Effect of percutaneous assisted approach on functional rehabilitation for total hip replacement compared to anterolateral approach: study protocol for a randomized controlled trial (original) (raw)
Related papers
Physiotherapy Practice and Research, 2015
BACKGROUND: Prolonged physical impairments are often reported post total hip replacement (THR). It is unclear which exercises should be performed to maximise rehabilitation following surgery. PURPOSE: The aim of this pilot study was to describe a method of imaging the relaxed posterior gluteus medius muscle in patients following surgery, and to measure the secondary outcome of relaxed muscle thickness of the posterior gluteus medius on the side of their THR following a rehabilitation intervention in this patient group. METHOD: This was a randomised controlled pilot study investigating the effect of functional exercise on the relaxed muscle thickness of the posterior gluteus medius as measured by real-time ultrasound. 57 patients were randomised to either a functional exercise class or usual care group. Real time ultrasound scanning of the posterior gluteus medius muscle were undertaken in both groups at baseline (week 12) and post intervention (week 18). RESULTS: There was no significant difference found in the size of the posterior gluteus medius between the intervention and control groups over the six week period of intervention. There was a statistically significant increase in the size of the posterior gluteus medius muscle at three points with a mean difference of 0.78 (95% CI 0.53-1.03), 1.05 (95% CI 0.67-1.43), 1.01 (95% CI 0.56-1.5) on the operated side in both groups over the six week period (p < 0.000). CONCLUSION: The thickness of the posterior gluteus medius on the operated side increased over a six week period from week 12 to week 18 post THR. There was no difference found in the thickness of the posterior gluteus medius in those attending a functional exercise class twice weekly and those receiving usual care.
Journal of Arthroplasty, 2008
Purported advantages of total hip arthroplasty performed with minimally invasive surgical (MIS) approaches are less muscle damage and faster recovery. There are little data scientifically evaluating these claims. Twenty-four consecutive hips were randomized to total hip arthroplasty through 1 of 3 MIS approaches (2-incision, mini-posterior, and mini-anterolateral). Each patient underwent preoperative and postoperative gait analysis. Gait parameters included vertical ground reaction force, velocity, single-leg stance time, limb-loading rate, and abductor torque. All 3 groups demonstrated overall improvements in gait parameters at 6 weeks postoperatively. The anterolateral approach patients showed a decrease in the vertical ground reaction force at mid-stance, whereas the 2-incision and posterior approaches demonstrated no significant change. These results fail to demonstrate any significant advantage of the 2-incision approach over the posterior approach in kinetic gait parameters. Furthermore, the anterolateral approach demonstrates a gait pattern consistent with abductor muscle injury in the early recovery period, despite the MIS approach. Key words: minimally invasive, hip arthroplasty, hip replacement, gait analysis, surgical approach.
A new anterolateral surgical approach for total hip replacement
Joints, 2016
Purpose: the purpose of the present paper is to present the short-term results of a “detachment-free” (DF) anterolateral approach for primary total hip replacement (THR) performed in a large series of patients. Methods: two hundred patients submitted to primary THR were retrospectively reviewed for the present study. In all cases, the surgery was performed using a minimally invasive DF anterolateral approach, which entails no disconnection of tendons and no muscle damage. The study population consisted of 96 men (48%) and 104 women (52%), with an average age of 69.4 years (range 38-75). Clinical and radiographic follow-up was performed after 12 months. Results: the clinical results, evaluated using the Harris Hip Score, were excellent in 95% of the cases and good in 5%; no cases had fair or poor results. X-rays taken at 3, 6 and 12 months after surgery did not show heterotopic ossification, mobilization of the prosthetic components, or hip dislocation. No infections, deep vein throm...
