Balance and proprioception impairment, assessment tools, and rehabilitation training in patients with total hip arthroplasty: a systematic review

Abstract

Background Osteoarthritis and subsequent total hip arthroplasty (THA) lead to damages to hip joint mechanoceptors, which in turns lead to impairments in proprioception. One of the abilities mainly affected by an altered joint proprioception is balance. The aim of this work was to investigate the balance and proprioception impairments, current assessment tools, and rehabilitation training after THA. Methods A systematic literature revision was conducted on PubMed, Web of Science and Cochrane databases. Articles reporting balance and proprioception impairments, current assessment tools, or rehabilitation interventions were included. Methodological quality was assessed using the Downs and Black checklist. A total of 41 articles were included, 33 discussing balance and proprioception assessment, and 8 dealing with training. Data related to type of surgical approach, type and timing of assessment protocols, assessment instrumentation, and type, volume and duration of the rehabilitation training were extracted from each study. Results Thirty-one studies were of high quality, 2 of moderate quality and 8 of low-quality. Literature review showed an improvement in balance following THA in comparison with the pre-operative performance, although balance abnormalities persist up to 5 years after surgery, with THA patients showing an increased risk for falls. Balance training is effective in all the rehabilitation phases if specifically structured for balance enhancement and consistent in training volume. It remains unclear which assessments are more appropriate for the different rehabilitation phases, and if differences exist between the different surgical procedures used for THA. Only two studies assessed proprioception. Conclusion Balance and proprioception show impairments up to 5 years after THA, increasing the risk of falls. However, patients with THA may benefit of an adequate balance training. Further research is needed to investigate the gaps in balance and proprioception assessment and training following THA surgery.

Immediate Effects of Single-Session High-Velocity Training for Lateral Trunk Movement on Gait Function in Early Postoperative Patients after Total Hip Arthroplasty: A Nonrandomized Controlled Trial

“…This result indicates that SSTT immediately improved not only gait speed, but also gait stability. Patients who underwent THA showed abnormal balance control, reflecting sensory and motor abnormalities [ 41 ]. SSTT, including head movement, may have contributed to sensory functions, including vestibular function [ 42 ] and improved gait stability.…”

Rehabilitation Phases, Precautions, and Mobility Goals Following Total Hip Arthroplasty

“…Many of the gait deviations observed preoperatively persist postoperatively; patients often demonstrate reduced walking speed, decreased stride length, and decreased single-limb support time [1]. Frequently, these patients also walk with reduced step length, decreased hip abduction muscle moments, reduced peak hip flexion and extension, and persistent balance impairments [3,4,14,22]. These findings highlight the importance of selecting appropriate pre-gait interventions, including those addressing range of motion, strengthening, neuromuscular activation, and balance training.…”

Results of total hip arthroplasty in patients with reduced bone mineral density

“…Значне покращення постуральної стабільності виявили, як і ми в свій роботі, A. C. Esbjоrnsson [19] та L. Labanca і співавт. [20]. Вони показали значуще зменшення латерального зміщення (переважна опора на одну кінцівку), хоча й не до рівня норми.…”