Advertisement

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

      Highlights

      • Hip abductor strength is associated with performance tests after total hip arthroplasty.
      • Hip abductor strength is associated with self-reported function after total hip arthroplasty.
      • Peak external adduction moments are associated with most performance tests.
      • Peak external adduction moments are not associated with self-reported function.

      Abstract

      Background

      A subset of total hip arthroplasty patients experience functional impairments past the first postoperative year. Poor hip abductor function is common before and in the early postoperative period. It is not known if abductor impairment is associated with long-term functional impairment. This study evaluated the relationships between static and dynamic abductor function and performance-based and self-reported function >1 year post-total hip arthroplasty.

      Methods

      Eighteen adults 1–5 years post-total hip arthroplasty participated. Static and dynamic abductor function were assessed through dynamometry and gait analysis, respectively. Subjects completed four physical performance tests and two self-report instruments.

      Findings

      Higher peak isometric abductor strength was associated with better performance-based function (P ≤ 0.001–0.030) and with self-reported function (P ≤ 0.001–0.012). Higher peak external adduction moment was associated with better results on 3 of 4 performance tests (P = 0.007–0.026). Together, static and dynamic abductor function predicted 35–77% of the variation in physical function. Abductor strength best predicted walking test results and self-reported function, while dynamic abductor function best predicted tests involving sit-to-stand

