Static and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty

Cinnamon, Christopher C.; Longworth, Jessica A.; Brunner, Jonas; Chau, Vivian K.; Ryan, Colleen A.; Dapiton, Kris; Chmell, Samuel J.; Foucher, Kharma C.

doi:10.1016/j.clinbiomech.2019.05.009

Cited by 11 publications

(9 citation statements)

References 40 publications

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“…At 12 th postoperative week's measurements, the only statistically significant difference was revealed at TUG test performance time of DAA-obese group. This is not surprising since it is well known that the hip abductor strength improved at 3 mo following THA performed by a conventional approach, such as Hardinge[ 32 ], while the hip abductor strength was linear associated with TUG test[ 33 ].…”

Section: Discussionmentioning

confidence: 94%

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial

Macheras¹,

Stasi²,

Triantafyllou³

et al. 2021

WJO

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BACKGROUND The increased prevalence of obesity has resulted in orthopedic surgeons being likely to face many patients with a high body mass index (BMI) who warrant total hip arthroplasties (THAs) over the coming years. Studies' findings considered the postoperative clinical, and functional outcomes in these patients are controversial, and selecting the most appropriate surgical approach remains debatable. AIM To compare pain-levels, functionality, and quality-of-life in obese and nonobese osteoarthritic patients who have undergone primary total hip arthroplasty through either direct-anterior-approach (DAA) or Hardinge-approach. METHODS One hundred and twenty participants (> 50 years) were divided into four groups according to the surgical approach (DAA or Hardinge) and patients' BMI (nonobese < 30 kg/m 2 vs obese ≥ 30 kg/m 2 ). Outcomes were measured preoperatively and postoperatively (6 th and 12 th week). Pain was measured with Face Pain Scale-Revised (FPS-R). Functionality was measured with Timed Up & Go (TUG) test and Modified Harris Hip Score-Greek version (MHHS-Gr). Quality-of-life was evaluated with the 12-item-International Hip Outcome Tool-Greek version (iHOT12-Gr) (Clinical Trial Identifier: ISRCTN15066737). RESULTS DAA vs Hardinge: (week 6) DAA-patients showed 12.2% less pain, more functionality (14.8% shorter TUG-performance time, 21.5% higher MHHS-Gr), and 38.16% better quality-of-life (iHOT12-Gr) compared to Hardinge-patients (all P values < 0.001). These differences were further increased on week 12 (all P values ≤ 0.05)]. DAA-obese vs Hardinge–obese: (week 6) DAA-obese patients had less pain, shorter TUG-performance time, better MHHS-Gr and iHOT12-Gr scores than Hardinge-obese (all P values < 0.01). (Week 12) Only the TUG-performance time of DAA-obese was significantly shortened (22.57%, P < 0.001). DAA-nonobese vs DAA-obese: no statistically significant differences were observed comparing the 6 th and 12 th weeks' outcomes. CONCLUSION DAA-groups reported less pain, more functionality and better quality-of-life, compared to the Hardinge-groups. The DAA benefited obese and nonobese patients, similarly yet faster, suggesting that it should be the more preferred choice for obese patients, instead of Hardinge. However, more comparative studies with more extended follow-up periods are needed to confirm our results and better evaluate all patients' long-term outcomes.

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Section: Discussionmentioning

confidence: 94%

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial

Macheras¹,

Stasi²,

Triantafyllou³

et al. 2021

WJO

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“…Damage of the abductor mechanism results in drop of the contralateral pelvis during single leg stance clinically manifested as a Trendelenburg gait. 11 Furthermore, abductor muscle strength deficit has been linked to knee OA, 5 12 patellofemoral pain syndrome 13 and chronic lower back pain. 14 Especially for the elderly population, loss of abduction function can compromise balance and increase the risk of falls.…”

Section: Introductionmentioning

confidence: 99%

“… 14 Especially for the elderly population, loss of abduction function can compromise balance and increase the risk of falls. 15 Specifically for THA, abductor muscle function has been shown to be directly associated with physical function 5 and important in limiting limping. 16 Overall, conservation of the abduction muscle strength is important not only for an optimal outcome of THA but also to prevent pain because of other orthopaedic conditions linked to abductor strength deficits.…”

