Martinez Lucas, Noé Nathalie, Simon Hermann, Beldame Julien, Matsoukis Jean, Brunel Helena, Van Driessche Stéphane, Billuart Fabien
Laboratoire d'analyse du mouvement, institut de formation en Masso-Kinésithérapie Saint-Michel, 68, rue du commerce, 75015 Paris, France.
Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France.
Orthop Traumatol Surg Res. 2022 Feb;108(1):103174. doi: 10.1016/j.otsr.2021.103174. Epub 2021 Dec 9.
After total hip arthroplasty (THA), patients continue to have muscular, functional and postural deficits. The literature seems to support the use of postoperative rehabilitation, especially self-directed programs. However, there is no set protocol for the management of postural disorders. Therefore, the purpose of this study was to compare postural parameters of a group of patients who underwent posterior THA followed by 2 different types of rehabilitation (stabilometric platform (SP) and home-based self-directed protocols) with a control group of operated patients who did not undergo rehabilitation and a control group of age-matched asymptomatic subjects.
We hypothesized that rehabilitation would normalize the stabilometric parameters.
A total of 67 subjects were enrolled in this study (mean age 67.85±1.22years) and divided into 4 groups. Forty-one of these subjects had undergone a posterior THA were randomly assigned between D10 and D21 to one of the following 3 groups: no rehabilitation control group (THACG=14), supervised rehabilitation with a stabilometric platform group (RSPG=16), and a self-directed home-based rehabilitation group (SDHRG=11). The 4th group was a control group made up of 26 age-matched asymptomatic nonoperated subjects (CG55-80). These rehabilitation protocols lasted 3weeks. At the end of the 3weeks, the groups performed the same stabilometric single leg and double leg stance tests (considering lower limb dominance) on an SP.
No significant differences were observed between groups in the bipedal stance, except between the CG55-80 and the THACG, where a higher energy expenditure was observed in the THACG during the static stance with eyes open (EO) and eyes closed (EC): increase in the path length (P) covered by the center of pressure (COP) (EO: p=01; EC: p=03) and the average velocity (V) of the COP (EO: p=01; EC: p=03). These differences were not observed in the SDHRG and RSPG whether they were compared with one another or with both control groups. In the unipedal stance, subjects in the RSPG and SDHRG showed greater muscle activity in the anterior and posterior chains and hip abductors, and used less energy to maintain the stance than those in the CG55-80, regardless of lower limb dominance: decrease in the mediolateral range of COP displacement (X) (hip abductor muscles) (p=02) and anteroposterior range of COP displacement (Y) (anterior and posterior chains) (p=3.49.10), 95% confidence ellipse area (E) of COP data (p=1.47.10), P (p=04) and V (p=04). The RSPG had a smaller E than the SDHRG (p=04), demonstrating a better postural stability during the unipedal stance performed on the dominant operated leg.
Our results were consistent with the literature on the benefits of rehabilitation after THA, thus confirming our hypothesis that rehabilitation normalized stabilometric parameters between D31-D45, depending on the subjects. These results provide new information regarding rehabilitation techniques to be implemented postoperatively after a THA. A home-based self-directed rehabilitation program is just as effective as an SP program in managing postural disorders.
II; randomized controlled trial with low statistical power.
全髋关节置换术（THA）后，患者仍存在肌肉、功能和姿势缺陷。文献似乎支持术后康复的应用，尤其是自我指导方案。然而，对于姿势障碍的管理尚无固定方案。因此，本研究的目的是比较一组接受后路THA并接受两种不同类型康复治疗（稳定平台（SP）和家庭自我指导方案）的患者与未接受康复治疗的手术患者对照组以及年龄匹配的无症状受试者对照组的姿势参数。
我们假设康复将使稳定参数正常化。
本研究共纳入67名受试者（平均年龄67.85±1.22岁），分为4组。其中41名接受过后路THA的受试者在D10至D21之间被随机分配到以下3组之一：无康复对照组（THACG = 14）、使用稳定平台的监督康复组（RSPG = 16）和家庭自我指导康复组（SDHRG = 11）。第4组是由26名年龄匹配的无症状未手术受试者组成的对照组（CG55 - 80）。这些康复方案持续3周。在3周结束时，各小组在SP上进行相同的稳定单腿和双腿站立测试（考虑下肢优势）。
在双脚站立时，各小组之间未观察到显著差异，但在CG55 - 80和THACG之间观察到差异，在睁眼（EO）和闭眼（EC）静态站立期间，THACG的能量消耗更高：压力中心（COP）覆盖的路径长度（P）增加（EO：p = 0.01；EC：p = 0.03）以及COP的平均速度（V）增加（EO：p = 0.01；EC：p = 0.03）。无论是将SDHRG和RSPG相互比较还是与两个对照组比较，均未观察到这些差异。在单腿站立时，RSPG和SDHRG的受试者在前、后链以及髋外展肌中表现出更大的肌肉活动，并且与CG55 - 80的受试者相比，维持站立时消耗的能量更少，无论下肢优势如何：COP位移的中外侧范围（X）（髋外展肌）减小（p = 0.02）以及COP位移的前后范围（Y）（前、后链）减小（p = 3.49×10⁻³），COP数据的95%置信椭圆面积（E）减小（p = 1.47×10⁻³），P减小（p = 0.04）以及V减小（p = 0.04）。RSPG的E比SDHRG小（p = 0.04），表明在优势手术腿上进行单腿站立时姿势稳定性更好。
我们的结果与关于THA后康复益处的文献一致，从而证实了我们的假设，即康复在D31 - D45之间使稳定参数正常化，具体取决于受试者。这些结果提供了关于THA术后应实施的康复技术的新信息。家庭自我指导康复方案在管理姿势障碍方面与SP方案同样有效。
II；统计功效较低的随机对照试验。