      Interpretation

      Static and dynamic abductor function were associated with physical function 1–5 years after total hip arthroplasty. These results support further investigation of interventions targeting abductor function for persons experiencing persistent impairments.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Amlie E.
        • Havelin L.I.
        • Furnes O.
        • Baste V.
        • Nordsletten L.
        • Hovik O.
        • Dimmen S.
        Worse patient-reported outcome after lateral approach than after anterior and posterolateral approach in primary hip arthroplasty. A cross-sectional questionnaire study of 1476 patients 1–3 years after surgery.
        Acta Orthop. 2014; 85: 463-469
        • Bazett-Jones D.M.
        • Cobb S.C.
        • Joshi M.N.
        • Cashin S.E.
        • Earl J.E.
        Normalizing hip muscle strength: establishing body-size-independent measurements.
        Arch. Phys. Med. Rehabil. 2011; 92: 76-82
        • Behery O.A.
        • Foucher K.C.
        Are Harris hip scores and gait mechanics related before and after THA?.
        Clin. Orthop. Relat. Res. 2014; 472: 3452-3461
        • Berstock J.
        • Blom A.
        • Beswick A.
        A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty.
        Ann. R. Coll. Surg. Engl. 2015; 97: 11-16
        • Bertocci G.E.
        • Munin M.C.
        • Frost K.L.
        • Burdett R.
        • Wassinger C.A.
        • Fitzgerald S.G.
        Isokinetic performance after total hip replacement.
        Am. J. Phys. Med. Rehabil. 2004; 83: 1-9
        • Beswick A.
        • Wylde V.
        • Gooberman Hill R.
        • Blom A.
        • Dieppe P.
        What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients.
        BMJ Open. 2012; 2: e000435
        • Bohannon R.W.
        Reference values for the five-repetition sit-to-stand test: a descriptive meta-analysis of data from elders.
        Percept. Mot. Skills. 2006; 103: 215-222
        • Dayton M.R.
        • Judd D.L.
        • Hogan C.A.
        • Stevens-Lapsley J.E.
        Performance-based versus self-reported outcomes using the hip disability and osteoarthritis outcome score after total hip arthroplasty.
        Am. J. Phys. Med. Rehabil. 2016; 95: 132-138
        • Dobson F.
        • Hinman R.S.
        • Roos E.M.
        • Abbott J.H.
        • Stratford P.
        • Davis A.M.
        • Buchbinder R.
        • Snyder-Mackler L.
        • Henrotin Y.
        • Thumboo J.
        • Hansen P.
        • Bennell K.L.
        OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis.
        Osteoarthr. Cartil. 2013; 21: 1042-1052
        • Ewen A.M.
        • Stewart S.
        • St Clair Gibson A.
        • Kashyap S.N.
        • Caplan N.
        Post-operative gait analysis in total hip replacement patients-a review of current literature and meta-analysis.
        Gait Posture. 2012; 36: 1-6
        • Foucher K.C.
        Preoperative gait mechanics predict clinical response to total hip arthroplasty.
        J. Orthop. Res. 2017; 35: 366-376
        • Foucher K.C.
        • Wimmer M.A.
        • Moisio K.C.
        • Hildebrand M.
        • Berli M.C.
        • Walker M.R.
        • Berger R.A.
        • Galante J.O.
        Time course and extent of functional recovery during the first postoperative year after minimally invasive total hip arthroplasty with two different surgical approaches—a randomized controlled trial.
        J. Biomech. 2011; 44: 372-378
        • Gilbey H.J.
        • Ackland T.R.
        • Wang A.W.
        • Morton A.R.
        • Trouchet T.
        • Tapper J.
        Exercise improves early functional recovery after total hip arthroplasty.
        Clin. Orthop. Relat. Res. 2003; 408: 193-200
        • Harrington M.E.
        • Zavatsky A.B.
        • Lawson S.E.M.
        • Yuan Z.
        • Theologis T.N.
        Prediction of the hip joint centre in adults, children, and patients with cerebral palsy based on magnetic resonance imaging.
        J. Biomech. 2007; 40: 595-602
        • Hawker G.A.
        • Badley E.M.
        • Borkhoff C.M.
        • Croxford R.
        • Davis A.M.
        • Dunn S.
        • Gignac M.A.
        • Jaglal S.B.
        • Kreder H.J.
        • Sale J.E.
        Which patients are most likely to benefit from total joint arthroplasty?.
        Arthritis Rheum. 2013; 65: 1243-1252
        • Heiberg K.E.
        • Bruun-Olsen V.
        • Ekeland A.
        • Mengshoel A.M.
        Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Followup one year after surgery.
        Arthritis Care & Research. 2012; 64: 415-423
        • Judd D.L.
        • Dennis D.A.
        • Thomas A.C.
        • Wolfe P.
        • Dayton M.R.
        • Stevens-Lapsley J.E.
        Muscle strength and functional recovery during the first year after THA.
        Clin. Orthop. Relat. Res. 2014; 472: 654-664
        • Judd D.L.
        • Winters J.D.
        • Stevens-Lapsley J.E.
        • Christiansen C.L.
        Effects of neuromuscular reeducation on hip mechanics and functional performance in patients after total hip arthroplasty: a case series.
        Clin. Biomech. (Bristol, Avon). 2016; 32: 49-55
        • Judge A.
        • Cooper C.
        • Williams S.
        • Dreinhoefer K.
        • Dieppe P.
        Patient-reported outcomes one year after primary hip replacement in a European Collaborative Cohort.
        Arthritis Care. Res. (Hoboken). 2010; 62: 480-488
        • Judge A.
        • Arden N.K.
        • Batra R.N.
        • Thomas G.
        • Beard D.
        • Javaid M.K.
        • Cooper C.
        • Murray D.
        • Exeter Primary Outcomes Study (EPOS) group
        The association of patient characteristics and surgical variables on symptoms of pain and function over 5 years following primary hip-replacement surgery: a prospective cohort study.
        BMJ Open. 2013; 3https://doi.org/10.1136/bmjopen-2012-002453
        • Kiernan D.
        • Malone A.
