Abductor muscle strengthening in THA patients operated with minimally invasive anterolateral approach for developmental hip dysplasia

Maria Grazia Benedetti, Lorenzo Cavazzuti, Marilina Amabile, Enrico Tassinari, Giordano Valente, Gabriele Zanotti, Enrico Vaienti, Stefania Orsini, Elisabetta Mariani, Fulvia Taddei

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: In developmental hip dysplasia (DDH) patients, the chronic dislocation of the femoral head with respect to the true acetabulum determines muscle contracture and atrophy, particularly of the abductor muscles, and leads to secondary osteoarthritis (OA) with severe motor dysfunction, pain and disability. The correct positioning when a total hip replacement (THR) is performed is fundamental to the recovery of gait function. Also, inadequate rehabilitation of the abductor muscles for pelvic stabilisation can be responsible for residual dysfunction. Consensus on a programme for abductor muscle strengthening in these patients is not currently available. The aim of this study was to evaluate the effectiveness of a specific program of exercises for strengthening the abductor muscles in these patients.

METHODS: A multicentre, prospective, randomised clinical trial was carried out in an outpatient rehabilitation setting on 103 patients given THR for DDH through a minimally invasive anterolateral approach. Patients were randomly divided into a Study Group, including 46 patients, and a Control Group, including 57 patients. All patients underwent standard early postoperative rehabilitation. In addition, the Study Group were given an extra 2-week rehabilitation once full weight-bearing on the operated limb was allowed, aimed at strengthening the abductor muscles. All patients were evaluated preoperatively, and at about 3 and 6 months postoperatively. Clinical measures (lower limb-length differences, hip range of motion, abductor muscle strength), and functional measures (WOMAC, HHS, 10mt WT, SF-12) were taken.

RESULTS: Hip range of motion and functional outcome measures showed a progressive improvement at follow ups in both groups, significantly higher in the Study Group. In particular, abductor strength at 6 months post-op improved by 92.5% with respect to 35.7% in the Control Group.

CONCLUSION: In addition to standard rehabilitation, a rehabilitation programme for strengthening the gluteal muscles in DDH patients who underwent THR determined an increase in muscle strength that improved functional performance and patient satisfaction.

Original languageEnglish
JournalHIP International
DOIs
Publication statusE-pub ahead of print - Sep 22 2019

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Tacrine
Hip Dislocation
Muscles
Rehabilitation
Hip Replacement Arthroplasties
Muscle Strength
Articular Range of Motion
Hip
Control Groups
Acetabulum
Muscular Atrophy
Recovery of Function
Weight-Bearing
Contracture
Thigh
Patient Satisfaction
Gait
Osteoarthritis
Lower Extremity
Consensus

Keywords

  • Developmental hip dysplasia
  • gluteal muscle weakness
  • outcome
  • rehabilitation
  • total hip replacement

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Abductor muscle strengthening in THA patients operated with minimally invasive anterolateral approach for developmental hip dysplasia. / Benedetti, Maria Grazia; Cavazzuti, Lorenzo; Amabile, Marilina; Tassinari, Enrico; Valente, Giordano; Zanotti, Gabriele; Vaienti, Enrico; Orsini, Stefania; Mariani, Elisabetta; Taddei, Fulvia.

In: HIP International, 22.09.2019.

Research output: Contribution to journalArticle

Benedetti, Maria Grazia ; Cavazzuti, Lorenzo ; Amabile, Marilina ; Tassinari, Enrico ; Valente, Giordano ; Zanotti, Gabriele ; Vaienti, Enrico ; Orsini, Stefania ; Mariani, Elisabetta ; Taddei, Fulvia. / Abductor muscle strengthening in THA patients operated with minimally invasive anterolateral approach for developmental hip dysplasia. In: HIP International. 2019.
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abstract = "OBJECTIVE: In developmental hip dysplasia (DDH) patients, the chronic dislocation of the femoral head with respect to the true acetabulum determines muscle contracture and atrophy, particularly of the abductor muscles, and leads to secondary osteoarthritis (OA) with severe motor dysfunction, pain and disability. The correct positioning when a total hip replacement (THR) is performed is fundamental to the recovery of gait function. Also, inadequate rehabilitation of the abductor muscles for pelvic stabilisation can be responsible for residual dysfunction. Consensus on a programme for abductor muscle strengthening in these patients is not currently available. The aim of this study was to evaluate the effectiveness of a specific program of exercises for strengthening the abductor muscles in these patients.METHODS: A multicentre, prospective, randomised clinical trial was carried out in an outpatient rehabilitation setting on 103 patients given THR for DDH through a minimally invasive anterolateral approach. Patients were randomly divided into a Study Group, including 46 patients, and a Control Group, including 57 patients. All patients underwent standard early postoperative rehabilitation. In addition, the Study Group were given an extra 2-week rehabilitation once full weight-bearing on the operated limb was allowed, aimed at strengthening the abductor muscles. All patients were evaluated preoperatively, and at about 3 and 6 months postoperatively. Clinical measures (lower limb-length differences, hip range of motion, abductor muscle strength), and functional measures (WOMAC, HHS, 10mt WT, SF-12) were taken.RESULTS: Hip range of motion and functional outcome measures showed a progressive improvement at follow ups in both groups, significantly higher in the Study Group. In particular, abductor strength at 6 months post-op improved by 92.5{\%} with respect to 35.7{\%} in the Control Group.CONCLUSION: In addition to standard rehabilitation, a rehabilitation programme for strengthening the gluteal muscles in DDH patients who underwent THR determined an increase in muscle strength that improved functional performance and patient satisfaction.",
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T1 - Abductor muscle strengthening in THA patients operated with minimally invasive anterolateral approach for developmental hip dysplasia

