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Muscular strength after total hip arthroplasty. A prospective comparison of 3 surgical approaches.

Winther SB, Husby VS, Foss OA, Wik TS, Svenningsen S, Engdal M, Haugan K, Husby OS - Acta Orthop (2015)

Bottom Line: The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach.At 3-month follow-up, no statistically significant differences between the groups were found.THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: a 1 Orthopaedic Research Centre, Orthopaedic Department, Trondheim University Hospital , Trondheim.

ABSTRACT

Background and purpose: Minimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches. PATIENTS AND METHODs: In a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach. Leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up.

Results: Differences in maximal strength change were greatest after 2 and 8 days. The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach. At 3-month follow-up, no statistically significant differences between the groups were found. The operated legs were 18% weaker in leg press and 15% weaker in abduction than the unoperated legs, and the results were similar between groups.

Interpretation: The posterior and anterior approaches appeared to have the least negative effect on abduction and leg press muscular strength in the first postoperative week; the posterior approach had the least negative effect, even up to 6 weeks postoperatively. THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery.

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Related in: MedlinePlus

Pain scores (numeric rating scale) in the direct lateral approach (DLA) group, the posterior approach (PA) group, and the anterior approach (AA) group pre- and postoperatively. The circles are outliers. These are defined as values that do not fall within the inner fences. The asterisks are extreme outliers. These represent cases or rows that have values more than 3 times the height of the boxes.
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Figure 0004: Pain scores (numeric rating scale) in the direct lateral approach (DLA) group, the posterior approach (PA) group, and the anterior approach (AA) group pre- and postoperatively. The circles are outliers. These are defined as values that do not fall within the inner fences. The asterisks are extreme outliers. These represent cases or rows that have values more than 3 times the height of the boxes.

Mentions: Of the 60 patients included in the study, 2 were excluded owing to complications, and 3 patients were lost to follow-up (Figure 1, see Supplementary data). There were no statistically significant differences in the patient baseline data, except for the leg-press test, where patients in the PA group were significantly stronger (Table 1). There were no statistically significant postoperative differences in pain scores between the groups at any of the follow-up assessments (p = 0.9) (Figure 4).


Muscular strength after total hip arthroplasty. A prospective comparison of 3 surgical approaches.

Winther SB, Husby VS, Foss OA, Wik TS, Svenningsen S, Engdal M, Haugan K, Husby OS - Acta Orthop (2015)

Pain scores (numeric rating scale) in the direct lateral approach (DLA) group, the posterior approach (PA) group, and the anterior approach (AA) group pre- and postoperatively. The circles are outliers. These are defined as values that do not fall within the inner fences. The asterisks are extreme outliers. These represent cases or rows that have values more than 3 times the height of the boxes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940587&req=5

Figure 0004: Pain scores (numeric rating scale) in the direct lateral approach (DLA) group, the posterior approach (PA) group, and the anterior approach (AA) group pre- and postoperatively. The circles are outliers. These are defined as values that do not fall within the inner fences. The asterisks are extreme outliers. These represent cases or rows that have values more than 3 times the height of the boxes.
Mentions: Of the 60 patients included in the study, 2 were excluded owing to complications, and 3 patients were lost to follow-up (Figure 1, see Supplementary data). There were no statistically significant differences in the patient baseline data, except for the leg-press test, where patients in the PA group were significantly stronger (Table 1). There were no statistically significant postoperative differences in pain scores between the groups at any of the follow-up assessments (p = 0.9) (Figure 4).

Bottom Line: The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach.At 3-month follow-up, no statistically significant differences between the groups were found.THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: a 1 Orthopaedic Research Centre, Orthopaedic Department, Trondheim University Hospital , Trondheim.

ABSTRACT

Background and purpose: Minimizing the decrease in muscular strength after total hip arthroplasty (THA) might allow patients to recover faster. We evaluated muscular strength in patients who were operated on using 3 surgical approaches. PATIENTS AND METHODs: In a prospective cohort study, 60 patients scheduled for primary THA were allocated to the direct lateral, posterior, or anterior approach. Leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up.

Results: Differences in maximal strength change were greatest after 2 and 8 days. The posterior and anterior approaches produced less decrease in muscular strength than the direct lateral approach. 6 weeks postoperatively, the posterior approach produced greater increase in muscular strength than the direct lateral approach, and resulted in a greater increase in abduction strength than the anterior approach. At 3-month follow-up, no statistically significant differences between the groups were found. The operated legs were 18% weaker in leg press and 15% weaker in abduction than the unoperated legs, and the results were similar between groups.

Interpretation: The posterior and anterior approaches appeared to have the least negative effect on abduction and leg press muscular strength in the first postoperative week; the posterior approach had the least negative effect, even up to 6 weeks postoperatively. THA patients have reduced muscle strength in the operated leg (compared to the unoperated leg) 3 months after surgery.

Show MeSH
Related in: MedlinePlus