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Ninomiya K, Takahira N, Ikeda T, Suzuki K, Sato R, Mihara M. Effects of perioperative exercise therapy combined with nutritional supplementation on functional recovery after fast-track total hip arthroplasty. J Orthop Sci 2023; 28:1291-1297. [PMID: 36272926 DOI: 10.1016/j.jos.2022.09.012] [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: 02/06/2022] [Revised: 08/23/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The combination of exercise therapy combined with nutritional supplementation (Nutr) is widely used for frail or sarcopenic older persons. However, the effects of Nutr in elderly patients after fast-track total hip arthroplasty (THA) are unknown. This study examined the effects of perioperative Nutr on muscle strength, functional performance, and quality of life (QOL) in frail elderly women after fast-track THA. METHODS A total of 58 frail elderly women aged 65-80 years scheduled for unilateral primary THA were randomly allocated to two groups: the physical exercise (Ex) combined with Nutr (Ex + Nutr; n = 29) group, and the Ex alone (Ex; n = 29) group. Protein and vitamin D supplements were provided daily from 4 weeks preoperatively to 8 weeks postoperatively (12 weeks) to the patients in the Ex + Nutr group, whereas the Ex group did not receive any supplements. Surgery and postoperative rehabilitation programmes during intervention were identical in both groups. Hip abductor and knee extensor muscle strength, functional performance (Timed Up & Go test, Harris Hip Score), and QOL (Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire) were assessed at baseline and at 12 weeks (8 weeks postoperatively). RESULTS After the intervention, hip abductor muscle strength on the contralateral leg and knee extensor muscle strength on both sides significantly improved in the Ex + Nutr group compared to the Ex group (p = 0.03, 0.01, and 0.01, respectively). However, hip abductor muscle strength on the operated side did not differ significantly between the groups (p = 0.23). There were no significant differences in functional performance and QOL. CONCLUSION Ex + Nutr does not have an additional effect on the improvement of hip abductor strength, functional performance, and QOL compared to Ex alone after fast-track THA. However, significant improvements were observed in the strength of some muscles after fast-track THA. TRIAL REGISTRATION UMIN 000042964. THE IRB APPROVAL This study was approved by the Mirai Iryo Reesearch Center (approval number TGE1602-115).
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Affiliation(s)
- Kazunari Ninomiya
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan.
| | - Naonobu Takahira
- Department of Orthopaedic Surgery of Clinical Medicine, Rehabilitation Sciences and Functional Restoration, Science of Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Takashi Ikeda
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan; School of Nursing and Rehabilitation Sciences, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Koji Suzuki
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan
| | - Ryoji Sato
- Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan
| | - Masahiko Mihara
- Department of Orthopaedic Surgery, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan
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Wongsak S, Jarungvittayakon C, Chulsomlee K, Jaovisidha S, Sa-ngasoongsong P. Abductor muscle function after anterolateral approach in patients with unilateral end-stage hip osteoarthritis undergoing total hip arthroplasty: A prospective study. Front Surg 2023; 10:1134355. [PMID: 37035573 PMCID: PMC10079918 DOI: 10.3389/fsurg.2023.1134355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Background Total hip arthroplasty (THA) is a successful procedure for treating end-stage hip osteoarthritis (OA). Regarding the surgical approach for THA, the anterolateral (AL) approach, which requires anterior hemimyotomy of the gluteus medius muscle, has shown a long-term favorable outcome. However, to date, complete information related to hip abductor muscle outcomes after the AL approach is unavailable. This study therefore aimed to evaluate the postoperative outcome of patients who undergo THA using the AL approach in terms of hip abductor muscle recovery, pain, function, and muscle healing status. Methods Twenty patients diagnosed with unilateral end-stage hip OA underwent cementless THA with the AL approach. All patient procedures were performed by a single surgeon. Preoperative and postoperative data were collected at 2-week, 6-week, 3-month, and 6-month follow-up periods. Hip abductor muscle power was measured via handheld dynamometer. The healing of the musculotendinous repair was evaluated with magnetic resonance imaging at 9 months. Results After THA, hip abductor muscle power in the operated hip significantly increased as early as 3 months post-procedure when compared with the preoperative value (p < 0.05). The other parameters-including pain score, Harris hip score, and WOMAC score-significantly improved as early as 2 weeks post-operation (p < 0.05). In all patients, MRI scans showed good healing of the muscle repair site without a gap in the gluteus medius muscle. However, three patients (15%) had some fibrosis and tendon swelling at the repair site. Conclusion This study demonstrated that patients with end-stage hip OA could experience significantly improved hip abductor motor function as early as 3 months after undergoing THA with the AL approach. Moreover, despite patients experiencing anterior hemimyotomy of the gluteus medius muscle, no significant complications emerged at the muscle repair site in the AL approach.
