The influence of the crutch setup on stability and weight-bearing parameters in post total hip replacement surgery patients during quiet standing

Balance Remains Impaired after Hip Arthroplasty: A Systematic Review and Best Evidence Synthesis

Background: Hip arthroplasty (HA) is the most common intervention for joint replacement, but there is no consensus in the literature on the real influence of this procedure on balance, or on what factors in the pre-operative, surgical, and post-operative stages may affect it. Purpose: To synthesize the evidence on how Hip Arthroplasty (HA) affects balance, identifying pre-operative, surgical, and postoperative risk factors that may impair balance in HA patients, with the aim to improve patients’ management strategies. Methods: A literature search was performed on PubMed, PeDRO, and Cochrane Collaboration on 25 May 2021. Inclusion criteria: clinical report of any level of evidence; written in English; with no time limitation; about balance changes in hip osteoarthritis (OA) patients undergoing HA and related factors. Results: 27 papers (391 patients) were included. Overall, the evidence suggested that balance is impaired immediately after surgery and, 4–12 months after surgery, it becomes better than preoperatively, although without reaching the level of healthy subjects. A strong level of evidence was found for hip resurfacing resulting in better balance restoration than total HA (THA), and for strength and ROM exercises after surgery positively influencing balance. Conclusion: Both the surgical technique and the post-operative protocols are key factors influencing balance; thus, they should be carefully evaluated when managing hip OA in patients undergoing HA. Moreover, balance at 4–12 months after surgery is better than preoperatively, although without reaching the level of the healthy population. Attention should be paid in the early post-operative phase, when balance may be impaired in patients undergoing HA.

Balance and proprioception impairment, assessment tools, and rehabilitation training in patients with total hip arthroplasty: a systematic review

BACKGROUND

Osteoarthritis and subsequent total hip arthroplasty (THA) lead to damages to hip joint mechanoceptors, which in turns lead to impairments in proprioception. One of the abilities mainly affected by an altered joint proprioception is balance. The aim of this work was to investigate the balance and proprioception impairments, current assessment tools, and rehabilitation training after THA.

METHODS

A systematic literature revision was conducted on PubMed, Web of Science and Cochrane databases. Articles reporting balance and proprioception impairments, current assessment tools, or rehabilitation interventions were included. Methodological quality was assessed using the Downs and Black checklist. A total of 41 articles were included, 33 discussing balance and proprioception assessment, and 8 dealing with training. Data related to type of surgical approach, type and timing of assessment protocols, assessment instrumentation, and type, volume and duration of the rehabilitation training were extracted from each study.

RESULTS

Thirty-one studies were of high quality, 2 of moderate quality and 8 of low-quality. Literature review showed an improvement in balance following THA in comparison with the pre-operative performance, although balance abnormalities persist up to 5 years after surgery, with THA patients showing an increased risk for falls. Balance training is effective in all the rehabilitation phases if specifically structured for balance enhancement and consistent in training volume. It remains unclear which assessments are more appropriate for the different rehabilitation phases, and if differences exist between the different surgical procedures used for THA. Only two studies assessed proprioception.

CONCLUSION

Balance and proprioception show impairments up to 5 years after THA, increasing the risk of falls. However, patients with THA may benefit of an adequate balance training. Further research is needed to investigate the gaps in balance and proprioception assessment and training following THA surgery.