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

Siri B Winther, Vigdis S Husby, Olav A Foss, Tina S Wik, Svein Svenningsen, Monika Engdal, Kristin Haugan, Otto S Husby, Siri B Winther, Vigdis S Husby, Olav A Foss, Tina S Wik, Svein Svenningsen, Monika Engdal, Kristin Haugan, Otto S Husby

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.

Trial registration: ClinicalTrials.gov NCT01506024.

Figures

Figure 4.
Figure 4.
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.
Figure 5.
Figure 5.
Postoperative leg-press strength compared with preoperative values (100%) in the direct lateral approach (DLA) group, the posterior approach (PA) group, and the anterior approach (AA) group. #, Δ , and □ show statistically significant differences in percent change relative to preoperative values between groups.
Figure 6.
Figure 6.
Postoperative abduction strength compared with preoperative values (100%) in the direct lateral approach (DLA) group, the posterior approach (PA) group, and the anterior approach (AA) group. #, Δ , and □ , see Figure 5

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