A randomized controlled trial on maximal strength training in 60 patients undergoing total hip arthroplasty

Siri B Winther, Olav A Foss, Otto S Husby, Tina S Wik, Jomar Klaksvik, Vigdis S Husby, Siri B Winther, Olav A Foss, Otto S Husby, Tina S Wik, Jomar Klaksvik, Vigdis S Husby

Abstract

Background and purpose - Total hip arthroplasty (THA) patients have reduced muscle strength after rehabilitation. In a previous efficacy trial, 4 weeks' early supervised maximal strength training (MST) increased muscle strength in unilateral THA patients <65 years. We have now evaluated muscle strength in an MST and in a conventional physiotherapy (CP) group after rehabilitation in regular clinical practice. Patients and methods - 60 primary THA patients were randomized to MST or CP between August 2015 and February 2016. The MST group trained at 85-90% of their maximal capacity in leg press and abduction of the operated leg (4 × 5 repetitions), 3 times a week at a municipal physiotherapy institute up to 3 months postoperatively. The CP group followed a training program designed by their respective physiotherapist, mainly exercises performed with low or no external loads. Patients were tested pre- 3, 6, and 12 months postoperatively. Primary outcomes were abduction and leg press strength at 3 months. Other parameters evaluated were pain, 6-min walk test, Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) Physical Function Short-form score. Results - 27 patients in each group completed the intervention. MST patients were substantially stronger in leg press and abduction than CP patients 3 (43 kg and 3 kg respectively) and 6 months (30 kg and 3 kg respectively) postoperatively (p ≤ 0.002). 1 year postoperatively, no intergroup differences were found. No other statistically significant intergroup differences were found. Interpretation - MST increases muscle strength more than CP in THA patients up to 6 months postoperatively, after 3 months' rehabilitation in clinical practice. It was well tolerated by the THA patients and seems feasible to conduct within regular clinical practice.

Figures

Figure 1.
Figure 1.
Patient inclusion and follow-up in the maximal strength training (MST) and conventional physiotherapy (CP) groups.
Figure 2.
Figure 2.
Set-up for the (a) leg press ergometer and (b) abduction pulling apparatus.
Figure 3.
Figure 3.
Leg press strength of the operated leg compared with preoperative values (100%) of the non-operated leg in the maximal strength training (MST) and conventional physiotherapy (CP) groups at 3, 6, and 12 months postoperatively. Model estimate with 95% confidence intervals.
Figure 4.
Figure 4.
Abduction strength of the operated leg compared with preoperative values (100%) of the non-operated leg in the maximal strength training (MST) and conventional physiotherapy (CP) groups at 3, 6, and 12 months postoperatively. Model estimate with 95% confidence intervals.
Figure 5.
Figure 5.
Pain score during mobilization on the numeric rating scale (NRS: 0–10) in the maximal strength training (MST) and conventional physiotherapy (CP) groups preoperatively and at 3, 6, and 12 months postoperatively. Model estimate with 95% confidence intervals.

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