2017
Total hip arthroplasty remains the treatment of choice for the symptomatic osteoarthritis of the hip. The most common approach used is the Posterior Approach of Moore (PA), known to give good and reliable results [1,2]. Nevertheless, during the last decades the minimal invasive approaches have become more and more popular, especially the Direct Anterior Approach (DAA) by Hueter [3]. This is mainly due to studies showing the advantage of faster recovery (in the first 6 to 12 weeks) and shorter length of stay in hospital but no advantage is seen in long term results [4-8]. However, it’s a technically demanding approach particularly during the early stage of the learning curve [9,10] with occurrence of more intra-operative fractures, nervous lesions and implant malpositioning [11-13]. Beside these two frequently used approaches, the mini-invasive anterolateral approach described by Rottinger (ALA) shows good functional and radiological results [14,15].
Functional exercise after total hip replacement (FEATHER) a randomised control trial
BMC Musculoskeletal Disorders, 2012
Background: Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR). It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life. Methods/design: This will be a single blind multi centre randomized control trial with two arms. Seventy subjects post primary total hip arthroplasty will be randomized into either an experimental group (n=35), or to a control group (n=35). The experimental group will attend a functional exercise class twice weekly for a six week period from week 12 to week 18 post surgery. The functional exercise group will follow a circuit based functional exercise class supervised by a chartered Physiotherapist. The control group will receive usual care. The principal investigator (BM) will perform blinded outcome assessments on all patients using validated measures for pain, stiffness, and function using the Western Ontario and Mc Master Universities Osteoarthritis index (WOMAC). This is the primary outcome measurement tool. Secondary outcome measurements include Quality of life (SF-36), 6 min walk test, Visual Analogue Scale, and the Berg Balance score. The WOMAC score will be collated on day five post surgery and repeated at week twelve and week eighteen. All other measurements will be taken at week 12 and repeated at week eighteen. In addition a blinded radiologist will measure gluteus medius cross sectional area using real time ultrasound for all subjects at week 12 and at week 18 to determine if the functional exercise programme has any effect on muscle size. Discussion: This randomised controlled trial will add to the body of evidence on the relationship between muscle size, functional ability, balance, quality of life and time post surgery in patients following total hip arthroplasty. The CONSORT guidelines will be followed to throughout. Ethical approval has been gained from the Ethics committee Health Services Executive Dublin North East.
The benefit of modified rehabilitation and minimally invasive techniques in total hip replacement
Annals of The Royal College of Surgeons of England, 2008
INTRODUCTIONWe wished to assess if an intensive rehabilitation regimen alone, or one combined with modified anaesthetic and surgical techniques, can change the speed of rehabilitation or the length of hospital stay after total hip replacement.PATIENTS AND METHODSWe compared 44 patients who had followed a traditional care pathway, with 38 patients who had rehabilitated under a new rehabilitation protocol, with 40 patients who had also received modified, minimally invasive techniques. The speed of rehabilitation was measured in terms of three specific milestones accomplished on the day after surgery.RESULTSWe found a statistically significant improvement in the day after surgery each activity was possible. The length of hospital stay was reduced from 6.5 days to 5.4 days to 4.1 days, a difference which was also statistically significant.CONCLUSIONSThe data support the view that a new rehabilitation protocol alone can reduce the length of hospital stay and hasten rehabilitation. The co...
International Orthopaedics, 2007
The interest in minimally invasive approaches for total hip replacement (THR) has not waned in any way. We carried out a prospective and comparative study in order to analyse the interest of the anterolateral minimal invasive (ALMI) approach in comparison with a minimally invasive posterior (MIP) approach. A group of 35 primary THRs with a large head using the ALMI approach was compared with a group of 43 THR performed through a MIP approach. The groups were not significantly different with respect to age, sex, bony mass index, ASA score, Charnley class, diagnoses and preoperative Womac index and PMA score. The preoperative Harris Hip Score was significantly lower in the ALMI group. The duration of surgical procedure was longer and the calculated blood loss more substantial in the ALMI group. The perioperative complications were significantly more frequent in this group, with four greater trochanter fractures, three false routes, one calcar fracture, and two rocking metal backs versus one femoral fracture in MIP group. Other postoperative data (implant positioning, morphine consumption, length of hospital stay, type of discharge) are comparable, as were the early functional results. No other complication has been noted during the first 6 months. The ALMI approach uses the intermuscular interval between the tensor fascia lata and the gluteus medius. It leaves intact the abductor muscles, the posterior capsule and the short external rotators. The early clinical results are excellent, despite the complications related to the initial learning curve for this approach and the use of a large head. The stability and the absence of muscular damage should permit acceleration of the postop-erative rehabilitation in parallel with less perioperative complications after the initial learning curve.
