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Minimizing Preoperative and Postoperative Limping in Patients After Total Hip Arthroplasty: Relevance of Hip Muscle Strength and Endurance

Horstmann, Thomas MD; Listringhaus, Rico MD; Brauner, Torsten PhD; Grau, Stefan PhD; Mündermann, Annegret PhD

American Journal of Physical Medicine & Rehabilitation: December 2013 - Volume 92 - Issue 12 - p 1060–1069
doi: 10.1097/PHM.0b013e3182970fc4
Original Research Articles

Objective: The aim of this study was to test the hypothesis that hip muscle function (strength and endurance) improves after total hip arthroplasty and is important for minimizing limping gait.

Design: Fifty-two patients who underwent total hip arthroplasty were assessed before and 6 mos after receiving a unilateral total hip endoprosthesis (Adaptiva stem with a Harris-Galante acetabular component). Severity of limping was assessed using a 4-point ordinal scale. Pain was assessed using a standardized ordinal scale. Eccentric, concentric, and isometric muscle strength and endurance of the hip extensors, flexors, adductors, and abductors were measured using a dynamometer.

Results: Postoperative limping severity and pain were significantly lower and postoperative muscle strength and endurance were significantly higher than the preoperative values (P < 0.05). The association between impaired muscle strength and endurance and limping severity was stronger postoperatively than preoperatively. This association was stronger for the hip extensor and flexor muscles than for the hip adductor and abductor muscles. Pain level was not associated with postoperative limping severity.

Conclusions: Hip extensor and flexor muscle strength and endurance seem to be relevant for minimizing postoperative limping in patients after total hip arthroplasty. Rehabilitation programs should include exercises aimed at improving hip extensor and flexor strength and endurance to improve gait function.

From the Medical Park Bad Wiessee St. Hubertus, Bad Wiessee, Germany (TH); Faculty for Sport and Health Sciences, Technical University of Munich, Munich, Germany (TH, TB); Center for Orthopedics and Traumatology, St. Anna Hospital, Herne, Germany (RL); Department of Sports Medicine, Medical Clinic, University of Tübingen, Tübingen, Germany (SG); Division of Sport Science, University of Konstanz, Konstanz, Germany (AM); and Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland (AM).

All correspondence and requests for reprints should be addressed to: Thomas Horstmann, MD, Medical Park Bad Wiessee GmbH u. Co. St. Hubertus, Sonnenfeldweg 29, 83707 Bad Wiessee, Germany.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2013 by Lippincott Williams & Wilkins