AU - Benedetti, Maria Grazia

AU - Cavazzuti, Lorenzo

AU - Amabile, Marilina

AU - Tassinari, Enrico

AU - Valente, Giordano

AU - Zanotti, Gabriele

AU - Vaienti, Enrico

AU - Orsini, Stefania

AU - Mariani, Elisabetta

AU - Taddei, Fulvia

PY - 2019/9/22

Y1 - 2019/9/22

N2 - OBJECTIVE: In developmental hip dysplasia (DDH) patients, the chronic dislocation of the femoral head with respect to the true acetabulum determines muscle contracture and atrophy, particularly of the abductor muscles, and leads to secondary osteoarthritis (OA) with severe motor dysfunction, pain and disability. The correct positioning when a total hip replacement (THR) is performed is fundamental to the recovery of gait function. Also, inadequate rehabilitation of the abductor muscles for pelvic stabilisation can be responsible for residual dysfunction. Consensus on a programme for abductor muscle strengthening in these patients is not currently available. The aim of this study was to evaluate the effectiveness of a specific program of exercises for strengthening the abductor muscles in these patients.METHODS: A multicentre, prospective, randomised clinical trial was carried out in an outpatient rehabilitation setting on 103 patients given THR for DDH through a minimally invasive anterolateral approach. Patients were randomly divided into a Study Group, including 46 patients, and a Control Group, including 57 patients. All patients underwent standard early postoperative rehabilitation. In addition, the Study Group were given an extra 2-week rehabilitation once full weight-bearing on the operated limb was allowed, aimed at strengthening the abductor muscles. All patients were evaluated preoperatively, and at about 3 and 6 months postoperatively. Clinical measures (lower limb-length differences, hip range of motion, abductor muscle strength), and functional measures (WOMAC, HHS, 10mt WT, SF-12) were taken.RESULTS: Hip range of motion and functional outcome measures showed a progressive improvement at follow ups in both groups, significantly higher in the Study Group. In particular, abductor strength at 6 months post-op improved by 92.5% with respect to 35.7% in the Control Group.CONCLUSION: In addition to standard rehabilitation, a rehabilitation programme for strengthening the gluteal muscles in DDH patients who underwent THR determined an increase in muscle strength that improved functional performance and patient satisfaction.

AB - OBJECTIVE: In developmental hip dysplasia (DDH) patients, the chronic dislocation of the femoral head with respect to the true acetabulum determines muscle contracture and atrophy, particularly of the abductor muscles, and leads to secondary osteoarthritis (OA) with severe motor dysfunction, pain and disability. The correct positioning when a total hip replacement (THR) is performed is fundamental to the recovery of gait function. Also, inadequate rehabilitation of the abductor muscles for pelvic stabilisation can be responsible for residual dysfunction. Consensus on a programme for abductor muscle strengthening in these patients is not currently available. The aim of this study was to evaluate the effectiveness of a specific program of exercises for strengthening the abductor muscles in these patients.METHODS: A multicentre, prospective, randomised clinical trial was carried out in an outpatient rehabilitation setting on 103 patients given THR for DDH through a minimally invasive anterolateral approach. Patients were randomly divided into a Study Group, including 46 patients, and a Control Group, including 57 patients. All patients underwent standard early postoperative rehabilitation. In addition, the Study Group were given an extra 2-week rehabilitation once full weight-bearing on the operated limb was allowed, aimed at strengthening the abductor muscles. All patients were evaluated preoperatively, and at about 3 and 6 months postoperatively. Clinical measures (lower limb-length differences, hip range of motion, abductor muscle strength), and functional measures (WOMAC, HHS, 10mt WT, SF-12) were taken.RESULTS: Hip range of motion and functional outcome measures showed a progressive improvement at follow ups in both groups, significantly higher in the Study Group. In particular, abductor strength at 6 months post-op improved by 92.5% with respect to 35.7% in the Control Group.CONCLUSION: In addition to standard rehabilitation, a rehabilitation programme for strengthening the gluteal muscles in DDH patients who underwent THR determined an increase in muscle strength that improved functional performance and patient satisfaction.

KW - Developmental hip dysplasia

KW - gluteal muscle weakness

KW - outcome

KW - rehabilitation

KW - total hip replacement

U2 - 10.1177/1120700019877174

DO - 10.1177/1120700019877174

M3 - Article

C2 - 31544524

JO - HIP International

JF - HIP International

SN - 1120-7000

ER -