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Affiliation(s)
- Siwadol Wongsak
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chavarat Jarungvittayakon
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Chavarat Jarungvittayakon
| | - Kulapat Chulsomlee
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphaneewan Jaovisidha
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paphon Sa-ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Sekita J, Takahira N, Iwamura G, Watanabe H, Kusaba A, Kondo S. A predictive model for hip abductor strength and knee extensor strength 12 months after total hip arthroplasty with an interaction term. BMC Musculoskelet Disord 2021; 22:827. [PMID: 34579703 PMCID: PMC8474772 DOI: 10.1186/s12891-021-04719-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/11/2021] [Indexed: 12/25/2022] Open
Abstract
Background Identifying populations with poor muscle recovery after total hip arthroplasty (THA) is important for postoperative physical therapy. Preoperative muscle strength is a strong factor that determines postoperative muscle strength. However, this effect may depend on other factors. Thus, predictive models with interaction terms are important for accurately predicting postoperative muscle strength. This study aimed to develop a predictive model for lower muscle strength 12 months after THA which incorporates interaction terms. Methods Subjects were female patients with hip osteoarthritis who underwent unilateral THA. Patients with locomotor disorders, neurological disorders, or postoperative complications were excluded. Hip abductor and knee extensor strength were measured, and a generalized linear model approach with preoperative muscle strength, age, body weight, height, disease duration, physical activity, and leg extension as explanatory variables was used to identify factors that determine muscle strength 12 months after THA. Models with interaction terms between preoperative muscle strength and other explanatory variables were also examined. Results A total of 82 patients were analyzed. Preoperative muscle strength, age, body weight, physical activity, and disease duration were extracted as factors that significantly and independently determine hip abductor and knee extensor strength. The interaction term between preoperative muscle strength and age was identified as a factor that significantly determines knee extensor strength. Regression coefficients for preoperative knee extensor strength and postoperative muscle strength were significant when age was +1 SD, but not when age was -1 SD. Conclusions The predictive model demonstrated that lower muscle strength 12 months after THA is determined by preoperative muscle strength, age, weight, physical activity, disease duration, and preoperative muscle strength, with the effect of preoperative muscle strength on knee extensor strength being dependent on age. When predicting postoperative knee extensor strength using preoperative muscle strength, it is important to consider the effect of age.
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Affiliation(s)
- Junya Sekita
- Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-shi, Kanagawa, 252-0373, Japan.,Department of Rehabilitation, Zama General Hospital, 1-50-1 Soubudai, Zama-shi, Kanagawa, 252-0011, Japan
| | - Naonobu Takahira
- Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-shi, Kanagawa, 252-0373, Japan. .,Department of Orthopaedic Surgery, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara-shi, Kanagawa, 252-0373, Japan. .,Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-shi, Kanagawa, 252-0373, Japan.
