Muscle weakness in hip osteoarthritis: A systematic review

Unilateral hip osteoarthritis: Its effects on preoperative lower limb muscle activation and intramuscular coordination patterns

The objective of this study was to test if patients with unilateral hip osteoarthritis (OA) show greater muscle activity asymmetry between their affected and non-affected limbs than healthy controls between their left and right limbs. Seventeen patients with unilateral hip OA (7 females, 10 males) and 17 age-matched healthy controls (7 females, 10 males) participated in this study. Both groups performed instrumented gait analysis at comparable speeds. Muscle activity was recorded simultaneously for the tibialis anterior (TA), gastrocnemius medialis (GM), vastus lateralis (VL), semitendinosus (ST), tensor fasciae latae (TFL), and gluteus medius (GLM) muscles. In hip OA patients, EMG data showed greater activity of the TA muscle in the non-affected limb, and greater TFL muscle activity in the affected limb. Compared to healthy controls, greater asymmetries between paired limbs were observed for the TA and GM muscles. Finally, the TFL muscle of the affected limb contributed more to the total limb muscle activity than did the non-affected limb. The observed alterations in TA and GM muscle activity in hip OA patients may be due to the greater peak braking and peak vertical forces measured in the non-affected limb. Contrary to this, greater TLF muscle activity of the affected limb indicates the demands put on stabilizing the hip during stance phase. Further studies are necessary to test whether leg length discrepancy affects muscle activation alterations between the affected and non-affected limb in unilateral hip OA patients.

A cycling and education programme for the treatment of hip osteoarthritis: a quality improvement study

Osteoarthritis of the hip is associated with pain, stiffness and limitations to activities of daily living. The aims of this quality improvement project were to introduce a service developed to promote the self-management of hip osteoarthritis through exercise and education and to assess the impact of the programme on pain, function and quality of life. The service was a six-week cycling and education programme and 119 participants took part. Statistically significant improvements were found for Oxford Hip Scores (Mean (SD) change 4.14, 95%, CI 3.02, 5.25, p < 0.001); Sit-to-stand scores (mean change 3.06, 95%, CI 2.33, 3.79, p < 0.001); EQ5D-5L Utility (mean change 0.06, 95%, CI 0.03, 0.09, p < 0.001); EQ5D VAS (mean change 7.05, 95%, CI 4.72, 9.39, p < 0.001); pain on weight-bearing (WB) (mean change 1.56, 95%, CI 0.77, 2.36, p < 0.001), HOOS function (median change (IQR) 7.35, 1.84 to 19.12, p < 0.001) and TUG test (median change 1.11, 0.31 to 2.43, p < 0.001). Participants reported improvements in pain and function; increased confidence in managing hip pain and an increase in motivation to exercise. These findings were supported by a patient and public involvement forum who suggested extending the programme to eight weeks. These results suggest that the service has potential in the management of hip osteoarthritis.

Preoperative progressive explosive-type resistance training is feasible and effective in patients with hip osteoarthritis scheduled for total hip arthroplasty--a randomized controlled trial

OBJECTIVE

To investigate the efficacy and feasibility of progressive explosive-type resistance training (RT) in patients with osteoarthritis (OA) of the hip scheduled for total hip arthroplasty (THA).

METHOD

Randomized controlled trial (1:1) in patients diagnosed with hip OA and scheduled for THA. The intervention group (IG) performed supervised preoperative progressive explosive-type RT twice a week for 10 weeks; four exercises (hip/thigh) performed in three series each (8-12 repetition maximum). The control group (CG) received 'care as usual'. Efficacy was reported as the between-group difference in the Hip Osteoarthritis Outcome Score (HOOS) (primary endpoint; ADL function), and leg muscle power at post intervention follow-up immediate before surgery. Intention-to-treat analyses were performed in a multilevel regression model adjusting for baseline, sex, age and weight. Feasibility was reported as adherence, exercise related pain and adverse effects. Post-surgical follow up will be reported separately. ClinicalTrials.gov registration: NCT01164111.

RESULTS

Eighty patients (age 70.4 ± 7.6 years, BMI 27.8 ± 4.6, 52 females (65%) were included. Adherence was high (93%) with acceptable exercise related pain (VAS score ≤ 5) reported in 83% of sessions and no adverse events. Changes in HOOS 'function' was 10.0 points 95%CI [4.7; 15.3] higher in IG compared to CG (P < 0.001). For all the remaining HOOS subscales IG scored significantly better (P < 0.03) and had higher leg extension muscle power (P < 0.0001) compared to CG.

