ESB Clinical Biomechanics Award 2018: Muscle atrophy-related increased joint loading after total hip arthroplasty and their postoperative change from 3 to 50 months

      Highlights

      • In vivo load measurements with instrumented hip implants were performed at 3 and 50 months postoperatively.
      • Individual CT analyses of the gluteal muscle status and fat ratio were performed at 3 and 50 months postoperatively.
      • The individual muscle status are influence the postoperative hip joint loading.
      • Our findings suggest that an impairment of periarticular musculature contributes to an increase of the in vivo joint loads.

      Abstract

      Background

      Hip joint loading is dominated by muscular activity. Thus, contact forces exceeding many times one's body weight are a consequence of imbalanced muscular activity. The objective was to analyze the influence of muscle atrophy after total hip arthroplasty on in vivo hip joint contact loading initially and long term. We hypothesized that an impaired periarticular muscle will lead to increase in vivo joint load, specifically in the long term.

      Methods

      Using a group of nine patients with instrumented hip implants, contact forces and muscle status were analyzed one day prior to 3 and 50 months after joint arthroplasty. In vivo load measurements were performed for different activities of daily living (ADL). Pre- and postoperative pelvic CT scans were analyzed to assess the periarticular muscle status. Finally, the muscle morphologies and in vivo contact forces were compared.

      Results

      At 3 months after total hip arthroplasty we found a significant correlation of lower lean gluteus minimus muscle (GMin) volume with higher loads during all tested activities of daily living. 50 months postoperatively statistical analysis revealed lower lean volume of the gluteus maximus to be correlated with higher joint loads in walking.

      Conclusion

      Our data generally show a good comparability between muscle status and joint contact forces and thus support our hypothesis that an impairment of periarticular musculature contributes to an increase of the in vivo joint loads after total hip arthroplasty. Effects were most pronounced during stair climbing and sit-down/stand-up from a chair at 3 months and during level walking at 50 months.
      To read this article in full you will need to make a payment
      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Adolphson P.
        • von Sivers K.
        • Dalen N.
        • Jonsson U.
        • Dahlborn M.
        Bone and muscle mass after hip arthroplasty. A quantitative computed tomography study in 20 arthrosis cases.
        Acta Orthop. Scand. 1993; 64: 181-184
        • Anderson F.C.
        • Pandy M.G.
        Individual muscle contributions to support in normal walking.
        Gait Posture. 2003; 17: 159—169
        • Anta-díaz B. De
        • Serralta-gomis J.
        • Lizaur-utrilla A.
        No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome.
        Int. Orthop. 2016; : 2025-2030https://doi.org/10.1007/s00264-015-3108-9
        • Arokoski M.H.
        • et al.
        Hip muscle strength and muscle cross sectional area in men with and without hip osteoarthritis.
        J. Rheumatol. 2002; 29: 2185-2195
        • Boren K.
        • et al.
        Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises.
        Int. J. Sports Phys. Ther. 2011; 6: 206-223
      1. Colgan, G., Walsh, M., Bennett, D., Rice, J. & O'Brien, T. Gait analysis and hip extensor function early post total hip replacement. J. Orthop. 13, 171–176 (2016).

