Siverling
- Hospital for Special Surgery, Integrative Care Center, 635 Madison Avenue, 5th floor, New York, NY, 10022, USA,
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Dunleavy K. Outcomes of hip resurfacing in a professional dancer: a case report. Physiother Theory Pract 2011; 28:142-60. [PMID: 21801098 DOI: 10.3109/09593985.2011.574784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A new surgical option (hip resurfacing arthroplasty) is now available for younger patients with hip osteoarthritis. A more aggressive rehabilitation program than the typical total hip arthroplasty protocol is needed for active individuals. This case report describes interventions used to maximize function in a 46-year-old professional dancer after hip resurfacing with a progressive therapeutic exercise program. Exercise choices were selected to address dance-specific requirements while respecting healing of the posterior capsular incision. Strengthening focused on hip abduction, extension, and external rotation. Precautions included avoiding gluteal stretching until 6 months. Pelvic alignment and weight-bearing distribution were emphasized. The patient was able to return to rehearsal by 7 months, at which time strength was equivalent to the unaffected leg. Range of motion reached unaffected side values at week 8 for internal rotation, week 11 for extension, week 13 for adduction, and week 28 for flexion. External rotation and abduction were still limited at 1 year, which influenced pelvic alignment with resultant pain on the unaffected side. Functional and impairment outcomes are presented with timelines to provide a basis for postoperative benchmarks for active clients after hip resurfacing. Although this case report presents a dance-specific program, exercise progressions for other active individuals may benefit from similar exercise intensity and sports-specific focus. Future rehabilitation programs should take into account possible flexion and external rotation range limitations and the need for gluteal muscle strengthening along with symmetry and pelvic alignment correction. Long-term studies investigating intensity of rehabilitation are warranted for patients intending to participate in higher level athletic activity.
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Affiliation(s)
- Kim Dunleavy
- Wayne State University, Eugene Applebaum College of Pharmacy and Health Sciences, Physical Therapy Program, Detroit, Michigan 48201, USA.
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Häkkinen A, Borg H, Hakulinen M, Jurvelin J, Anttila E, Parviainen T, Kiviranta I. Bone mineral density of the proximal femur after hip resurfacing arthroplasty: 1-year follow-up study. BMC Musculoskelet Disord 2011; 12:100. [PMID: 21595913 PMCID: PMC3117755 DOI: 10.1186/1471-2474-12-100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 05/19/2011] [Indexed: 11/25/2022] Open
Abstract
Background Hip resurfacing arthroplasty (HRA) is considered a bone-preserving procedure and may eliminate proximal femoral stress shielding and osteolysis. However, in addition to implant-related stress-shielding factors, various patient-related factors may also have an effect on bone mineral density (BMD) of the proximal femur in patients with HRA. Thus, we studied the effects of stem-neck angle, demographic variables, and physical functioning on the BMD of the proximal femur in a one-year follow-up. Methods Thirty three patients (9 females and 24 males) with a mean (SD) age of 55 (9) years were included in the study. BMD was measured two days and 3, 6, and 12 months postoperatively and 10 regions of interest (ROI) were used. Stem-neck angle was analyzed from anteroposterior radiographs. Results Three months postoperatively, BMD decreased in six out of 10 regions of interest (ROI) on the side operated on and in one ROI on the control side (p < 0.05) compared to the second postoperative day. At 12 months, BMD had increased in 7 ROIs on the operated side and one ROI on the control side (all p < 0.001). Correlation was found between the stem-neck angle and BMD in ROIs 2, 3, 7, and 9 (r = 0.36 - 0.61). In multiple regression analysis, stem-neck angle, age, sex, body mass index, and walking distance did not explain the BMD changes. Conclusions After an early drop, the BMD of the upper femur was restored and even exceeded the preoperative level at one year follow-up. From a clinical standpoint, the changes in BMD in these HRA patients could not be explained by stem-neck angle or patient related factors.
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Affiliation(s)
- Arja Häkkinen
- Department of Physical Medicine and Rehabilitation, Jyväskylä Central Hospital, and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Marker DR, Seyler TM, Bhave A, Zywiel MG, Mont MA. Does commitment to rehabilitation influence clinical outcome of total hip resurfacing arthroplasty? J Orthop Surg Res 2010; 5:20. [PMID: 20307288 PMCID: PMC2857827 DOI: 10.1186/1749-799x-5-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 03/22/2010] [Indexed: 12/21/2022] Open
Abstract
Background The purpose of this study was to evaluate whether compliance and rehabilitative efforts were predictors of early clinical outcome of total hip resurfacing arthroplasty. Methods A cross-sectional survey was utilized to collect information from 147 resurfacing patients, who were operated on by a single surgeon, regarding their level of commitment to rehabilitation following surgery. Patients were followed for a mean of 52 months (range, 24 to 90 months). Clinical outcomes and functional capabilities were assessed utilizing the Harris hip objective rating system, the SF-12 Health Survey, and an eleven-point satisfaction score. A linear regression analysis was used to determine whether there was any correlation between the rehabilitation commitment scores and any of the outcome measures, and a multivariate regression model was used to control for potentially confounding factors. Results Overall, an increased level of commitment to rehabilitation was positively correlated with each of the following outcome measures: SF-12 Mental Component Score, SF-12 Physical Component Score, Harris Hip score, and satisfaction scores. These correlations remained statistically significant in the multivariate regression model. Conclusions Patients who were more committed to their therapy after hip resurfacing returned to higher levels of functionality and were more satisfied following their surgery.
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Affiliation(s)
- David R Marker
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
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