DOI QR코드

DOI QR Code

The Effect of adding Hip Abductor Strengthening to Conventional Rehabilitation on Muscular Strength and Physical Function following Total Knee Replacement

  • Kim, San-Han (Department of Physical Therapy Graduate School Sahmyook University) ;
  • Park, Hye-Kang (Rehabilitation Center, Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital) ;
  • Lee, Wan-Hee (Department of Physical Therapy, Sahmyook University, College of Health Science)
  • Received : 2021.12.01
  • Accepted : 2022.01.28
  • Published : 2022.03.31

Abstract

Objective: This study aimed to investigate the effect of adding hip abductor strengthening to conventional rehabilitation on muscle strength and physical function following total knee replacement (TKR) for knee osteoarthritis. Design: Randomized controlled trial Methods: Thirty-five participants were randomly allocated to exercise groups I (n=18) and II (n=17). Group I underwent hip abductor training and conventional rehabilitation for 30 min per day, 5 days per week for 4 weeks. Group II underwent conventional rehabilitation for 30 min per day, 5 days per week for 4 weeks. The participants in both groups also received continuous passive motion therapy for 15 min per day, 5 days per week for 4 weeks. To investigate the effect of the intervention, the Biodex dynamometer was used to measure the peak torque of both knee extensors and hip abductors. This study used the Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS) to assess physical function, as well as the figure-of-8 walk test (F8W) and the stair climb test (SCT). Results: According to the interventions, exercise groups I and II showed significantly improved muscle strength and KOS-ADLS, F8W, and SCT scores (p<0.001). Compared with that of exercise group II, exercise group I showed significantly improved hip abductor strength (p<0.001) and KOS-ADLS, F8W, and SCT scores (p<0.05). Conclusions: The results of this study indicate that the combination of hip abductor strengthening and conventional rehabilitation is an effective exercise method to increase hip abductor muscle strength and physical function after TKR.

