Long-term functional outcomes after total hip arthroplasty: a cross-sectional study with control group
DOI:
https://doi.org/10.11606/issn.2317-0190.v33e241536Keywords:
Arthroplasty, Replacement, Hip, Muscle Strength, Gait Analysis, Quality of LifeAbstract
Total hip arthroplasty (THA) is effective in reducing pain and restoring function, but gait and strength deficits may still be present after clinical recovery. Objective: To compare hip muscle strength, functional status, gait, and quality of life between individuals who underwent THA and healthy controls. Method: Cross-sectional comparative study. Participants who underwent THA using the Moore technique (≥ 12 months postoperative) were compared with age- and sex-matched controls. Assessment included isometric muscle strength (handheld dynamometer), functional status (Harris Hip Score – HHS), quality of life (WHOQOL-bref), and two-plane gait kinematic analysis. Independent t-tests and Mann-Whitney tests were used (p ≤ 0,05). Results: Forty-five participants were included (THA= 25; control= 20). The THA group showed reduced muscle strength in all evaluated muscle groups (p ≤ 0.001) and lower hip and trunk range of motion during gait compared with controls. HHS indicated reasonable functional status. No significant differences were found in quality of life. Conclusion: Individuals with THA exhibited reduced muscle strength and gait alterations compared with controls, while maintaining reasonable functional status and satisfactory quality of life at the time of the assessment.
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GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508-e522. Doi: http://dx.doi.org/10.1016/S2665-9913(23)00163-7
Ferreira MC, Oliveira JCP, Zidan FF, Franciozi CES, Luzo MVM, Abdalla RJ. Artroplastia total de joelho e quadril: a preocupante realidade assistencial do Sistema Único de Sa-úde brasileiro. Rev Bras Ortop. 2018;53(4):432-40. Doi: http://dx.doi.org/10.1016/j.rbo.2016.11.002
Liu XW, Zi Y, Xiang LB, Wang Y. Total hip arthroplasty: areview of advances, advantages and limitations. Int J Clin Exp Med. 2015;8(1):27-36.
Zhong L, Kwong PW-H, Zhang JJ, Sidarta A, Yu CC-W. Gait kinetics before and after total hip arthroplasty in people with unilateral hip osteoarthritis. PLoS One 20(6): e0326502. Doi: http://dx.doi.org/10.1371/journal.pone.0326502
Kim YH, Park JW, Patel C, Kim DY. Polyethylene wear and osteolysis after cementless total hip arthroplasty with alu-mina-on-highly cross-linked polyethylene bearings in patients younger than thirty years of age. J Bone Joint Surg Am. 2013;95(12):1088-93. Doi: http://dx.doi.org/10.2106/JBJS.L.01211
Moretti VM, Post ZD. Surgical Approaches for Total Hip Arthroplasty. Indian J Orthop. 2017;51(4):368-376. Doi: http://dx.doi.org/10.4103/ortho.IJOrtho_317_16
Smith JS, Ozuzu OC, Haffer H. Total Hip Arthroplasty Trends in Younger Patients: Evidence from National Registries. J Arthroplasty. 2024;39(2):450-6.
Johnson-Lynn SE, Guppy IS, Inman D, et al. Long-term implant survivorship and modes of failure in modern primary total hip arthroplasty: a systematic review and meta-analysis. Bone Joint J. 2023;105-B(6):581-91.
Ang JJM, Onggo JR, Stokes CM, Ambikaipalan A. Comparing direct anterior approach versus posterior approach or lateral approach in total hip arthroplasty: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2023;33(7):2773-2792. Doi: http://dx.doi.org/10.1007/s00590-023-03528-8
Miller LE, Sershon RA, Browne JA. The direct anterior approach for total hip arthroplasty: a systematic review of outcomes and learning curve. JBJS Rev. 2023;11(3).