CONCLUSION

Progressive explosive-type RT was feasible in the included group of hip OA patients scheduled for THA and resulted in significant improvement in self-reported outcomes and increased leg muscle power.

Hip Strength Deficits in Patients With Symptomatic Femoroacetabular Impingement and Labral Tears

PURPOSE

To determine the prevalence of hip strength deficits in a consecutive cohort of patients with unilateral femoroacetabular impingement (FAI) compared with the asymptomatic contralateral hip.

METHODS

Fifty consecutive patients undergoing hip arthroscopy for symptomatic FAI underwent preoperative hip strength dynamometer measurements and were included in the study. Manual isometric hip strength measurements were performed with a handheld dynamometer and included measurements of various hip strengths (flexion, extension, adduction, abduction, internal rotation, and external rotation). Weakness greater than or equal to 10% for any given measurement was defined as a strength deficit in this study. Clinical data including age, gender, size of labral tear, and preoperative outcome scores were recorded. Outcome scores included the modified Harris Hip Score and Short Form 12 Physical Component.

RESULTS

The mean age of patients in the study was 32.0 years (range, 18.1 to 49.8 years). There were 32 male and 18 female patients. Hip abduction strength deficits were seen in 46% of patients and flexion strength deficits in 42% of patients. An 8% decrease in strength of the involved hip was seen in flexion, and an 8.7% decrease was seen in abduction. Patients with hip flexion strength deficits had a loss of function (mean modified Harris Hip Score, 57.8 v 66.1; P = .021) and larger labral tears (mean, 39 mm v 28 mm; P = .003). Hip flexion strength deficits correlated with loss of hip flexion (r = 0.373, P = .008).

CONCLUSIONS

Hip strength deficits were common in patients presenting with unilateral symptomatic FAI and occurred most commonly in hip abduction and flexion. Strength deficits in hip flexion were associated with decreased function, loss of motion, and larger labral tears in patients with FAI and labral tears.

LEVEL OF EVIDENCE

Level IV, prognostic case series.

Relationship between strength, pain, and different measures of functional ability in patients with end-stage hip osteoarthritis

OBJECTIVE

Performance tests and self-reported questionnaires capture different domains of function in patients with lower extremity osteoarthritis, but the impairments related to each of these domains have not been elucidated. The purpose of this study was to determine how strength and joint pain influence performance-based tests and self-reported questionnaires of functional ability of individuals with end-stage hip osteoarthritis.

METHODS

Fifty-six patients scheduled to undergo unilateral total hip arthroplasty were included in this cross-sectional analysis. Subjects completed the Hip Outcome Survey (HOS) and pain in the affected hip was quantified on a scale from 0-10. Performance-based tests included the Six-Minute Walk Test (6MWT), the Timed Up & Go (TUG), and the Stair Climbing Test (SCT). Isometric strength of the hip abductors and knee extensors was tested and recorded. Hierarchical linear regressions were created to determine the contributions of pain, knee extensor strength, and hip strength for each outcome measure (TUG, 6MWT, SCT, and HOS). Height and body mass index were entered first, followed by pain, then knee extensor strength, and then hip abduction strength.

RESULTS

Greater pain significantly predicted lower HOS scores, but hip strength did not significantly improve the model. Hip pain was also significantly related to TUG, SCT, and 6MWT values, but hip and knee strength explained additional variance for these performance-based measures.

CONCLUSION

Self-report and performance-based measures capture different aspects of disability and are influenced by different underlying impairments. Both types of outcome measures should be used in studies that evaluate functional changes in patients with hip osteoarthritis.

Persons with chronic hip joint pain exhibit reduced hip muscle strength

STUDY DESIGN

Controlled laboratory cross-sectional study. Objectives To assess strength differences of the hip rotator and abductor muscle groups in young adults with chronic hip joint pain (CHJP) and asymptomatic controls. A secondary objective was to determine if strength in the uninvolved hip of those with unilateral CHJP differs from that in asymptomatic controls.

BACKGROUND

Little is known about the relationship between hip muscle strength and CHJP in young adults.

METHODS

Thirty-five participants with CHJP and 35 matched controls (18 to 40 years of age) participated. Using handheld dynamometry, strength of the hip external rotators and internal rotators was assessed with the hip flexed to 90° and 0°. To assess external rotator and internal rotator strength, the hip was placed at the end range of external rotation and internal rotation, respectively. Strength of the hip abductors was assessed in sidelying, with the hip in 15° of abduction. Break tests were performed to determine maximum muscle force, and the average torque was calculated using the corresponding moment arm. Independent-sample t tests were used to compare strength values between (1) the involved limb in participants with CHJP and the corresponding limb in the matched controls, and (2) the uninvolved limb in participants with unilateral CHJP and the corresponding limb in the matched controls.

