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

• Published in: Acta orthopaedica Vol. 87; no. 1; pp. 22 - 28
• Main Authors: Winther, Siri B, Husby, Vigdis S, Foss, Olav A, Wik, Tina S, Svenningsen, Svein, Engdal, Monika, Haugan, Kristin, Husby, Otto S
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 02.01.2016; Medical Journals Sweden
• Subjects: Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Arthroplasty, Replacement, Hip - rehabilitation; Cohort Studies; Female; Follow-Up Studies; Hip Prosthesis; Humans; Male; Middle Aged; Muscle Strength - physiology; Muscle Weakness - etiology; Muscle Weakness - physiopathology; Muscle Weakness - rehabilitation; Osteoarthritis, Hip - surgery; Pain Measurement; Patient Positioning; Postoperative Care; Preoperative Care - methods; Prospective Studies; Range of Motion, Articular - physiology; Recovery of Function; Risk Assessment; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 1745-3674; 1745-3682
• DOI: 10.3109/17453674.2015.1068032

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.