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Lalevée M, Martinez L, Rey B, Beldame J, Matsoukis J, Poirier T, Brunel H, Van Driessche S, Noé N, Billuart F. Gait analysis after total hip arthroplasty by direct minimally invasive anterolateral approach: A controlled study. Orthop Traumatol Surg Res 2023; 109:103521. [PMID: 36539033 DOI: 10.1016/j.otsr.2022.103521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/13/2022] [Accepted: 09/26/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Clinical and functional improvement after minimally invasive total hip arthroplasty (THA) has become increasingly controversial. The minimally invasive anterolateral approach (MIALA) allows rapid recovery resulting in a reduced need for rehabilitation. Alterations in muscle and static balance have previously been demonstrated. Results in the context of quantified gait analysis (QGA) and MIALA compared to an asymptomatic population remain unknown beyond one year postoperatively. Thus, the main objective of this controlled study was to compare the spatiotemporal parameters of gait, obtained using a QGA, beyond one year postoperatively in subjects operated on for THA by MIALA, with a group of asymptomatic subjects of the same age. The secondary objectives of the study were to compare the other QGA and EMG data acquired in operated subjects with asymptomatic subjects. HYPOTHESIS We hypothesized that QGA and EMG parameters would not normalize beyond one year postoperatively. PATIENTS AND METHODS Thirty-one subjects were recruited, including 16 patients (68 years old; IQR: 65-70) who underwent MIALA, at 15.5 months postoperatively (IQR: 13-17) and 15 asymptomatic subjects (62 years old; IQR: 61-71). Subjects underwent QGA and maximal isometric muscle force tests on the gluteus medius, gluteus maximus, Tensor Fascia Lata (TFL) and Sartorius muscles. Spatiotemporal gait parameters were the primary endpoint. The other QGA parameters: kinetics (characteristic values of vertical ground reaction forces, peak hip moments) and kinematics (hip joint amplitudes and pelvic mobility in the frontal and sagittal plane) constituted the secondary criteria. RESULTS Five subjects were excluded for unrestored offset. Walking speed was lower in operated patients (1.03m/s versus 1.18m/s, p=0.005). Maximal isometric muscle force moments were lower in patients operated on for the gluteus maximus and medius as well as the TFL (p<0.005). The vertical ground reaction forces were lower for the operated patients for the loading phase (FzFCmax, p=0.001), the single stance phase (FzSPmin, p=5.05.10-2) and the swing phase (FzTOmax, p=0.0002). The moments were lower in the sagittal plane for the operated patients (0.6N.m for the operated versus 1.1N.m for the asymptomatic, p=0.02). The pelvic amplitudes in the sagittal plane were lower for operated patients (3.3° versus 7.2°, p=0.05). DISCUSSION Our hypothesis appears to be validated. Gait deficits persisted beyond one year postoperatively after THA with MIALA. A decrease in walking speed, maximal isometric muscle force of the gluteus medius and gluteus maximus and TFL was observed, as well as a decrease in propulsive force and peak hip moment. Functionally, these results could signify muscle damage following surgery, requiring rehabilitation for improved muscle function. LEVEL OF PROOF III: Non-randomized controlled trial.
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Affiliation(s)
- Matthieu Lalevée
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Service de chirurgie orthopédique et traumatologique, Centre Hospitalier Universitaire de Rouen, 76000 Rouen, France
| | - Lucas Martinez
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de Recherche ERPHAN, UR 20201, UVSQ, France
| | - Benjamin Rey
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Julien Beldame
- Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de chirurgie orthopédique, Groupe Hospitalier du Havre, BP24, 76083, Le Havre cedex, France
| | - Thomas Poirier
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Stéphane Van Driessche
- Polyclinique Sainte-Marguerite, 5, avenue de la Font Sainte-Marguerite, 89000 Auxerre, France
| | - Nathalie Noé
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France
| | - Fabien Billuart
- Laboratoire d'analyse du mouvement, Institut de Formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France; Unité de Recherche ERPHAN, UR 20201, UVSQ, France; Université de Paris-Saclay, UFR Simone Veil-Santé, 2, avenue de la Source de la Bièvre, 78180 Montigny-le-Bretonneux, France.
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