Temporiti F1, Zanotti G1, Furone R1, Barbaglia A1, Grappiolo G1, Loppini M2, Gatti R1,2
1Humanitas Research Hospital, Rozzano, Milan, Italy, 2Humanitas University, Pieve Emanuele, Milan, Italy
Background: Total hip arthroplasty (THA) is a successful surgical treatment able to relief pain and to quickly restore independence and quality of life. A considerable number of these patients, requires a bilateral treatment. The advancements in surgical techniques have made the bilateral THA surgery possible through one-stage procedure. This approach is comparable to unilateral THA in term of postoperative complication rate and implies similar length of hospital stay, decreased operative time and overall cost reduction. However, no studies compare the postural and functional recovery after simultaneous bilateral or unilateral THA. Bilateral THA is more invasive than unilateral, but it has the advantage to not allow adaptive strategies with the non-affected limb. Thus, our hypothesis is that the functional recovery of these patients can be similar or faster than patients with unilateral THA.
Purpose: The aim of the study is to compare the postural and functional performances in patients operated of unilateral or simultaneous bilateral THA.
Methods: Forty patients aged from 45 to 65 years old admitted for simultaneous bilateral THA (n=20) or unilateral THA (n=20) were enrolled in the study. They were assessed for symmetry in their lower limbs weight distribution (Body Weight Distribution Symmetry Index - BWDSI) and for postural stability (Global Centre of Pressure Length of Trace - LoT) during a 60 seconds quiet standing task performed with open and closed eyes. Symmetry in body weight distribution was also evaluated during the sitting down on a chair. Finally, pain during the quiet standing (Numeric Rating Scale - NRS), walking ability (Timed Up and Go Test - TUG) and kinesiophobia (Tampa Scale of Kinesiophobia - TSK) were assessed. Symmetry in body weight distribution, postural stability, pain and kinesiophobia were assessed before surgery, after three and seven days, while walking ability were evaluated only before and seven days after surgery.
Results: No significant differences between the two groups were recorded before surgery, except for LoT during closed eyes standing which was greater in bilateral-THA group (p=0.014). After surgery, Mixed Model ANOVA revealed significant between-group difference for BWDSI during the quiet standing in open eyes (p=0.017) and closed eyes (p=0.042) conditions and during the stand-to-sit (p 0.001) in favor of bilateral-THA group. A shorter LoT was observed in unilateral-THA group in closed eyes condition (p=0.013). TUG, NRS and TSK showed no significant between-group differences.
Conclusion(s): Bilateral THA patients showed better body weight distribution and similar walking ability, pain and fear of movement than patients undergoing unilateral THA, in early postoperative phase. A greater postural stability was observed in unilateral THA patients who mainly rely on their non-affected limb to maintain balance, without exploiting the motor potential of the affected limb.
Implications: Simultaneous bilateral THA surgery has several clinical advantages and a similar trajectory of recovery compared to unilateral surgery. Patients with bilateral hip joints pathologies can to consider this surgical approach without the risk to compromise their motor and functional recovery.
Keywords: Bilateral total hip arthroplasty, functional performance, recovery of function
Funding acknowledgements: The authors did not receive any funding.
Purpose: The aim of the study is to compare the postural and functional performances in patients operated of unilateral or simultaneous bilateral THA.
Methods: Forty patients aged from 45 to 65 years old admitted for simultaneous bilateral THA (n=20) or unilateral THA (n=20) were enrolled in the study. They were assessed for symmetry in their lower limbs weight distribution (Body Weight Distribution Symmetry Index - BWDSI) and for postural stability (Global Centre of Pressure Length of Trace - LoT) during a 60 seconds quiet standing task performed with open and closed eyes. Symmetry in body weight distribution was also evaluated during the sitting down on a chair. Finally, pain during the quiet standing (Numeric Rating Scale - NRS), walking ability (Timed Up and Go Test - TUG) and kinesiophobia (Tampa Scale of Kinesiophobia - TSK) were assessed. Symmetry in body weight distribution, postural stability, pain and kinesiophobia were assessed before surgery, after three and seven days, while walking ability were evaluated only before and seven days after surgery.
Results: No significant differences between the two groups were recorded before surgery, except for LoT during closed eyes standing which was greater in bilateral-THA group (p=0.014). After surgery, Mixed Model ANOVA revealed significant between-group difference for BWDSI during the quiet standing in open eyes (p=0.017) and closed eyes (p=0.042) conditions and during the stand-to-sit (p 0.001) in favor of bilateral-THA group. A shorter LoT was observed in unilateral-THA group in closed eyes condition (p=0.013). TUG, NRS and TSK showed no significant between-group differences.
Conclusion(s): Bilateral THA patients showed better body weight distribution and similar walking ability, pain and fear of movement than patients undergoing unilateral THA, in early postoperative phase. A greater postural stability was observed in unilateral THA patients who mainly rely on their non-affected limb to maintain balance, without exploiting the motor potential of the affected limb.
Implications: Simultaneous bilateral THA surgery has several clinical advantages and a similar trajectory of recovery compared to unilateral surgery. Patients with bilateral hip joints pathologies can to consider this surgical approach without the risk to compromise their motor and functional recovery.
Keywords: Bilateral total hip arthroplasty, functional performance, recovery of function
Funding acknowledgements: The authors did not receive any funding.
Topic: Musculoskeletal: lower limb; Human movement analysis; Orthopaedics
Ethics approval required: Yes
Institution: Humanitas Clinical and Research Hospital
Ethics committee: Internal Ethical Committee of the Humanitas Clinical and Research Hospital
Ethics number: 172/17
All authors, affiliations and abstracts have been published as submitted.