Keywords

References

  1. Cram, P., Lu, X., Kates, S. L., Singh, J. A., Li, Y., & Wolf, B. R. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012;308(12):1227-1236. https://doi.org/10.1001/2012.jama.11153
  2. Stevens-Lapsley, J. E., Balter, J. E., Kohrt, W. M., & Eckhoff, D. G. Quadriceps and hamstrings muscle dysfunction after total knee arthroplasty. Clin Orthop Relat Res. 2010;468(9):2460-2468. https://doi.org/10.1007/s11999-009-1219-6
  3. Mizner, R. L., Petterson, S. C., Stevens, J. E., Vandenborne, K., & Snyder-Mackler, L. Early quadriceps strength loss after total knee arthroplasty. The contributions of muscle atrophy and failure of voluntary muscle activation. J Bone Joint Surg Am. 2005;87(5):1047-1053. https://doi.org/10.2106/00004623-200505000-00016
  4. Berman, A. T., Bosacco, S. J., & Israelite, C. Evaluation of total knee arthroplasty using isokinetic testing. Clin Orthop Relat Res. 1991;271(271):106-113.
  5. Berger, M. J., McKenzie, C. A., Chess, D. G., Goela, A., & Doherty, T. J. Quadriceps neuromuscular function and self-reported functional ability in knee osteoarthritis. J Appl Physiol (1985). 2012;113(2):255-262. https://doi.org/10.1152/japplphysiol.00947.2011
  6. Silva, M., Shepherd, E. F., Jackson, W. O., Pratt, J. A., McClung, C. D., & Schmalzried, T. P. Knee strength after total knee arthroplasty. J Arthroplasty. 2003;18(5):605-611. https://doi.org/10.1016/S0883-5403(03)00191-8
  7. Westby, M. D., & Backman, C. L. Patient and health professional views on rehabilitation practices and outcomes following total hip and knee arthroplasty for osteoarthritis: a focus group study. BMC Health Serv Res. 2010;10(1):119. https://doi.org/10.1186/1472-6963-10-119
  8. Costa, R. A., Oliveira, L. M. d., Watanabe, S. H., Jones, A., & Natour, J. Isokinetic assessment of the hip muscles in patients with osteoarthritis of the knee. Clinics (Sao Paulo). 2010;65(12):1253-1259. https://doi.org/10.1590/S1807-59322010001200006
  9. Neumann, D. A. Kinesiology of the hip: a focus on muscular actions. J Orthop Sports Phys Ther. 2010;40(2):82-94. https://doi.org/10.2519/jospt.2010.3025
  10. Mundermann, A., Dyrby, C. O., & Andriacchi, T. P. Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. Arthritis Rheum. 2005;52(9):2835-2844. https://doi.org/10.1002/art.21262
  11. Hinman, R. S., Hunt, M. A., Creaby, M. W., Wrigley, T. V., McManus, F. J., & Bennell, K. L. Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis Care Res. 2010;62(8):1190-1193. https://doi.org/10.1002/acr.20199
  12. Heiderscheit, B. C. Lower extremity injuries: is it just about hip strength? J Orthop Sports Phys Ther. 2010;40(2):39-41. https://doi.org/10.2519/jospt.2010.0102
  13. Piva, S. R., Teixeira, P. E., Almeida, G. J., Gil, A. B., DiGioia, A. M., Levison, T. J., & Fitzgerald, G. K. Contribution of hip abductor strength to physical function in patients with total knee arthroplasty. Phys Ther. 2011;91(2):225-233. https://doi.org/10.2522/ptj.20100122
  14. Han, A. S. Y., et al Early rehabilitation after total knee replacement surgery: a multicenter, noninferiority, randomized clinical trial comparing a home exercise program with usual outpatient care. Arthritis Care Res. 2015;67(2):196-202. https://doi.org/10.1002/acr.22457
  15. Alnahdi, A. H., Zeni, J. A., & Snyder-Mackler, L. Hip abductor strength reliability and association with physical function after unilateral total knee arthroplasty: a cross-sectional study. Phys Ther. 2014;94(8):1154-1162. https://doi.org/10.2522/ptj.20130335
  16. Schache, M. B., McClelland, J. A., & Webster, K. E. Does the addition of hip strengthening exercises improve outcomes following total knee arthroplasty? A study protocol for a randomized trial. BMC Musculoskelet Disord. 2016;17(1):259. https://doi.org/10.1186/s12891-016-1104-x
  17. Aagaard, P., Simonsen, E. B., Magnusson, S. P., Larsson, B., & Dyhre-Poulsen, P. A new concept for isokinetic hamstring: quadriceps muscle strength ratio. Am J Sports Med. 1998;26(2):231-237. https://doi.org/10.1177/03635465980260021201
  18. Chang, T. F., Liou, T. H., Chen, C. H., Huang, Y. C., & Chang, K. H. Effects of elastic-band exercise on lower-extremity function among female patients with osteoarthritis of the knee. Disabil Rehabil. 2012;34(20):1727-1735. https://doi.org/10.3109/09638288.2012.660598
  19. Ferber, R., Kendall, K. D., & Farr, L. Changes in knee biomechanics after a hip-abductor strengthening protocol for runners with patellofemoral pain syndrome. J Athl Train. 2011;46(2):142-149. https://doi.org/10.4085/1062-6050-46.2.142
  20. Bade, M. J., & Stevens-Lapsley, J. E. Early high-intensity rehabilitation following total knee arthroplasty improves outcomes. J Orthop Sports Phys Ther. 2011;41(12):932-941. https://doi.org/10.2519/jospt.2011.3734
  21. Antich, T. J., & Brewster, C. E. Modification of quadriceps femoris muscle exercises during knee rehabilitation. Phys Ther. 1986;66(8):1246-1251. https://doi.org/10.1093/ptj/66.8.1246
  22. Irrgang, J. J., Snyder-Mackler, L., Wainner, R. S., Fu, F. H., & Harner, C. D. Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am. 1998;80(8):1132-1145. https://doi.org/10.2106/00004623-199808000-00006
  23. Hess, R. J., Brach, J. S., Piva, S. R., & VanSwearingen, J. M. Walking skill can be assessed in older adults: validity of the Figure-of-8 Walk Test. Phys Ther. 2010;90(1):89-99. https://doi.org/10.2522/ptj.20080121
  24. Kennedy, D. M., Stratford, P. W., Wessel, J., Gollish, J. D., & Penney, D. Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. BMC Musculoskelet Disord, 2005;6(1):3. https://doi.org/10.1186/1471-2474-6-3
  25. Sled, E. A., Khoja, L., Deluzio, K. J., Olney, S. J., & Culham, E. G. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial. Phys Ther. 2010;90(6):895-904. https://doi.org/10.2522/ptj.20090294
  26. Selistre, L. F. A., Goncalves, G. H., Nakagawa, T. H., Petrella, M., Jones, R. K., & Mattiello, S. M. The role of hip abductor strength on the frontal plane of gait in subjects with medial knee osteoarthritis. Physiother Res Int. 2019;24(4):e1779.
  27. Harikesavan, K., Chakravarty, R. D., Maiya, A. G., Hegde, S. P., & Y Shivanna, S. Y. Hip abductor strengthening improves physical function following total knee replacement: one-year follow-up of a randomized pilot study. Open Rheumatol J. 2017;11:30-42. https://doi.org/10.2174/1874312901711010030
  28. Benedetti, M. G., Catani, F., Bilotta, T. W., Marcacci, M., Mariani, E., & Giannini, S. Muscle activation pattern and gait biomechanics after total knee replacement. Clin Biomech (Bristol Avon). 2003;18(9):871-876. https://doi.org/10.1016/S0268-0033(03)00146-3
  29. Iijima, H., Yorozu, A., Suzuki, Y., Eguchi, R., Aoyama, T., & Takahashi, M. Specific contribution of hip abductor muscle strength to turning movement in individuals with knee osteoarthritis. Osteoarthr Cartil. 2018;26:S388.
  30. Mizner, R. L., Petterson, S. C., & Snyder-Mackler, L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005;35(7):424-436. https://doi.org/10.2519/jospt.2005.35.7.424