Abductor Muscle Strength Deficit in Patients After Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Ismailidis, Petros; Kvarda, Peter; Vach, Werner; Cadosch, Dieter; Appenzeller-Herzog, Christian; Mündermann, Annegret

doi:10.1016/j.arth.2021.03.042

Cited by 15 publications

(7 citation statements)

References 46 publications

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“…Recovery of muscle strength ( e.g. , quadriceps and hip abductors)—which coincides with this period ( Mizner, Petterson & Snyder-Mackler, 2005 ; Ismailidis et al, 2021 ) –may underly these improvements in walking capacity. As for trunk kinematics, both individuals after TKA and THA showed an increase in lumbar coronal RoM from two to fifteen months after surgery, which may relate to the restored ability of the hip abductors to control frontal plane pelvic movement ( Bolink et al, 2016 ; Reininga et al, 2012 ).…”

Section: Discussionmentioning

confidence: 99%

Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures

Boekesteijn

Smolders

Busch

et al. 2022

PeerJ

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Background Inertial sensors hold the promise to objectively measure functional recovery after total knee (TKA) and hip arthroplasty (THA), but their value in addition to patient-reported outcome measures (PROMs) has yet to be demonstrated. This study investigated recovery of gait after TKA and THA using inertial sensors, and compared results to recovery of self-reported scores of pain and function. Methods PROMs and gait parameters were assessed before and at two and fifteen months after TKA (n = 24) and THA (n = 24). Gait parameters were compared with healthy individuals (n = 27) of similar age. Gait data were collected using inertial sensors on the feet, lower back, and trunk. Participants walked for two minutes back and forth over a 6m walkway with 180° turns. PROMs were obtained using the Knee Injury and Osteoarthritis Outcome Scores and Hip Disability and Osteoarthritis Outcome Score. Results Gait parameters recovered to the level of healthy controls after both TKA and THA. Early improvements were found in gait-related trunk kinematics, while spatiotemporal gait parameters mainly improved between two and fifteen months after TKA and THA. Compared to the large and early improvements found in of PROMs, these gait parameters showed a different trajectory, with a marked discordance between the outcome of both methods at two months post-operatively. Conclusion Sensor-derived gait parameters were responsive to TKA and THA, showing different recovery trajectories for spatiotemporal gait parameters and gait-related trunk kinematics. Fifteen months after TKA and THA, there were no remaining gait differences with respect to healthy controls. Given the discordance in recovery trajectories between gait parameters and PROMs, sensor-derived gait parameters seem to carry relevant information for evaluation of physical function that is not captured by self-reported scores.

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Section: Discussionmentioning

confidence: 99%

Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures

Boekesteijn

Smolders

Busch

et al. 2022

PeerJ

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“…Third, the pelvic alignment, the implant position, and other confounding factors were not assessed in this study. Whereas femoral offsets could influence hip abductor strength after THA [27], a recent study has shown that alterations in acetabular and femoral offsets after THA have no effect on postoperative gait function [28]. Fourth, it remains uncertain whether patients with bilateral symptomatic osteoarthritis or severe hip deformity may show similar results.…”

Section: Discussionmentioning

confidence: 99%

Association of preoperative variables of ipsilateral hip abductor muscles with gait function after total hip arthroplasty: a retrospective study