RESULTS

Compared to controls, participants with CHJP demonstrated weakness of 16% to 28% (P<.01) in all muscle groups tested in the involved hip. The uninvolved hip of 22 subjects with unilateral CHJP demonstrated weakness of 18% and 16% (P<.05) in the external rotators (0°) and abductors, respectively, when compared to the corresponding limb of the matched controls.

CONCLUSION

The results of the present study demonstrate that persons with CHJP have weakness in the hip rotator and hip abductor muscles. Weakness also was found in the uninvolved hip of persons with CHJP.

Efficacy of rehabilitation programs for improving muscle strength in people with hip or knee osteoarthritis: a systematic review with meta-analysis

To analyse the effect of exercise-based rehabilitation programs for improving lower limb muscle strength in individuals with hip or knee osteoarthritis (OA). A systematic search utilizing seven databases identified randomized controlled trials (RCTs) evaluating lower limb strength outcomes of exercise-based interventions for participants with hip or knee OA. All studies were screened for eligibility and methodological quality. Quality of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Data were pooled and meta-analyses performed where appropriate. Forty RCTs were included and the majority (77%) involved resistance based exercise programs. For knee OA populations, there was high quality evidence for improved knee extension (standardized mean difference (SMD) = 0.47, 95% confidence intervals (CI) 0.29, 0.66) and flexion strength (SMD = 0.74, 95% CI 0.56, 0.92) with low-intensity resistance program when compared to a control at short term (ST) follow-up. There was moderate quality evidence for a large effect favouring high-intensity resistance programs (SMD = 0.76, 95% CI 0.47, 1.06) when compared to a control. This effect was sustained at intermediate term (IT) follow-up (SMD = 0.80, 95% CI 0.44, 1.17). Few studies reported on outcomes at long term (LT) follow-up. Only one study reported on a population with hip OA. When compared to a control group, high-intensity resistance exercise demonstrated moderate quality of evidence for large and sustained improvements for knee muscle strength in knee OA patients. Further work is needed to compare different modes of exercise at a LT follow-up for knee OA patients and to address the dearth of literature evaluating exercise interventions in people with hip OA.

Interrater and intrarater reliability of common clinical standing balance tests for people with hip osteoarthritis

BACKGROUND

Hip osteoarthritis (OA) is a common musculoskeletal condition affecting older individuals. Clinical balance tests are frequently used to assess standing balance in these people. There is insufficient information regarding the reliability of these tests.

OBJECTIVE

The aim of this study was to estimate reliability and measurement error of 4 common clinical standing balance tests in people with hip OA.

DESIGN

A prospective study was conducted with repeated measures between 2 independent raters within 1 session and within 1 rater over a 1-week interval.

METHODS

Thirty people with hip OA were evaluated. Reliability was estimated for the Four-Square Step Test, Step Test, Functional Reach Test, and Timed Single-Leg Stance Test using intraclass correlation coefficients (ICC [2,1]). Measurement error was expressed as standard error of measurement and minimal detectable change.

RESULTS

The Four-Square Step Test, Step Test, and Timed Single-Leg Stance Test were sufficiently reliable between raters (ICC=.85-.94, lower 1-sided 95% confidence interval [95% CI]=.71-.89), whereas the Step Test (standing on study limb) and Timed Single-Leg Stance Test (standing on nonstudy limb) were sufficiently reliable within a rater over a 1-week interval (ICC=.91, lower 1-sided 95% CI=.80-.83). The Step Test (standing on study limb) and Timed Single-Leg Stance Test (standing on nonstudy limb) achieved optimal levels of reliability (ICC >.90, lower 1-sided 95% CI >.70), with acceptable measurement error (<10%) for clinical outcome measures. The Functional Reach Test was not sufficiently reliable. A ceiling effect was detected for the Timed Single-Leg Stance Test.

LIMITATIONS

Reliability was assessed only between 2 raters during a single session and within 1 rater over a 1-week interval, which limits generalizability.

CONCLUSIONS

The Step Test (standing on study limb) is recommended as a highly reliable test with acceptable measurement error for assessing standing balance in people with hip OA.

