Unilateral vs. bilateral total hip arthroplasty - the influence of medial femoral head offset and effects on strength and aerobic endurance capacity.

The purpose of the present study was to determine whether unilaterally operated total hip arthroplasty (THA) patients were superior to bilaterally operated THA patients with respect to aerobic endurance capacity, muscle strength and gait patterns 3-5 years after surgery, and to what extent medial femoral head offset (FO) influenced hip abductor strength. 10 unilaterally operated THA patients with normal FO (UNO), 10 bilaterally operated THA patients with normal FO (BNO) and 10 bilaterally operated THA patients with abnormal offset (BDO) participated in the study. Improved muscle strength in the healthy leg of the UNO did not result in differences compared to the BNO and the BDO in work efficiency, gait patterns or maximal oxygen consumption (VO2max ) A reduced FO in the BDO did not result in lower hip abduction strength compared to the BNO. However, a correlation between reduced FO and low abduction strength was found in the BDO (r=0.866, p=0.001). Future focus should be on the quality of rehabilitation.

Early postoperative maximal strength training improves work efficiency 6-12 months after osteoarthritis-induced total hip arthroplasty in patients younger than 60 years.

OBJECTIVE: To assess physical outcome of early maximal strength training after total hip arthroplasty. DESIGN: Six- and 12-mo follow-up of 24 (22) total hip arthroplasty patients randomly assigned to 4 wks of maximal strength training and conventional rehabilitation and to conventional rehabilitation only was conducted. After the intervention period, all patients attended conventional rehabilitation. Outcome measures were hip abduction and leg press strength, gait patterns, work efficiency, maximal oxygen consumption, and health-related quality of life. RESULTS: Work efficiency was significantly higher in the strength training and conventional rehabilitation group compared with the conventional rehabilitation-only group after 6 and 12 mos by 29% and 30%, respectively. Leg press for the healthy leg and rate of force development for the operated leg were significantly higher in the strength training and conventional rehabilitation group compared with the conventional rehabilitation-only group 12 mos postoperatively by 36% and 74%, respectively. CONCLUSIONS: This study demonstrates higher work efficiency after 6 and 12 mos and improved rate of force development after 12 mos in total hip arthroplasty patients who performed early maximal strength training combined with conventional rehabilitation after total hip arthroplasty surgery compared with total hip arthroplasty patients receiving conventional rehabilitation only. However, the study indicates that a prolonged maximal strength training program and aerobic endurance training are required to fully recover total hip arthroplasty patients.

Early maximal strength training is an efficient treatment for patients operated with total hip arthroplasty.

UNLABELLED: Husby VS, Helgerud J, Bjørgen S, Husby OS, Benum P, Hoff J. Early maximal strength training is an efficient treatment for patients operated with total hip arthroplasty. OBJECTIVE: To compare muscle strength, work efficiency, gait patterns, and quality of life in patients undergoing total hip arthroplasty (THA) randomly assigned to either maximal strength training or a conventional rehabilitation program. DESIGN: A randomized controlled study. SETTING: Research laboratory, rehabilitation center, and physical therapy clinic. PARTICIPANTS: Patients (N=24) with osteoarthritis as the main reason for THA were randomly assigned to perform maximal strength training (n=12) or conventional rehabilitation (n=12). INTERVENTIONS: The maximal strength training group (STG) performed maximal strength training in leg press and abduction with the operated leg only 5 times a week for 4 weeks in addition to the conventional rehabilitation program. The conventional rehabilitation group (CRG) received supervised physical therapy 3 to 5 times a week for 4 weeks. MAIN OUTCOME MEASURES: 1-repetition maximum (1RM) leg press strength, 1RM abduction strength, rate of force development (RFD), work efficiency, gait patterns, and quality of life. RESULTS: 1RM increased in the bilateral leg press (P<.002) and in the operated leg separately (P<.002) in the STG compared with the CRG. 1RM abduction strength in the operated leg (P<.002) and the healthy leg (P<.002) increased in the STG compared with the CRG. RFD increased in the STG compared with the CRG (P(g)=.030), followed by a trend towards increased peak force in the STG (P(g)=.053) (P(g) = probability for differences between groups). Work efficiency tended to improve in the STG compared with the CRG (P=.065). No differences in gait patterns were revealed between the groups after the training intervention. CONCLUSIONS: Early maximal strength training 1 week postoperatively is feasible and an efficient treatment to regain muscular strength for patients who have undergone THA, demonstrated by a significantly larger increase in muscular strength and a trend towards a better work efficiency in the STG compared with the CRG.

Aerobic high intensity one and two legs interval cycling in chronic obstructive pulmonary disease: the sum of the parts is greater than the whole.

The purpose of this study was to investigate whether individual leg cycling could produce higher whole body peak oxygen uptake (VO(2peak)) than two legs cycling during aerobic high intensity interval training in chronic obstructive pulmonary disease (COPD) patients. Nineteen patients trained in 24 supervised cycling sessions either by one leg training (OLT) (n = 12) or by two legs training (TLT) (n = 7) at 4 x 4 min intervals at 85-95% of peak heart rate. Whole body VO(2peak) and peak work rate increased significantly by 12 and 23% in the OLT, and by 6 and 12% in the TLT from pre- to post-training, respectively, and were significantly greater in the OLT than the TLT (P < 0.05). The present study demonstrates that one leg aerobic high intensity interval cycling is superior to two legs in increasing whole body VO(2peak), indicating a muscle rather than a cardiovascular limitation to VO(2peak) in these COPD patients.