et al. 2022

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Background This study aimed to identify the association of preoperative variables of ipsilateral hip abductors with gait function after total hip arthroplasty (THA). Methods This study enrolled 42 patients who underwent unilateral primary THA for osteoarthritis. Gait speed and Timed Up-and-Go test were conducted 6 months postoperatively. Preoperative composition of the glutei medius and minimus and the upper portion of gluteus maximus was evaluated by computed tomography. Cross-sectional area ratio of individual composition to the total muscle was calculated. Preoperative variables associated with gait speed and Timed Up-and-Go test after THA were identified by using stepwise regression analysis. Results Faster gait speed and shorter Timed Up-and-Go test correlated with smaller cross-sectional area of low-density lean tissue or intramuscular adipose tissue (low-density lean tissue plus intramuscular fat) in the glutei medius and minimus and lower cross-sectional area ratio of low-density lean tissue to the total glutei medius and minimus. Faster gait speed and shorter Timed Up-and-Go test also correlated with larger cross-sectional area of lean muscle mass in the gluteus maximus, higher cross-sectional area ratio of lean muscle mass to the total gluteus maximus, and lower cross-sectional area ratio of intramuscular fat or intramuscular adipose tissue to the total gluteus maximus. Faster gait speed additionally correlated with larger total cross-sectional area of the gluteus maximus. Regression analysis showed that the total cross-sectional area of the gluteus maximus and the low-density lean tissue cross-sectional area of the glutei medius and minimus were the explanatory variables of gait speed and Timed Up-and-Go test after THA, respectively. Conclusions There was a potential association between preoperative composition of ipsilateral hip abductors and gait function 6 months after THA. This study indicates a predictive role of preoperative assessment of ipsilateral hip abductor composition in the recovery of gait function after THA.

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“…In our study, we evaluated MRI at 1 year postoperatively, and we were unable to track MRI changes beyond that time. Ismailidis et al [14] stated that hip abductor muscle weakness might gradually improve during the first 24 months after THA. It is possible that M-CSA atrophy and fatty atrophy in MRI may resolve in the future when MRI is followed for more than one year.…”

Section: Discussionmentioning

confidence: 99%

MRI Findings of Muscle Damage after Total Hip Arthroplasty Using the Complete Muscle Preserving Anterolateral Supine Approach

et al. 2022

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Background and Objectives: We performed anterolateral total hip arthroplasty (ALS THA) with the purpose of complete muscle-tendon preservation without muscle-tendon dissection. This study aimed to evaluate muscle damage in the periprosthetic hip joint muscles of patients undergoing ALS THA at 1-year post-operative hip magnetic resonance imaging (MRI). Materials and Methods: We evaluated changes in the muscle cross-sectional area (M-CSA) and fatty atrophy of the periprosthetic muscles. We also assessed the Harris hip score on pre-operative and 12-month post-operative MRI in 66 patients who underwent ALS THA. The grade of M-CSA atrophy was classified into no atrophy, slight atrophy, moderate atrophy, and severe atrophy. Fatty atrophy was classified as improved, no change, and worsened using the Goutallier classification. Results: More than 90% of patients’ M-CSA had no atrophy in the obturator internus (Oi), obturator externus (Oe), gluteus medius (Gmed), and gluteus minimus (Gmin), and some improvement was observed in terms of fatty atrophy. In contrast, M-CSA of the tensor fascia latae (TFL) muscle was clearly decreased, and there was no improvement in the TFL fatty atrophy. However, the presence or absence of TFL atrophy did not affect clinical outcome. Conclusions: We performed the complete muscle preserving procedure, ALS THA, with attention to preserving the Oi and Oe by direct visual confirmation and gentle treatment of the Gmed and Gmin with effective retraction. Post-operative M-CSA atrophy evaluation on MRI showed that the Oi, Oe, Gmed, and Gmin were satisfactorily preserved; however, the TFL was clearly atrophic. In the ALS approach, where entry is made between Gmed and TFL, atrophy of the TFL due to superior gluteal nerve injury must be tolerated to some extent.

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Abductor Muscle Strength Deficit in Patients After Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 46 publications

Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures

Objective monitoring of functional recovery after total knee and hip arthroplasty using sensor-derived gait measures

Association of preoperative variables of ipsilateral hip abductor muscles with gait function after total hip arthroplasty: a retrospective study

MRI Findings of Muscle Damage after Total Hip Arthroplasty Using the Complete Muscle Preserving Anterolateral Supine Approach

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