Physical Medicine and Rehabilitation Unit, IRCCS - Rizzoli Orthopaedic Institute, Bologna Italy.
Orthopaedic-Traumatology and Prosthetic surgery and revisions of hip and knee implants, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy.
Hip Int. 2021 Jan;31(1):66-74. doi: 10.1177/1120700019877174. Epub 2019 Sep 22.
In developmental hip dysplasia (DDH) patients, the chronic dislocation of the femoral head with respect to the true acetabulum determines muscle contracture and atrophy, particularly of the abductor muscles, and leads to secondary osteoarthritis (OA) with severe motor dysfunction, pain and disability. The correct positioning when a total hip replacement (THR) is performed is fundamental to the recovery of gait function. Also, inadequate rehabilitation of the abductor muscles for pelvic stabilisation can be responsible for residual dysfunction. Consensus on a programme for abductor muscle strengthening in these patients is not currently available. The aim of this study was to evaluate the effectiveness of a specific program of exercises for strengthening the abductor muscles in these patients.
A multicentre, prospective, randomised clinical trial was carried out in an outpatient rehabilitation setting on 103 patients given THR for DDH through a minimally-invasive anterolateral approach. Patients were randomly divided into a Study Group, including 46 patients, and a Control Group, including 57 patients. All patients underwent standard early postoperative rehabilitation. In addition, the Study Group were given an extra 2-week rehabilitation once full weight-bearing on the operated limb was allowed, aimed at strengthening the abductor muscles. All patients were evaluated preoperatively, and at about 3 and 6 months postoperatively. Clinical measures (lower limb-length differences, hip range of motion, abductor muscle strength), and functional measures (WOMAC, HHS, 10mt WT, SF-12) were taken.
Hip range of motion and functional outcome measures showed a progressive improvement at follow ups in both groups, significantly higher in the Study Group. In particular, abductor strength at 6 months post-op improved by 92.5% with respect to 35.7% in the Control Group.
In addition to standard rehabilitation, a rehabilitation programme for strengthening the gluteal muscles in DDH patients who underwent THR determined an increase in muscle strength that improved functional performance and patient satisfaction.
在发育性髋关节发育不良（DDH）患者中，股骨头相对于真髋臼的慢性脱位决定了肌肉挛缩和萎缩，特别是外展肌，并导致继发性骨关节炎（OA），严重的运动功能障碍、疼痛和残疾。全髋关节置换术（THR）时正确的定位对于恢复步态功能至关重要。此外，对于骨盆稳定的外展肌康复不足可能是导致残余功能障碍的原因。目前对于这些患者的外展肌强化方案尚无共识。本研究旨在评估针对这些患者的特定外展肌强化计划的有效性。
在门诊康复环境中，对 103 例通过微创前外侧入路接受 THR 治疗 DDH 的患者进行了一项多中心、前瞻性、随机临床试验。患者被随机分为研究组（46 例）和对照组（57 例）。所有患者均接受标准的早期术后康复。此外，研究组在允许患肢完全负重后，还额外接受为期 2 周的康复治疗，以增强外展肌。所有患者均在术前以及术后约 3 个月和 6 个月进行评估。临床评估（下肢长度差异、髋关节活动范围、外展肌力量）和功能评估（WOMAC、HHS、10mtWT、SF-12）。
两组患者的髋关节活动范围和功能结果测量值在随访时均呈逐渐改善，研究组改善更显著。特别是，研究组术后 6 个月的外展肌力量较术后 3 个月增加了 92.5%，而对照组仅增加了 35.7%。
除了标准康复之外，对于接受 THR 的 DDH 患者，增加外展肌的康复计划可增加肌肉力量，从而改善功能表现和患者满意度。
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