Functional recovery of muscles after minimally invasive total hip arthroplasty
Instructional course lectures
Whether mini-incision total hip arthroplasty is associated with accelerated postoperative recovery is a subject of considerable controversy. A study was conducted to compare objective outcomes using gait analysis as a measure for recovery of function in patients treated with three different minimally invasive surgical approaches and the traditional posterior approach. Sixty-nine patients underwent instrumented gait analysis at self-selected and fast velocities preoperatively and at 6 weeks and 3 months postoperatively. Four surgical groups were studied-30 treated with posterior mini-incisions, 11 anterolateral, 10 anterior Judet, and 18 traditional posterior long incisions. Overall, gait velocity increased slightly at 6 weeks and significantly at 3 months. However, there were no significant differences between groups for velocity, cadence, stride length, single-limb support time, or double-limb support time at 6 weeks or 3 months postoperatively. These data indicate that patients un...
2007
The aim of this study was to evaluate the correlation between radiographic geometric measurements (abductor lever arm and abductor muscle length) and abductor muscle function in osteoarthritic hip joint patients after surgery. Thirteen patients (11 males and 2 females, aged 55 to 74 years old) were evaluated at least 6 months after unilateral total hip replacement due to primary coxarthrosis. The length of the abductor muscles and their lever arm were measured on standardized antero-posterior hip radiographs taken in supine position; the product of these two values, namely the dysfunction index (DI), was considered an estimate for the hip abductor torque. The abductor muscle function was evaluated through the measurement of the range (degrees) and duration (seconds) of maximal active hip abduction (with patients in lateral decubitus) and through the time sustaining the Trendelenburg test position (single leg stance). Considering the percentage of variation, related to the contralateral hip joint (used as control), a signiWcant positive correlation was found between both, abductor lever length and DI, and the time of maximal hip abduction (r = 0.61 and r = 0.63, P < 0.05). Moreover, a positive trend (P = 0.08) was found between DI and the time spent in Trendelenburg position (r = 0.54). The presented data provide evidence that lever arm and DI of hip abductor muscles are correlated with muscular capacity to resist fatigue. These results emphasize the importance of thorough surgical planning before total hip replacement with emphasis to the geometric hip parameters, which seem to determine the clinical outcome.
Research Square (Research Square), 2023
Background: This study sought to compare the differences in the early postoperative clinical outcomes of Asian patients who underwent total hip arthroplasty (THA) using the minimally invasive anterolateral approach (MIAL) or the lateral approach (LA). Methods: This retrospective study examined the data of 80 consecutive patients who underwent THA between January 2020 and September 2021. Of the patients, the MIAL was used in 41 patients, and the LA was used in 39 patients. The modi ed Harris Hip Score (mHHS) survey and the 36-item Short-Form Health Survey (SF-36) were administered during the rst 3 postoperative months. Surgical parameters, the time it took to complete indoor self-care activities, and complications were also analyzed. Results: No signi cant differences were found in the patients' baseline characteristics. At 5 days postoperatively, the mHHS, visual analogue scale (VAS) score, and positive rate of the Trendelenburg test were signi cantly better in the MIAL group than the LA group. The time it took to engage in indoor selfcare was signi cantly shorter in the MIAL group than the LA group. At 6 weeks postoperatively, the results of the mHHS and the majority of the SF-36 items were signi cantly higher in the MIAL group than the LA group. At 12 weeks postoperatively, there was no statistical difference in the mHHSs between the two groups; however, the scores for most SF-36 items, except the vitality and emotional role items, were signi cantly higher in the MIAL group than the LA group. The complication rates were comparable between the two groups. Conclusions: The MIAL facilitated quicker recovery for Asian patients, who showed earlier indoor selfcare, better hip function, and better health related quality of life; however, the complication rates of the MIAL and LA groups were comparable.