Contralateral Hip Abductor Muscle Strength Associated with Comfort of Getting into and out of the Car after Total Hip Arthroplasty.

There are no studies that have investigated the characteristics of car use across THA patients, including those who do not drive. This study aimed to evaluate, in THA patients, (1) postoperative car usage, (2) comfort while entering and exiting a car, and (3) whether lower limb muscle strength affects action comfort. One hundred seventy-two post-THA patients completed the questionnaire in 2020, along with assessments of hip abductor and knee extensor muscle strength before surgery and at discharge. Patients whose overall comfort level was judged as comfortable were defined as the comfort group; others were placed in the discomfort group. Of the 172 patients, 161 reported car usage at a mean of 5.6 years after THA. Of these, 114 and 47 patients were placed in the comfort and discomfort groups, respectively. Patients in the discomfort group were three times more likely to experience discomfort using the contralateral side door than the surgical side door, and about twice as many patients experienced discomfort when entering as when exiting. Lower preoperative contralateral hip abductor muscle strength was the only independent predictor for discomfort. The take-home messages were that prevention of contralateral-side weakness may improve comfort during the action after THA.

Prevalence and Characteristics of Frailty at 6 months FollOwing Total Hip and Knee Arthroplasty in Patients With End-Stage OA.

Introduction: Lower-limb osteoarthritis (OA) in the elderly can be a risk factor for frailty, which is the preliminary of disability, but it may be reversible with appropriate interventions. We aimed to use the Kihon Check List (KCL) to assess multiple domains of frailty and to identify the characteristics of frailty in patients with hip or knee OA following total joint arthroplasty. Materials and Methods: This study included 136 ≥ 65-year-old patients (mean age: 73.0 years) who underwent total arthroplasty with end-stage hip and knee OA. We assessed frailty status, instrumental activities of daily living (IADL), and health-related quality of life (HRQoL) according to the KCL, functional ambulatory index (FAI) and EuroQol-5 Dimension (EQ5D), respectively, as well as the extent of pain preoperatively and at postoperative 6 months. Results: Using KCL, seventy-eight (57.4%) patients were frail preoperatively, but the prevalence significantly decreased to 52 patients (38.2%) at postoperative 6 months. Total arthroplasty intervention provided significant improvements in the total KCL scores, including the physical domain (P < .01), pain (P < .01), FAI scores (P < .01), and EQ5D (P < .01), but not the social domain. Multivariate logistic regression analysis identified age at surgery (OR: .93, 95% CI: .86-.99) and preoperative FAI score (OR: 1.10, 95% CI: 1.03-1.19) as independent predictors of postoperative frailty. Conclusions: Total arthroplasty procedures on patients with hip and knee OA reduced their KCL score, but social aspects were less improved than physical aspects in the shortterm. Older age and preoperative lower IADL score can be useful for accurately estimating less improvement of frailty in the early postoperative phase. Our results suggest that long term follow-up of OA is needed to provide comprehensive interventions, including in social aspects, especially for patients with lower activity.

Evaluation of the balance function before and after total knee arthroplasty using Berg balance scale.

INTRODUCTION: The purpose of this study was to evaluate balance function before and after total knee arthroplasty (TKA) using Berg balance scale (BBS). The study also aimed to identify factors associated with balance impairment. MATERIALS AND METHODS: Ninety-three knees in 90 patients were prospectively evaluated using their BBS scores, passive knee extension/flexion angles, Visual analogue scale for pain scores, hip-knee-ankle angles, and knee extensor/flexor muscle strengths before and after TKA. A total BBS score of less than 45 indicates an enhanced risk of multiple falls. Multivariate logistic regression models were performed to elucidate factors associated with post-operative BBS score. RESULTS: A significant difference in mean pre- and post-operative BBS scores were noted (49.3 ± 6.4 vs. 52.2 ± 4.7) (p < 0.05). The percentage of pre- and post-operative BBS scores less than 45 were 20% and 10% (p < 0.05). Rheumatoid Arthritis (RA), lower pre-operative BBS score, and larger post-operative knee flexion contracture were significantly associated with lower post-operative BBS score (p < 0.01). The post-operative knee flexion contracture greater than 10° was significantly associated with substantially high odds of post-operative BBS scores less than 45 (Odds ratio 7.6; 95% confidential interval 1.69-34.17). CONCLUSIONS: While TKA significantly improved BBS scores, 10% of the patients remained at a risk for multiple falls. RA, lower pre-operative BBS score, and post-operative knee flexion contracture greater than 10° retained balance impairment even after TKA.

Do component position and muscle strength affect the cup-head translation during gait after total hip arthroplasty?

INTRODUCTION: This study examined whether the component position or muscle strength affects the cup-head translation under in vivo weight-bearing conditions after total hip arthroplasty (THA). We hypothesized that there was a correlation between the hip offset or abductor strength and cup-head translation during gait. MATERIALS AND METHODS: We prospectively evaluated 31 patients undergoing unilateral cementless primary THA. The cup height, cup/stem offset, and limb length discrepancy were measured on anterior-posterior bilateral hip radiographic images. The isometric muscle strength of the lower limbs was quantified using a handheld dynamometer. Continuous radiographic images were recorded during gait, and cup-head translation was analysed using a computer-assisted method. RESULTS: The average cup height, cup/stem offset, and limb length discrepancy were - 3.8 ± 5.1 mm, 1.2 ± 5.2 mm/- 0.7 ± 7.7 mm, and - 2.1 ± 5.2 mm, respectively. The average hip abductor/flexor and knee extensor strength were 86% ± 18%/85% ± 17% and 88% ± 17% of the contralateral healthy hip, respectively. The average cup-head translation during swing phase of gait was - 0.003 ± 0.31 mm. Multiple regression analyses found no significant independent predictors of cup-head translation (p > 0.05). CONCLUSIONS: The component position or muscle strength did not significantly influence cup-head translation during gait after well-positioned primary THA.