Gluteal muscle damage leads to higher in vivo hip joint loads 3 months after total hip arthroplasty

Abstract

BackgroundTotal hip arthroplasty (THA) is in most cases improving patients´ life quality immediately after surgery. However, a closer look at these patients, especially with modern gait analysis methods, reveals also negative consequences due to the surgical approach related injury to the pelvic muscles. We hypothesized that this damage will have a negative impact on hip joint contact forces during activities of daily living (ADL).Methods10 patients undergoing THA received an instrumented hip joint implant enabling real time in vivo measurements of hip joint loads using a direct lateral approach. Pre- and 3 months postoperative computed tomography (CT) scans were used for evaluation of the periarticular muscle status, using muscle volume, fat ratio and lean muscle volume as parameters. An analysis of in vivo hip contact forces was made 3 months after THA during ADL (walking, stair climbing, chair rising and sitting) and correlated with the morphology of the periarticular muscles.ResultsWe found a significant decrease of volume by 25% (-3 to -45, p = 0.005) and increase in fat ratio of the Gluteus Minimus (Gmin), resulting in a decrease in lean muscle volume of 28% (-48 to 0, p = 0.008). This was accompanied by an inverse development in the Tensor Fasciae Latae (TFL) resulting in a lean muscle volume increase of 34% (-2 to -102, p = 0.013). Changes in Gluteus Medius (Gmed) and Gluteus Maximus (Gmax) have not been observed in the short-term follow up. A decreased Gmin lean muscle volume was found to strongly correlate with high in vivo joint contact forces in all tested ADL.ConclusionThe decrease of Gmin volume can be seen as a direct effect of THA surgery, whereas the increase of TFL might compensate for loss of Gmin volume. Lean muscle volume and fat ratio were better predictors for joint contact forces than total muscle volume. These effects were most pronounced during sitting down and standing up due to the higher demand on the gluteal muscles during these activities.

Effects of Hip Abductor Strengthening on Musculoskeletal Loading in Hip Dysplasia Patients after Total Hip Replacement

“…Sørensen et al [35] reported a normal hip muscle function during walking after 12 month periacetabular osteotomy, and found that joint force magnitude continued to be higher than normal, justifying this finding with the need for joint structures of a longer time to heal than muscles, with a residual pain alleviating strategy. Damm et al [36] reported a correlation between muscle atrophy, fatty degeneration and higher hip joint forces. Fatty atrophy was observed after THR contributing to functional outcome deterioration [37].…”

Mid-term and long-term results of restoring rotation center in revision hip arthroplasty

“…Wu et al [20] believed that the recovery of the gluteus medius' strength and the balance of soft tissue around the hip were very important, which could affect the outcoming of THA. Damm P et al [21]. also recognized the importance of the gluteus medius muscle and believed that the situation of gluteus medius muscle strength should be fully considered before and after surgery, otherwise, the surgical efficacy would be affected.…”

Belastung und Beanspruchung der unteren Extremität

“…Es konnte ferner gezeigt werden, dass sich nach 20-minütigem langsamen Gehen bei 2,5 km/h die Gelenkkräfte nicht verändern [9]. Unstimmigkeiten zwischen den Messungen, insbesondere zwischen [7] und [9], lassen sich darauf zurückführen, dass die Dysfunktion eines Muskels die Gelenkskontaktkraft erhöht (Impaired gait), weil ein Teil des erforderlichen Gelenksmoments durch andere Muskeln kompensiert werden muss, die unvorteilhaft kurze Hebelarme besitzen und hierdurch höhere Gelenkskräfte erzeugen [10,11]. Während bis hier lediglich die resultierende Gelenkskraft und wegen des steilen Einfallswinkels damit quasi die kompressive Kraftkomponente im Sinne der Belastung beachtet wurde, wurden in den Untersuchungen auch andere strukturelle Beanspruchungen, wie Biege-und Torsionsmomente gemessen.…”

“…Die effektive Pufferwirkung der Muskulatur kann auch darin gesehen werden, dass es innerhalb der Bewegungsklassen zu vergleichbaren Belastungen kommt. Ist die Funktion eines Muskels allerdings gestört, kommt es konsequenterweise zu einem entsprechenden Belastungsanstieg, wie am Beispiel des M. Glutaeus minimus beobachtet werden konnte [11]. Diese Ergebnisse unterstreichen den hohen Wert eines kombinierten Kraft-und Sensomotoriktrainings in der Rehabilitation und Prävention.…”