Development of a valid simplified Chinese version of the Oxford Hip Score in patients with hip osteoarthritis

BACKGROUND

Although the Oxford Hip Score has been translated and validated in several languages, there is currently no Chinese version of the outcomes measurement. Our study aims to crossculturally adapt and validate the Oxford Hip Score into a simplified Chinese version.

QUESTIONS/PURPOSES

We tested the (1) reliability; (2) validity; and (3) responsiveness of the Chinese version of the Oxford Hip Score.

METHODS

First we translated the Oxford Hip Score into simplified Chinese, then back into English, then held a consensus meeting to achieve the final simplified Chinese version. Then we evaluated the psychometric properties of Chinese version of the Oxford Hip Score in patients undergoing total hip arthroplasty (THA). All patients undergoing THA between July and December 2012 were invited to participate in this study; a total of 108 (79% of 136 invited) did so. To assess the test-retest validity, all participants completed the Chinese version of the Oxford Hip Score again with a 2-week interval. Pearson correlation coefficient was used to evaluate the construct validity between the Chinese version of the Oxford Hip Score and visual analog scale (VAS), Harris hip score, and eight individual domains of the SF-36. Responsiveness was demonstrated by comparing the pre- and postoperative scores of the Chinese version of the Oxford Hip Score.

RESULTS

The test-retest reliability with intraclass correlation coefficient (0.937) and internal consistency with Cronbach's alpha (0.91) were excellent. The Chinese version of the Oxford Hip Score correlated with the Harris hip score (0.89, p < 0.01), VAS (-0.79, p < 0.01), and Physical Functioning (0.79, p < 0.01) and Bodily Pain (0.70, p < 0.01) domains of SF-36, which suggested construct validity. No floor or ceiling effects were found. The effect size and standardized response mean values were 3.52 and 3.31, respectively, indicating good responsiveness.

CONCLUSIONS

The Chinese version of the Oxford Hip Score showed good reliability, validity, and responsiveness in evaluating standard Chinese-speaking patients with hip osteoarthritis undergoing THA. It can be used by clinical surgeons as a complement to the traditional outcome measures.

Spatial-temporal gait characteristics in individuals with hip osteoarthritis: a systematic literature review and meta-analysis

STUDY DESIGN

Systematic literature review and meta-analysis.

OBJECTIVE

To systematically review and critically evaluate the literature to determine how basic gait characteristics are altered in individuals with hip osteoarthritis (OA).

BACKGROUND

Hip OA is a progressive musculoskeletal condition that leads to pain, stiffness, and functional limitation in activities such as walking. Understanding gait dysfunction in people with hip OA may contribute to more effective management of the disease.

METHODS

Eleven electronic research databases were searched. Studies comparing basic gait parameters in individuals with hip OA to healthy controls and the affected to the contralateral limb of individuals with hip OA were included. The studies were critically appraised for methodological quality. Available data were extracted, and meta-analysis was performed, with standardized effect sizes (Cohen d) and corresponding 95% confidence intervals computed for gait speed, cadence, step and stride length, stance, swing and double-stance duration, and step width.

RESULTS

The final analysis included 30 articles. Self-selected gait speed was 26% slower in individuals with hip OA relative to controls, which was explained by shorter stride length. Consistent evidence was found for greater asymmetry in individuals with hip OA than controls, with shorter step length and stance duration in the affected compared to the contralateral limb.

CONCLUSION

Individuals with hip OA walk at a slower speed and exhibit greater gait asymmetry than controls. Gait speed and asymmetry can be readily assessed clinically and represent a simple way of objectively evaluating gait dysfunction and monitoring treatment progress in individuals with hip OA.

Bearing arms against osteoarthritis and sarcopenia: when cartilage and skeletal muscle find common interest in talking together

Osteoarthritis, a disease characterized by cartilage degradation, abnormal subchondral bone remodelling and some grade of inflammation, and sarcopenia, a condition of pathological muscle weakness associated with altered muscle mass, strength, and function, are prevalent disorders in elderly people. There is increasing evidence that decline in lower limb muscle strength is associated with knee or hip osteoarthritis in a context of pain, altered joint stability, maladapted postures and defective neuromuscular communication. At the cellular and molecular levels, chondrocytes and myoblasts share common pathological targets and pathways, and the close anatomical location of both cell types suggest a possibility of paracrine communication. In this review, we examine the relationship between osteoarthritis and sarcopenia in the musculoskeletal field, and discuss the potential advantage of concomitant therapies, or how each disorder may benefit from treatment of the other.