Lepley AS, Lepley LK. Mechanisms of Arthrogenic Muscle Inhibition. J Sport Rehabil. 2021;31(6):707-716. Doi: http://dx.doi.org/10.1123/jsr.2020-0479
Guimarães RP, Alves DPL, Silva GB, Bittar ST, Ono NK, Hon-da E, et al. Tradução e adaptação transcultural do instrumento de avaliação do quadril "Harris Hip Score". Acta Ortop Bras. 2010; 18(3):142-7 Doi: http://dx.doi.org/10.1590/S1413-78522010000300005
Snell DL, Siegert RJ, Surgenor LJ, Dunn JA, Hooper GJ. Evaluating quality of life outcomes following joint replacement: psychometric evaluation of a short form of the WHOQOL-Bref. Qual Life Res. 2016;25(1):51-61. Doi: http://dx.doi.org/10.1007/s11136-015-1044-1
Piva SR, Goodnite EA, Childs JD. Strength around the hip and flexibility of soft tissues in individuals with and without patel-lofemoral pain syndrome. J Orthop Sports Phys Ther. 2005;35(12):793-801. Doi: http://dx.doi.org/10.2519/jospt.2005.35.12.793
Colgan G, Walsh M, Bennett D, Rice J, O'Brien T. Gait analysis and hip extensor function early post total hip replacement. J Orthop. 2016;13(3):171-6. Doi: http://dx.doi.org/10.1016/j.jor.2016.03.005
Tateuchi H, Tsukagoshi R, Fukumoto Y, Oda S, Ichihashi N. Immediate effects of different ankle pushoff instructions dur-ing walking exercise on hip kinematics and kinetics in individuals with total hip arthroplasty. Gait Posture. 2011;33(4):609-14. Doi: http://dx.doi.org/10.1016/j.gaitpost.2011.01.018
Miettinen HJA, Mäkirinne-Kallio N, Kröger H, Miettinen SSA. Health-Related Quality of Life after Hip and Knee Arthroplasty Operations. Scand J Surg. 2021;110(3):427-433. Doi: http://dx.doi.org/10.1177/1457496920952232
Singh V, Bieganowski T, Huang S, Karia R, Davidovitch RI, Schwarzkopf R. The Forgotten Joint Score patient-acceptable symptom state following primary total hip arthroplasty. Bone Jt Open. 2022;3(4):307-313. Doi: http://dx.doi.org/10.1302/2633-1462.34.BJO-2022-0010.R1
Kawano T, Sawada Y, Nishiguchi S. Preoperative Muscle Quality as a Predictor of Physical Function after Total Hip Arthroplasty. J Clin Med. 2025;14(6):1861.
Aleksandrowicz K, Winiarska A, Dominiak D. The Effect of Total Hip Replacement with Post-Surgical Monitoring and Physiotherapeutic Intervention on Gait in Women: A One-Year Prospective Study Using the Statistical Parametric Mapping Method. J Clin Med.2025;14(3):964.
Singh G, Zha S, Richards J. A narrative review of muscular strength recovery in hip replacement patients. J Clin Orthop Trauma. 2024;52:102074.
Okazawa K, Furu M, Kamiya M. Association of early gait parameters with functional recovery following total hip arthroplasty: a prospective cohort study. Sci Rep. 2025;15(1):13272
Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsidera-tion? Arch Phys Med Rehabil. 2012;93(7):1292-4. Doi: http://dx.doi.org/10.1016/j.apmr.2012.02.014
Lan P, Chen X, Fang Z, Zhang J, Liu S, Liu Y. Effects of Comorbidities on Pain and Function After Total Hip Arthroplasty. Front Surg. 2022;9:829303. Doi: http://dx.doi.org/10.3389/fsurg.2022.829303
Ben Elyahu R, Ohana N, Agabaria E, Biadsi A, Segal D, Yaaco-bi E, et al. Direct Anterior vs. Direct Lateral Approach Total Hip Arthroplasty for Displaced Femoral Neck Fracture. J Clin Med. 2023;12(15):5019. Doi: http://dx.doi.org/10.3390/jcm12155019
Judd DL, Dennis DA, Thomas AC, Wolfe P, Dayton MR, Ste-vens-Lapsley JE. Muscle strength and functional recovery during the first year after THA. Clin Orthop Relat Res. 2014;472(2):654-64. Doi: http://dx.doi.org/10.1007/s11999-013-3136-y
Winther SB, Foss OA, Husby OS, Wik TS, Klaksvik J, Husby VS. Muscular strength and function after total hip arthroplasty performed with three different surgical approaches: one-year follow-up study. Hip Int. 2019;29(4):405-411. Doi: 10.1177/1120700018810673
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