        • O'Brien T.
        • Simms C.K.
        The clinical impact of hip joint centre regression equation error on kinematics and kinetics during paediatric gait.
        Gait Posture. 2015; 41: 175-179
        • Kolk S.
        • Minten M.J.M.
        • Van Bon G.E.A.
        • Rijnen W.H.
        • Geurts A.C.H.
        • Verdonschot N.
        • Weerdesteyn V.
        Gait and gait-related activities of daily living after total hip arthroplasty: a systematic review.
        Clin. Biomech. 2014; 29: 705-718
        • Minns Lowe C.J.
        • Barker K.L.
        • Dewey M.E.
        • Sackley C.M.
        Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic review of clinical trials.
        BMC Musculoskelet. Disord. 2009; 10: 98
        • Minns Lowe C.J.
        • Davies L.
        • Sackley C.M.
        • Barker K.L.
        Effectiveness of land-based physiotherapy exercise following hospital discharge following hip arthroplasty for osteoarthritis: an updated systematic review.
        Physiotherapy (United Kingdom). 2015; 101: 252-265
        • Moisio K.C.
        • Sumner D.R.
        • Shott S.
        • Hurwitz D.E.
        Normalization of joint moments during gait: a comparison of two techniques.
        J. Biomech. 2003; 36: 599-603
        • Monaghan B.
        • Cunningham P.
        • Harrington P.
        • Hing W.
        • Blake C.
        • O'Dohertya D.
        • Cusack T.
        Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement.
        Physiotherapy. 2017; 103: 283-288
        • Naal F.D.
        • Impellizzeri F.M.
        • Leunig M.
        Which is the best activity rating scale for patients undergoing total joint arthroplasty?.
        Clin. Orthop. Relat. Res. 2009; 467: 958-965
        • Nankaku M.
        • Ikeguchi R.
        • Goto K.
        • So K.
        • Kuroda Y.
        • Matsuda S.
        Hip external rotator exercise contributes to improving physical functions in the early stage after total hip arthroplasty using an anterolateral approach: a randomized controlled trial.
        Disabil. Rehabil. 2016; 38: 2178-2183
        • Nilsdotter A.
        • Lohmander L.S.
        • Klssbo M.
        • Roos E.
        Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement.
        BMC Musculoskelet. Disord. 2003; 4: 10
        • Podsiadlo D.
        • Richardson S.
        The timed “Up & Go”: a test of basic functional mobility for frail elderly persons.
        J. Am. Geriatr. Soc. 1991; 39: 142-148
        • Queen R.M.
        • Appleton J.S.
        • Butler R.J.
        • Newman E.T.
        • Kelley S.S.
        • Attarian D.E.
        • Bolognesi M.P.
        Total hip arthroplasty surgical approach does not alter postoperative gait mechanics one year after surgery.
        PM R. 2014; 6: 221-6; quiz 226
        • Rasch A.
        • Dalen N.
        • Berg H.E.
        Muscle strength, gait, and balance in 20 patients with hip osteoarthritis followed for 2 years after THA.
        Acta Orthop. 2010; 81: 183-188
        • Rathod P.A.
        • Orishimo K.F.
        • Kremenic I.J.
        • Deshmukh A.J.
        • Rodriguez J.A.
        Similar improvement in gait parameters following direct anterior & posterior approach total hip arthroplasty.
        J. Arthroplast. 2014; 29: 1261-1264
        • Schalet B.D.
        • Hays R.D.
        • Jensen S.E.
        • Beaumont J.L.
        • Fries J.F.
        • Cella D.
        Validity of PROMIS physical function measured in diverse clinical samples.
        J. Clin. Epidemiol. 2016; 73: 112-118
        • Shih C.H.
        • Du Y.K.
        • Lin Y.H.
        • Wu C.C.
        Muscular recovery around the hip joint after total hip arthroplasty.
        Clin. Orthop. Relat. Res. 1994; : 115-120
        • Sicard-Rosenbaum L.
        • Light K.E.
        • Behrman A.L.
        Gait, lower extremity strength, and self-assessed mobility after hip arthroplasty.
        J. Gerontol. A Biol. Sci. Med. Sci. 2002; 57: M47-M51
        • Singh J.A.
        • Lewallen D.G.
        Patient-level clinically meaningful improvements in activities of daily living and pain after total hip arthroplasty: data from a large US institutional registry.
        Rheumatology (Oxford). 2013; 52: 1108-1118
        • Stratford P.W.
        • Kennedy D.M.
        Performance measures were necessary to obtain a complete picture of osteoarthritic patients.
        J Clin Epidemiol. February. 2006; 59: 160-167
        • Stratford P.W.
        • Kennedy D.M.
        • Hanna S.E.
        Condition-specific Western Ontario McMaster Osteoarthritis Index was not superior to region-specific Lower Extremity Functional Scale at detecting change.
        J. Clin. Epidemiol. 2004; 57: 1025-1032
        • Tsukagoshi R.
        • Tateuchi H.
        • Fukumoto Y.
        • Ibuki S.
        • Akiyama H.
        • So K.
        • Kuroda Y.
        • Okumura H.
        • Ichihashi N.
        Functional performance of female patients more than 6 months after total hip arthroplasty shows greater improvement with weight-bearing exercise than with non-weight-bearing exercise. Randomized controlled trial.
        Eur. J. Phys. Rehabil. Med. 2014; 50: 665-675
        • Unlu E.
        • Eksioglu E.
        • Aydog E.
        • Aydog S.T.
        • Atay G.
        The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study.
        Clin. Rehabil. 2007; 21: 706-711
        • Vaz M.D.
        • Kramer J.F.
        • Rorabeck C.H.
        • Bourne R.B.
        Isometric hip abductor strength following total hip replacement and its relationship to functional assessments.
        J. Orthop. Sports Phys. Ther. 1993; 18: 526-531
        • Widler K.
        • Glatthorn J.
        • Bizzini M.
        • Impellizzeri F.
        • Munzinger U.
        • Leunig M.
        • Maffiuletti N.
        Assessment of hip abductor muscle strength. A validity and reliability study.
        Journal of Bone and Joint Surgery American. 2009; 91: 2666-2672