Long W T, Dorr L D, Healy B, Perry J
King-Drew Medical Hospital, Los Angeles, California.
Clin Orthop Relat Res. 1993 Mar(288):73-7.
Eighteen patients with unilateral hip disease had noncemented total hip arthroplasty. Clinical follow-up data were complete to five years postsurgery. Gait analysis was done preoperatively, at three and six months, and at one and two years. Force plate data showed continued weakness of the operated hip in all patients at two years postsurgery. Preoperative dynamic electromyograms (EMGs) were abnormal in eight patients and showed two patterns. Stance loss seen in three patients was characterized by absence of activity of the gluteus medius and upper and lower gluteus maximus muscles. In five patients, continuous activity occurred in the tensor fascia lata, rectus femoris, and adductor longus muscles during the entire gait cycle. Postoperatively, all abnormal EMGs returned to normal. Four patients with a normal preoperative EMG developed abnormal EMG patterns postoperatively, demonstrating either a prolonged stance or stance loss pattern. All four of these hips have been revised. Although gait characteristics return to normal by two years postsurgery, weakness of the hip persists. This weakness jeopardizes the implant fixation interface. This study supports the prohibition of activities that cause high impact loading of total hip arthroplasties and suggests that a prolonged exercise program be employed postoperatively.
18例单侧髋关节疾病患者接受了非骨水泥型全髋关节置换术。临床随访数据完整至术后5年。术前、术后3个月、6个月、1年和2年进行了步态分析。测力板数据显示，所有患者术后2年手术侧髋关节持续存在无力。8例患者术前动态肌电图（EMG）异常，表现为两种模式。3例患者出现站立位丧失，其特征为臀中肌以及臀大肌上、下部无活动。5例患者在整个步态周期中阔筋膜张肌、股直肌和长收肌持续活动。术后，所有异常肌电图均恢复正常。4例术前肌电图正常的患者术后出现异常肌电图模式，表现为站立期延长或站立位丧失模式。所有这4例髋关节均已翻修。尽管术后2年步态特征恢复正常，但髋关节无力仍然存在。这种无力会危及植入物固定界面。本研究支持禁止进行导致全髋关节置换术承受高冲击负荷的活动，并建议术后采用长期锻炼方案。