        • Correa T.A.
        • Crossley K.M.
        • Kim H.J.
        • Pandy M.G.
        Contributions of individual muscles to hip joint contact force in normal walking.
        J. Biomech. 2010; 43: 1618-1622
        • Daguet E.
        • et al.
        Fat content of hip muscles: an anteroposterior gradient.
        J. Bone Jt. Surg. 2011; 93–A: 1897-1905
        • Damm P.
        • et al.
        Friction in total hip joint prosthesis measured in vivo during walking.
        PLoS One. 2013; 8
        • Damm P.
        • Zonneveld J.
        • Brackertz S.
        • Streitparth F.
        • Winkler T.
        Gluteal muscle damage leads to higher in vivo hip joint loads 3 months after total hip arthroplasty.
        PLoS One. 2018; 13: 1-11
        • Duda Georg N.
        Influence of Muscle Forces on the Internal Loading in the Femur During Gait.
        Technische Universität Hamburg-Harburg, 1996
        • Duda G.N.
        • Schneider E.
        • Chaot E.Y.S.
        • Section B.
        Internal forces and moments in the femur during walking.
        J. Biomech. 1997; 30: 933-941
        • Duda G.N.
        • et al.
        Influence of muscle forces on femoral strain distribution.
        J. Biomech. 1998; 31: 841-846
        • Engelken F.
        • et al.
        Assessment of fatty degeneration of the gluteal muscles in patients with THA using MRI: reliability and accuracy of the Goutallier and quartile classification systems.
        J. Arthroplast. 2014; 29: 149-153
        • Foucher K.C.
        • Hurwitz D.E.
        • Wimmer M.A.
        Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients.
        J. Biomech. 2007; 40: 3432-3437
        • Gladstone J.N.
        • Bishop J.Y.
        • Lo I.K.Y.
        • Flatow E.L.
        American journal of sports fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and.
        Sport. Med. 2007; : 719-728https://doi.org/10.1177/0363546506297539
        • Gottschall J.S.
        • Okita N.
        • Sheehan R.C.
        Muscle activity patterns of the tensor fascia latae and adductor longus for ramp and stair walking.
        J. Electromyogr. Kinesiol. 2012; 22: 67-73
      2. Health at a Glance: Europe 2016: State of Health in the EU Cycle. Hip Replacement Surgery. 2014 (or nearest year)
        • Heller M.O.
        • et al.
        Musculo-skeletal loading conditions at the hip during walking and stair climbing.
        J. Biomech. 2001; 34: 883-893
        • Heller M.O.
        • et al.
        Determination of muscle loading at the hip joint for use in pre-clinical testing.
        J. Biomech. 2005; 38: 1155-1163
        • Heller M.O.
        • et al.
        Muskuloskeletale Belastungsanalysen.
        Orthopade. 2007; 36: 188-194
        • Jixiang T.
        • Hong C.
        • Cheng C.
        • Xi L.
        • Wei H.
        The strength and function of hip abductors following anterolateral minimally invasive total hip arthroplasty.
        . 2014; 17: 73-78
        • LIN H.-C.
        • LU T.-W.
        • HSU H.-C.
        Three-dimensional analysis of kinematic and kinetic coordination of the lower limb joints during stair ascent and descent.
        Biomed. Eng. Appl. Basis Commun. 2004; 16: 101-108
        • McCrory J.L.
        • White S.C.
        • Lifeso R.M.
        Vertical ground reaction forces: objective measures of gait following hip arthroplasty.
        Gait Posture. 2001; 14: 104-109
        • Rasch A.
        • Byström A.H.
        • Dalen N.
        • Berg H.E.
        Reduced muscle radiological density, cross-sectional area, and strength of major hip and knee muscles in 22 patients with hip osteoarthritis.
        Acta Orthop. 2007; 78: 505-510
        • Rasch A.
        • Byström A.H.
        • Dalén N.
        • Martinez-Carranza N.
        • Berg H.E.
        Persisting muscle atrophy two years after replacement of the hip.
        J. Bone Jt. Surgery, Br. 2009; 91–B: 583 LP-588
        • Rodríguez-Roiz J.M.
        • et al.
        Hypertrophy of the tensor fascia lata muscle as a complication of total hip arthroplasty.
        Eur. J. Orthop. Surg. Traumatol. 2017; 27: 255-259
        • Semciw A.I.
        • Green R.A.
        • Murley G.S.
        • Pizzari T.
        Gluteus minimus: an intramuscular EMG investigation of anterior and posterior segments during gait.
        Gait Posture. 2014; 39: 822-826
        • Suetta C.
        • et al.
        Training-induced changes in muscle CSA, muscle strength, EMG, and rate of force development in elderly subjects after long-term unilateral disuse.
        J. Appl. Physiol. 2004; 97: 1954-1961
        • Sutter R.
        • et al.
        Abductor tendon tears are associated with hypertrophy of the tensor fasciae latae muscle.
        Skelet. Radiol. 2013; 42: 627-633
        • Tohtz S.
        • Mu M.
        • Dewey M.
        • Springer I.
        Evidence of Reduced Muscle Trauma Through a Minimally Invasive Anterolateral Approach by Means of MRI.
        2010: 3192-3200https://doi.org/10.1007/s11999-010-1378-5
        • Uemura K.
        • Takao M.
        • Sakai T.
        Volume increases of the gluteus maximus, gluteus medius, and thigh muscles after hip arthroplasty.
        J. Arthroplast. 2016; 31: 906-912
        • Von Roth P.
        • et al.
        Significant Muscle Damage After Multiple Revision Total Hip Replacements Through the Direct Lateral Approach.
        2014: 1618-1622https://doi.org/10.1302/0301-620X.96B12.34256