Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Germany.
Arch Orthop Trauma Surg. 2024 Aug;144(8):3323-3336. doi: 10.1007/s00402-024-05479-z. Epub 2024 Aug 6.
Muscular deficits as part of severe osteoarthritis of the hip may persist for up to two years following total hip arthroplasty (THA). No study has evaluated the mid-term benefit of a modified enhanced-recovery-after-surgery (ERAS) concept on muscular strength of the hip in detail thus far. We (1) investigated if a modified ERAS-concept for primary THA improves the mid-term rehabilitation of muscular strength and (2) compared the clinical outcome using validated clinical scores.
In a prospective, single-blinded, randomized controlled trial we compared patients receiving primary THA with a modified ERAS concept (n = 12, ERAS-group) and such receiving conventional THA (n = 12, non-ERAS) at three months and one year postoperatively. For assessment of isokinetic muscular strength, a Biodex-Dynamometer was used (peak-torque, total-work, power). The clinical outcome was evaluated by using clinical scores (Patient-Related-Outcome-Measures (PROMs), WOMAC-index (Western-Ontario-and-McMaster-Universities-Osteoarthritis-Index), HHS (Harris-Hip-Score) and EQ-5D-3L-score.
Three-months postoperatively, isokinetic strength (peak-torque, total-work, power) and active range of motion was significantly better in the modified ERAS group. One year postoperatively, the total work for flexion was significantly higher than in the Non-ERAS group, whilst peak-torque and power did not show significant differences. Evaluation of clinical scores revealed excellent results at both time points in both groups. However, we could not detect any significant differences between both groups in respect of the clinical outcome.
With regard to muscular strength, this study supports the implementation of an ERAS concept for primary THA. The combination with a modified ERAS concept lead to faster rehabilitation for up to one-year postoperatively, reflected by significant higher muscular strength (peak-torque, total-work, power). Possibly, because common scores are not sensitive enough, the results are not reflected in the clinical outcome. Further larger randomized controlled trials are necessary for long-term evaluation.
全髋关节置换术（THA）后，髋关节严重骨关节炎的肌肉功能障碍可能持续长达两年。迄今为止，尚无研究详细评估改良术后加速康复（ERAS）方案对髋关节肌肉力量的中期获益。我们（1）研究了原发性 THA 的改良 ERAS 方案是否能改善中期肌肉力量康复情况，（2）并通过验证后的临床评分比较了临床结果。
前瞻性、单盲、随机对照试验中，我们比较了接受改良 ERAS 方案（n=12，ERAS 组）和常规 THA（n=12，非 ERAS 组）的原发性 THA 患者在术后 3 个月和 1 年时的等速肌肉力量（峰值扭矩、总功、功率）。采用 Biodex-Dynamometer 进行评估。通过患者相关结局测量（PROMs）、WOMAC 指数（西部安大略省和麦克马斯特大学骨关节炎指数）、HHS（Harris 髋关节评分）和 EQ-5D-3L 评分评估临床结果。
术后 3 个月时，改良 ERAS 组的等速肌肉力量（峰值扭矩、总功、功率）和主动活动范围明显更好。术后 1 年时，屈曲的总功明显高于非 ERAS 组，而峰值扭矩和功率无显著差异。在两个时间点，两组的临床评分均显示出优异的结果。但是，我们没有发现两组之间在临床结果方面存在任何显著差异。
在肌肉力量方面，本研究支持将 ERAS 方案应用于原发性 THA。改良 ERAS 方案的结合使术后长达 1 年的康复更快，表现为显著更高的肌肉力量（峰值扭矩、总功、功率）。可能是因为常见评分不够敏感，结果没有反映在临床结果中。需要进一步进行更大规模的随机对照试验以进行长期评估。
