A randomized controlled trial on maximal strength training in 60 patients undergoing total hip arthroplasty

Abstract

Background and purposeTotal hip arthroplasty (THA) patients have reduced muscle strength after rehabilitation. In a previous efficacy trial, 4 weeks’ early supervised maximal strength training (MST) increased muscle strength in unilateral THA patients <65 years. We have now evaluated muscle strength in an MST and in a conventional physiotherapy (CP) group after rehabilitation in regular clinical practice.Patients and methods60 primary THA patients were randomized to MST or CP between August 2015 and February 2016. The MST group trained at 85–90% of their maximal capacity in leg press and abduction of the operated leg (4 × 5 repetitions), 3 times a week at a municipal physiotherapy institute up to 3 months postoperatively. The CP group followed a training program designed by their respective physiotherapist, mainly exercises performed with low or no external loads. Patients were tested pre- 3, 6, and 12 months postoperatively. Primary outcomes were abduction and leg press strength at 3 months. Other parameters evaluated were pain, 6-min walk test, Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) Physical Function Short-form score.Results27 patients in each group completed the intervention. MST patients were substantially stronger in leg press and abduction than CP patients 3 (43 kg and 3 kg respectively) and 6 months (30 kg and 3 kg respectively) postoperatively (p ≤ 0.002). 1 year postoperatively, no intergroup differences were found. No other statistically significant intergroup differences were found.InterpretationMST increases muscle strength more than CP in THA patients up to 6 months postoperatively, after 3 months’ rehabilitation in clinical practice. It was well tolerated by the THA patients and seems feasible to conduct within regular clinical practice.

Influência da reabilitação física sobre aspectos funcionais em indivíduos submetidos à artroplastia total de quadril: uma revisão sistemática

“…In relation to dynamic exercises, the prescription of a protocol with two sets of 10 repetitions is recommended to increase muscle strength in untrained individuals 37 . Among our findings, only eight studies showed the number of series and repetitions used in dynamic exercise protocols 7,9,17,20,29,[37][38][39] .…”

“…Load prescriptions of 60% to 70% of 1-repetition maximum (1RM) are indicated to increase muscle strength in healthy older adults 40 . This review shows significant results for strength improvement in patients submitted to THA with moderate to high intensity prescriptions, using 50%, 65%, 70%, 80%, 85, 90% 1RM 15,20,[37][38][39]41 . However, muscle strength was also increased when low intensity exercises (10%, 30% and 40% 1RM) were used 13,29,49,50 .…”

Clinical and cost-effectiveness of physiotherapy interventions following total hip replacement: a systematic review and meta-analysis

“…RR as for intervention group Flexors Int: Hip Questionnaire-12 (median, range) = 16 (12, 38) Cot: Hip Questionnaire-12 (median, range) = 17.5 (12, 33) Jan et al [ 20 ]/USA/12 weeks Total = 53 Int = 26 Cot = 27 Int = 58.8 (12.9) Cot = 57.0 (12.8) Int = 34 Cot = 37 Patients underwent a 12-week home program that included hip flexion, range of motion exercises for both hip joints; strengthening exercises for bilateral hip flexors, extensors, and abductors; and a 30-min walk every day No training Flexors, Int = 57.5 (22.3); Cont = 50.8 (21.2) MD = 0.31 [− 0.23, 0.85, p = 0.26] Function score, Int = 13.1 (0.6); p < 0.05 Cot = 12.0 (1.4), MD = 0.922 [0.356, 1.49, p = 0.001] Husby et al [ 37 ]/Norway/5 weeks Total = 24 Int = 12 Cot = 12 Int = 58 (5) Cot = 56 (8) Int = 58 Cot = 66 Patients performed maximal strength training (STG) in leg press and abduction with the operated leg only five times a week for 4 weeks in addition to the conventional rehabilitation program Patients received supervised physical therapy three-to-five times a week for 4 weeks 1-repetition maximum increased in the bilateral leg press ( p < 0.002) and in the operated leg separately ( p < 0.002) in the intervention compared with the control Monaghan et al [ 26 ]/Ireland/18 weeks Total = 63 Int = 32 Cot = 31 Int = 68(8); Cot = 69 (9) Int = 37 Cot = 26 The participants were taught 12 exercises by the supervising physiotherapist. They also attended classes twice weekly for 6 weeks, and were not given any additional exercises as a home exercise program All patients were advised to walk daily with crutches until review by the orthopaedic surgeon at 6 weeks, increasing the distance gradually to approximately 1 mile after 1 month Mean % at week 18 (Int vs Cot) WOMAC (pain) = − 0.81 (− 1.8 to 0.2), p = 0.1; WOMAC (stiffness) = − 0.44 (− 1.2 to − 0.28); p = 0.2; WOMAC functio n = − 4.0 (− 0.71 to 1.0); p = 0.04 Winther et al [ 35 ]/Norway/12 months Total = 63 Int = 31 Cot = 29 …”

“… − 1 − 1 + 1 ? + 1 + 1 Monticone et al [ 30 ] + 1 + 1 − 1 + 1 + 1 + 1 + 1 Mikkelsen et al [ 34 ] + 1 + 1 − 1 + 1 + 1 + 1 + 1 Winther et al [ 35 ] ? − 1 − 1 ?…”

Increased Muscle Strength Limits Postural Sway During Daily Living Activities in Total Hip Arthroplasty Patients

“…21 Studies focusing on intense interventions to efficiently restore muscle strength after THA demonstrate that maximal strength training (MST) is significantly more efficient compared with less intensive strength training. 22,23 Previously, results demonstrating that MST increases muscle strength in the lower limbs considerably more than conventional rehabilitation (CR) in THA patients after a 3-mo rehabilitation program has been published. 23 The present exploratory study aimed to investigate the effect of MST on postural sway after THA, performed before and after a battery of physical performance tests that resemble daily living activities.…”