Surgery-induced changes and early recovery of hip-muscle strength, leg-press power, and functional performance after fast-track total hip arthroplasty: a prospective cohort study

Bente Holm, Kristian Thorborg, Henrik Husted, Henrik Kehlet, Thomas Bandholm, Bente Holm, Kristian Thorborg, Henrik Husted, Henrik Kehlet, Thomas Bandholm

Abstract

Background: By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits.

Objectives: Firstly, to quantify changes (compared to pre-operative values) in hip muscle strength, leg-press power, and functional performance in the first week after THA, and secondly, to explore relationships between the muscle strength changes, and changes in hip pain, systemic inflammation, and thigh swelling.

Design: Prospective, cohort study.

Setting: Convenience sample of patients receiving a THA at Copenhagen University Hospital, Hvidovre, Denmark, between March and December 2011.

Participants: Thirty-five patients (65.9 ± 7.2 years) undergoing THA.

Main outcome measures: Hip muscle strength, leg-press power, performance-based function, and self-reported disability were determined prior to, and 2 and 8 days after, THA (Day 2 and 8, respectively). Hip pain, thigh swelling, and C-Reactive Protein were also determined.

Results: Five patients were lost to follow-up. Hip muscle strength and leg press power were substantially reduced at Day 2 (range of reductions: 41-58%, P<0.001), but less pronounced at Day 8 (range of reductions: 23-31%, P<0.017). Self-reported symptoms and function (HOOS: Pain, Symptoms, and ADL) improved at Day 8 (P<0.014). Changes in hip pain, C-Reactive Protein, and thigh swelling were not related to the muscle strength and power losses.

Conclusions: Hip muscle strength and leg-press power decreased substantially in the first week after THA - especially at Day 2 - with some recovery at Day 8. The muscle strength loss and power loss were not related to changes in hip pain, systemic inflammation, or thigh swelling. In contrast, self-reported symptoms and function improved. These data on surgery-induced changes in muscle strength may help design impairment-directed, post-operative rehabilitation to be introduced soon after surgery.

Trial registration: ClinicalTrials.gov NCT01246674.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Changes in muscle strength/power over…
Figure 1. Changes in muscle strength/power over time in the operated leg.
The secondary y-axis applies to the leg-press power measurement. *Day 2 statistically different from Pre-surgery, and Day 8 statistically different from Day 2 and Pre-surgery.
Figure 2. Changes in self-reported disability over…
Figure 2. Changes in self-reported disability over time in the operated leg. *statistically different from Pre-surgery.

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