Orthopaedic Research Unit, Dept. of Orthopaedic Surgery and Traumatology, Odense University Hospital, Inst. of Clinical Research, University of Southern Denmark, Denmark.
Osteoarthritis Cartilage. 2011 Sep;19(9):1108-16. doi: 10.1016/j.joca.2011.06.011. Epub 2011 Jun 28.
To evaluate the effect of resurfacing vs standard total hip replacement on post-surgery hip and knee muscle strength recovery in a prospective randomised controlled trial at the Department of Orthopaedics, University Hospital, Odense, Denmark.
Forty-three patients were randomised into (A) standard total hip arthroplasty (S-THA) and (B) resurfacing total hip arthroplasty (R-THA). Pre-surgery assessment and follow-up were conducted (8, 26 and 52 wks). Maximal isometric muscle strength (Nm) and between-limb asymmetry for the knee extensors/flexors, hip adductors/abductors, hip extensors/flexors were analysed.
Maximal knee extensor and hip abductor strength were higher in S-THA than R-THA at 52 wks post-surgery (P ≤ 0.05) and hip extensors tended to be higher in S-THA at 52 wks (P = 0.06). All muscle groups showed substantial between-limb strength asymmetry (7-29%) with the affected side being weakest (P ≤ 0.05) and hip flexors being most affected. Asymmetry was present in half of the muscle groups at 26 wks (P ≤ 0.05), and remained present for the hip flexors and hip adductors at 52 wks (P ≤ 0.05).
R-THA patients showed an attenuated and delayed recovery in maximal lower limb muscle strength (in 2/6 muscle groups) compared to S-THA. Notably, the attenuated strength recovery following R-THA was most markedly manifested in the late phase (1 yr) of post-surgical recovery, and appeared to be due to the detachment of the lower half of the gluteus maximus muscle rather than implant design per se. Thus, the present data failed to support the hypothesis that R-THA would result in an enhanced strength rehabilitation compared to S-THA. Further, between-limb asymmetry remained present for hip flexors and adductors after 52 wks.
NCT01229293.
在丹麦奥胡斯大学医院骨科进行的一项前瞻性随机对照试验中，评估表面置换与标准全髋关节置换对术后髋关节和膝关节肌肉力量恢复的影响。
43 名患者被随机分为（A）标准全髋关节置换术（S-THA）和（B）表面置换全髋关节置换术（R-THA）。在术前评估和随访中（8、26 和 52 周）进行了分析。分析了最大等长肌肉力量（Nm）和膝关节伸肌/屈肌、髋关节内收肌/外展肌、髋关节伸肌/屈肌的两腿间不对称。
在术后 52 周时，S-THA 的最大膝关节伸肌和髋关节外展肌力量高于 R-THA（P≤0.05），而髋关节伸肌在 52 周时倾向于更高（P=0.06）。所有肌肉群均表现出明显的两腿间力量不对称（7-29%），患侧最弱（P≤0.05），髋关节屈肌受影响最大。在 26 周时，一半的肌肉群存在不对称（P≤0.05），在 52 周时，髋关节屈肌和髋关节内收肌仍存在不对称（P≤0.05）。
与 S-THA 相比，R-THA 患者的下肢最大肌肉力量的恢复较弱且延迟（在 6 个肌肉群中的 2 个）。值得注意的是，R-THA 后力量恢复减弱的情况在术后康复的晚期（1 年）最为明显，这似乎是由于臀大肌下半部分的分离，而不是植入物设计本身。因此，目前的数据并未支持 R-THA 会比 S-THA 产生更强的力量康复的假设。此外，52 周后，髋关节屈肌和内收肌的两腿间不对称仍然存在。
NCT01229293。
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