QUANTITATIVE GAIT ANALYSIS BEYOND ONE YEAR POSTOPERATIVE OF TOTAL HIP ARTHROPLASTY BY MINI-INVASIVE ANTERO-LATERAL APPROACH: <EM>WHAT IMPLICATIONS IN REHABILITATION?</EM>

L. Martinez¹, M. Lalevée², B. Rey³, J. Beldame⁴, J. Matsoukis⁵, T. Poirier³, H. Brunel³, S. Van Driessche⁶, N. Noé³, F. Billuart¹

¹IFMK Saint Michel - Université Paris-Saclay, Paris, France, ²Centre Hospitalier Universitaire de Rouen, Service de Chirurgie Orthopédique et Traumatologique, Rouen, France, ³IFMK Saint Michel, Paris, France, ⁴Clinique Mégival, Saint-Aubin-sur-Scie, France, ⁵Groupe Hospitalier du Havre, Département de Chirurgie Orthopédique, Le Havre, France, ⁶Polyclinique Sainte Marguerite, Auxerre, France

Background: Total Hip Arthroplasty (THA) by Minimally Invasive Antero-Lateral Approach (MIALA) would lead to rapid recovery and question the interest of rehabilitation. However, postoperative clinical and functional improvements are increasingly controversial. Indeed, static balance and gait alterations have been previously reported during the first postoperative months. However, these alterations in a context of Quantitative Gait Analysis (QGA) when comparing with asymptomatic subjects are lacking beyond one year postoperatively.

Purpose: The main objective of this study was to compare the spatio-temporal parameters of QGA, beyond one year postoperatively in subjects operated on by MIALA with age-matched asymptomatic subjects. The secondary objectives were to compare the muscular, kinematic and kinetic data of QGA in operated and asymptomatic subjects. We hypothesized that QGA parameters would not normalize beyond one year postoperatively.

Methods: Ethical approval was obtained on April 12, 2019 (2017-A03157-46). 31 subjects were recruited, including 16 subjects operated on by MIALA (68 years-old; Interquartile Range (IR): 65-70), at 15.5 months postoperatively (IR: 13-17) and 15 asymptomatic subjects (62 years-old; IR: 61-71) . Subjects underwent QGA and isometric maximal muscle strength tests on the Gluteus Medius (GME) and Gluteus Maximus (GMA), Tensor Fascia Lata (TFL) and Sartorius muscles. Spatio-temporal parameters (walking speed and single leg support) were the principal judgment criteria. Kinetic parameters (vertical ground reaction forces, hip moments in the 3 planes) and kinematics (coxofemoral and pelvic amplitudes) were the secondary judgment criteria. The comparisons of the parameters were carried out with Mann-Whitney tests. The statistics are expressed in medians and IR.

Results: There was no significant difference between the 2 groups in terms of their characteristics, allowing comparison of the groups. Walking speed was lower in operated subjects (1.03 m/s versus 1.18 m/s, p=0.005). Isometric maximal muscle strengths were lower in operated subjects for the GMA, GME and TFL (p<0.005). Vertical ground reaction forces were lower for operated subjects for the cushioning phase (FzCP_max, p=0.001), the unipodal stance phase (FzPA_min, p=5.05.10^-2) and the propulsion phase (FzDP_max, p=0.0002). The moments were lower for operated subjects in the sagittal plane (0.6 N.m for the operated versus 1.1 N.m for the asymptomatic, p=0.02). Pelvic amplitudes in the sagittal plane were lower for the operated subjects (3.3° versus 7.2°, p=0.05). There was no significant difference in coxofemoral amplitude between operated and asymptomatic subjects either in the frontal (p=0.64) or sagittal (p=0.18) plane.

Conclusions: Our hypothesis was validated. QGA deficits always seemed to persist beyond one year postoperatively after THA by MIALA. A decrease in walking speed, maximum isometric muscle strength of the GMA, GME and TFL was observed, as well as a decrease in propulsive force, hip moments and pelvic amplitude.

Implications: The results reflect muscle lesions following surgery and give major importance to specific rehabilitation to limit the persistence of the disorders observed beyond one year postoperatively. A protocol associating specific rehabilitation of the different phases of the gait cycle with isometric muscle strengthening of the GMA, GME, TFL and functional exercises for the pelvic mobility in the sagittal plane could be considered.

Funding acknowledgements: No funding was received for this study

Keywords:
Total Hip Arthroplasty
Gait Analysis
Rehabilitation

Topics:
Orthopaedics
Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: CHU de Poitiers

Committee: Comité de Protection des Personnes du CHU de Poitiers

Ethics number: 2017-A03157-46