| | - Genki Iwamura
- Department of Rehabilitation, Zama General Hospital, 1-50-1 Soubudai, Zama-shi, Kanagawa, 252-0011, Japan
| | - Hiroyuki Watanabe
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara-shi, Kanagawa, 252-0373, Japan
| | - Atsushi Kusaba
- Institute of Joint Replacement and Rheumatology, Zama General Hospital, 1-50-1 Soubudai, Zama-shi, Kanagawa, 252-0011, Japan
| | - Saiji Kondo
- Institute of Joint Replacement and Rheumatology, Zama General Hospital, 1-50-1 Soubudai, Zama-shi, Kanagawa, 252-0011, Japan
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Ninomiya K, Takahira N, Ikeda T, Suzuki K, Sato R, Hirakawa K. Predictors of falls in patients during the first year after total hip arthroplasty: A prospective cohort study. Health Sci Rep 2020; 3:e184. [PMID: 32832704 PMCID: PMC7436168 DOI: 10.1002/hsr2.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/18/2020] [Accepted: 07/09/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Since falls after total hip arthroplasty (THA) cause severe complications such as dislocation and fractures around the femoral stem, it is important to investigate what factors predict of falls. Thus, investigating predictors of falls in patients waiting for THA would be valuable as it lead to more strategic interventions to prevent these problems. The purpose of this study was to evaluate the predictors of falls in patients during the first year after THA. METHODS This is a prospective cohort study. A total of 157 patients who underwent THA for unilateral hip osteoarthritis were analyzed. The incidence of falls during the first year after THA was monitored, and patients were classified into a "faller" and "non-faller" group. The following factors were compared between the two groups: demographic data (age, sex, body mass index, leg length discrepancy, length of hospital stay, and history of falling), preoperative hip abductor muscle strength, functional performance (single leg stance and maximum walking speed), pain during walking, and physical activity. RESULTS On multivariate logistic regression analysis, preoperative hip abductor muscle strength on the affected side and a history of falling were predictors of falls during the first year after THA. On subsequent receiver operating characteristic curve analysis, preoperative hip abductor muscle strength on the affected side was retained as a significant predictor, with a cut-off strength of 0.46 Nm/kg differentiating the faller and non-faller groups with a specificity of 73.6%, specificity of 50.0%, and area under the curve of 70.2%. CONCLUSIONS Finding from the present study suggested that clinicians should focus on low preoperative hip abductor muscle strength on the affected side and a history of falling to prevent falls during the first year after THA.
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Affiliation(s)
- Kazunari Ninomiya
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
- Sensory and Motor ControlKitasato University Graduate School of Medical SciensesSagamiharaKanagawaJapan
| | - Naonobu Takahira
- Sensory and Motor ControlKitasato University Graduate School of Medical SciensesSagamiharaKanagawaJapan
- Department of RehabilitationSchool of Allied Health Sciences, Kitasato UniversitySagamiharaKanagawaJapan
| | - Takashi Ikeda
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
- Department of Nursing and Rehabilitation SciencesShowa UniversityTokyoJapan
| | - Koji Suzuki
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
| | - Ryoji Sato
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
| | - Kazuo Hirakawa
- Department of RehabilitationShonan Kamakura Joint Reconstruction CenterKamakuraKanagawaJapan
- Department of Orthopaedic SurgeryShonan Kamakura Joint Reconstruction Center, KamakuraKanagawaJapan
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Ninomiya K, Hirakawa K, Ikeda T, Nakura N, Suzuki K. Patients 10 years after total hip arthroplasty have the deficits in functional performance, physical activity, and high fall rate compared to healthy adults. Phys Ther Res 2018; 21:53-58. [PMID: 30697510 DOI: 10.1298/ptr.e9941] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 08/07/2018] [Indexed: 12/23/2022]
Abstract
Background Long-term results in muscle strength, physical activity (PA), and functional improvement after total hip arthroplasty (THA) have not been studied. The purpose of this study was to evaluate the deficits in functional performance, PA, and high fall rate in patient 10 years after THA compared to healthy adults. Methods The subjects were 58 patients who underwent primary THA for unilateral hip osteoarthritis 10 years, and 46 healthy adults. Hip abductor strength, balance function (single-leg stance time), Maximal Walking Speed (MWS), fall rate, and PA (IPAQ short ver.) were evaluated. The unpaired t-test and χ2 test were used to assess differences between the groups. Statistical significance was set at p value <0.05. Results Compared to healthy adults, THA patients had 9.5% less hip abductor muscle strength on the operated side, 42.1% shorter single-leg stance time on the operated side, 14.8% slower MWS, 2.0 times less High-PA group, and 2.8 times higher fall rate (p<0.05). Conclusion This study showed that hip abductor muscle strength, gait speed, balance function, and PA were significantly lower in patients 10 years after THA than in healthy adults. Additionally, the fall rate was significantly higher in patients 10 years post-THA than in healthy adults.
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Affiliation(s)
| | | | - Takashi Ikeda
- Showa University Department of Nursing and Rehabilitation Sciences
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