WHICH REHABILITATION OF POSTURAL PARAMETERS AFTER TOTAL HIP ARTHROPLASTY BY POSTERIOR APPROACH: COMPARISON OF 2 REHABILITATION PROTOCOLS. RANDOMIZED CONTROLLED STUDY

L. Martinez¹, N. Noé², H. Simon², J. Beldame², H. Brunel², S. Van Driessche³, F. Billuart¹

¹IFMK Saint Michel - Université Paris-Saclay, Paris, France, ²IFMK Saint Michel, Paris, France, ³Polyclinique Sainte Marguerite, Auxerre, France

Background: After Total Hip Arthroplasty (THA), patients continue to have 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.

Purpose: The objective of this study was to compare stabilometric parameters of subjects operated on posterior THA followed by 2 different rehabilitation protocols (stabilometric platform and home-based self-directed protocols) with a control group of operated subjects who did not undergo rehabilitation and a control group of age-matched asymptomatic subjects. We hypothesized that rehabilitation would normalize the stabilometric parameters.

Methods: Ethical approval was obtained by Le Havre Hospital. 67 subjects were enrolled (67.85±1.22 years-old) and divided into 4 groups. 41 subjects had undergone a posterior THA and were randomly assigned between 10 and 21 postoperative days 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 4^th group was a control group made up of 26 age-matched asymptomatic subjects (CG55-80). Rehabilitation protocols lasted 3 weeks. After these 3 weeks, the groups performed the same stabilometric single leg and double leg stance tests (considering lower limb dominance) on a stabilometric plateform (SP), in 2 conditions for bipedal tests: Eyes Open (EO) and Eyes Closed (EC). The following parameters of Center of Pressure (COP) were selected: mediolateral (X_range) and anteroposterior (Y_range) range of COP displacements,Path Length (P_length), average velocity (V_avg), Ellipse area of COP (E_area). Comparisons were performed for each variable and test on the SP with a Kruskal-Wallis H test, while paired comparisons were obtained using a Mann-Whitney U test.

Results: There was no significant difference between the groups in terms of their characteristics, allowing comparison of the groups. SDHRG and RSPG achieved over 90% of rehabilitation protocols. Differences were observed in the bipedal stance between CG55-80 and THACG in EO and EC conditions. THACG had higher P_length (EO: p=0.01; EC: p=0.03) and V_avg (EO: p=0.01; EC: p=0.03), meaning higher energy expenditure than CG55-80. These differences were not observed with SDHRG and RSPG compared with CG55-80, meaning normalized parameters. In the unipedal stance, RSPG and SDHRG had lower X_range(p=0.02), Y_range (p<0.05), E_area (p<0.05), P_length(p=0.04) and V_avg(p=0.04) than CG55-80, meaning less energy expenditure to maintain the stance and greater muscle activity in the anterior and posterior chains and hip abductors. No difference between SDHRG and RSPG was observed.

Conclusions: Our hypothesis was validated. Subjects who completed the 2 different rehabilitation programs had the same or better stabilometric parameters than the CG55-80. Therefore, both these protocols seem to restore the stabilometric parameters.

Implications: These results confirmed that more intensive rehabilitation could be necessary to restore postural capacities. We therefore recommend the early implementation of either a home-based self-directed rehabilitation program or a rehabilitation program with an SP, depending on the patient’s abilities.

Funding acknowledgements: No funding was received for this study

Keywords:
Total Hip Arthroplasty
Rehabilitation
Stabilometry

Topics:
Orthopaedics
Musculoskeletal: lower limb

Did this work require ethics approval? Yes

Institution: Groupe Hospitalier du Havre

Committee: Comité d'Ethique du Groupement Hospitalier du Havre

Ethics number: 1022014