Section: Introductionmentioning

confidence: 99%

Abductor muscle strength deficit in patients after total hip arthroplasty for hip osteoarthritis: a protocol for a systematic review and meta-analysis

et al. 2020

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IntroductionConservation of abductor muscle strength is directly associated with physical function after total hip replacement (THA). Although many studies have tried to explore and quantify a potential abductor muscle strength deficit after THA as well as identify possible causes and treatment options, this topic has not been addressed systematically.Methods and analysisHuman-based studies reporting measurements of hip abductor strength will be included in this review. Studies reporting on hip abductor strength measured manually or isometric measurements at an abduction angle other than 0° will not be considered. No restriction will be placed on study design, publication date operative approach, prosthesis design, age and sex of the patients or severity of OA. Data sources will be Embase via embase.com, Medline ALL via Ovid and the Cochrane Central Register of Controlled Trials. The preliminary search was conducted on 5 May 2019. Data regarding absolute values or torque ratio of hip abductor torque between sides as well as patient demographic data, surgical approaches and rehabilitation protocols will be extracted. The assessment of quality and risk of bias will be performed with the modified Newcastle-Ottawa Scale. The screening, data extraction and quality assessment will be performed by two reviewers independently. Where necessary, a third review author will make a final judgement. Narrative synthesis as well as tabular presentation of the extracted data will be included. Whenever possible, metaregression and subgroup specific meta-analyses will be used to investigate the influence of time since THA and type of measurement (isokinetic or isometric) on the different outcomes. In case of sufficient information, these analyses will be extended to include characteristics such as age, sex, surgical approach or rehabilitation programme.Ethics and disseminationNo ethics approval is required. The results will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42020153185.

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“…Secondary hip abductors are the piriformis, sartorius, and rectus femoris muscles [1]. Adequate abductor muscle function has been directly linked to good physical function [2] and minimal or absent limping [3] after total hip arthroplasty (THA). Furthermore, limited abductor muscle function increases the risk of falls [4].…”

mentioning

confidence: 99%

“…Furthermore, limited abductor muscle function increases the risk of falls [4]. While severe loss of abductor strength results in Trendelenburg gait [5], already slighter strength deficits have been associated with longterm negative effects such as knee osteoarthritis (OA) [2,6], patellofemoral pain syndrome [7], or chronic lower back pain [8]. Consequently, postoperative hip abductor muscle function may affect the outcome of THA directly by preventing falls or indirectly by preventing pain as a consequence of orthopedic pathologies related to abductor muscle strength deficits.…”

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confidence: 99%

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

Ismailidis

Kvarda

Vach

et al. 2021

The Journal of Arthroplasty

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Background: The aims of this study were to assess and quantify hip abductor muscle strength deficits after total hip arthroplasty (THA) and to determine associations with external factors. Methods: Studies reporting on hip abductor muscle strength before and/or after THA performed for osteoarthritis or atraumatic osteonecrosis of the hip were considered for inclusion. Data sources were Embase, Medline, and the Cochrane Central Register of Controlled Trials. Muscle strength on the affected side was compared with the healthy contralateral side or with control subjects. Study quality was assessed using a modified Newcastle-Ottawa Scale.Results: Nineteen studies reporting on 875 subjects met the inclusion criteria. Patients scheduled for THA had a mean strength deficit of 18.6% (95% confidence interval (CI) [À33.9, À3.2%]) compared with control subjects. Abductor muscle strength then increased by 20.2% (CI [5.6, 34.8%]) at 4-6 months, 29.6% (CI [4.7, 54.4%]) at 9-12 months, and 49.8% (CI [À31.0, 130.6%]) at 18-24 months postoperatively compared with preoperative values. For unilateral THA, the mean torque ratio was 86.3% (CI [75.4, 97.2%]) and 93.4% (CI [75.1, 111.6%]) before and >24 months after THA, respectively. Study quality was low to moderate. Conclusion: Hip abductor muscle strength deficits may gradually improve during 24 months after THA possibly without complete recovery. Cautious interpretation of these findings is warranted because highquality evidence is largely missing.

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Static and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty

Cited by 11 publications

References 40 publications

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial

Abductor muscle strength deficit in patients after total hip arthroplasty for hip osteoarthritis: a protocol for a systematic review and meta-analysis

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

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Static and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty

Cited by 11 publications

References 40 publications

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients: A randomized controlled trial

Abductor muscle strength deficit in patients after total hip arthroplasty for hip osteoarthritis: a protocol for a systematic review and meta-analysis

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

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Static and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty