Improving Rehabilitation Outcomes After Total Hip Arthroplasty

目前，美国每年进行超过 230,000 例全髋关节置换术 (THA) 缓解与骨关节炎（OA）相关的疼痛和残疾。但肌力完全恢复 髋关节置换术后的功能仍然是一个重大挑战。影响身体完全恢复的主要因素 功能是存在慢性运动代偿，这可能是最大的康复 THA 后的挑战。这些运动补偿反映了未能完全修复所导致的力量损失 髋关节 OA 和 THA 以及未能将肌肉力量增益融入功能性运动中。 执行功能任务期间的功能力量整合是指身体 产生稳定、协调的动作。在髋关节周围，最佳的功能力量整合很大程度上取决于 取决于髋部外展肌产生髋部外展力矩的能力，从而稳定骨盆 在执行单边姿态任务时。因此，在功能任务期间无法整合髋关节外展肌力量会导致 功能性任务期间髋部外展力矩较低，导致骨盆稳定性和运动较差 补偿。这种功能力量整合的缺乏可能解释了功能力量长期存在的缺陷。 THA 后恢复。然而，目前的康复实践并不以力量和力量的整合为目标。 功能性运动解决运动代偿问题，改善身体机能。 强调 THA 后功能力量整合的康复计划有可能 通过更大的髋关节改善运动代偿，显着改善术后身体功能 功能期间的外展肌力量和募集，提供更好的骨盆控制和运动质量。 因此，拟议的调查涉及一项随机对照试验，以确定是否进行为期 8 周的研究 功能力量整合（FSI）计划对身体功能和肌肉表现的改善超过 对接受单侧 THA 的退伍军人进行控制干预 (CON)。第二个目标是确定 FSI 是否 改善功能活动（步行和爬楼梯）期间的运动补偿。 功能和生物力学结果将在术前 (PRE) 和术后 3 小时进行评估 时间点：干预中点，4周（POST1），干预终点，8周（POST2）（主要 终点）和晚期恢复，26 周（POST3）。

Currently, over 230,000 total hip arthroplasties (THA) are performed each year in the United States to alleviate pain and disability associated with osteoarthritis (OA). However, full recovery of muscle strength and function after hip arthroplasty remains a major challenge. A major factor influencing full recovery of physical function is the presence of chronic movement compensations, which may be the biggest rehabilitative challenge after THA. These movement compensations reflect failure to fully remediate strength losses resulting from hip OA and THA as well as a failure to integrate muscle strength gains into functional movement. Functional strength integration during performance of functional tasks refers to the ability of the body to produce stable, coordinated movements. Around the hip joint, optimal functional strength integration is largely dependent on the ability of hip abductor muscles to produce hip abduction moments, which stabilize the pelvis during unilateral stance tasks. Thus, inability to integrate hip abductor strength during functional tasks leads to lower hip abduction moments during functional tasks, resulting in poor pelvic stability and movement compensations. This lack of functional strength integration possibly explains lingering deficits in functional recovery after THA. However, current rehabilitation practices do not target the integration of strength and functional movement to resolve movement compensations for improved physical function. A rehabilitation program emphasizing functional strength integration after THA has the potential to substantially improve postoperative physical function by improving movement compensations with greater hip abductor strength and recruitment during function, providing greater pelvic control and movement quality. Therefore, the proposed investigation involves a randomized controlled trial to determine if an 8-week functional strength integration (FSI) program improves physical function and muscle performance more than control intervention (CON) in Veterans undergoing unilateral THA. The secondary goal is to determine if FSI improves movement compensations during functional activity (walking and stair climbing). Functional and biomechanical outcomes will be assessed pre-operatively (PRE) and at three postoperative time points: intervention mid-point, 4 weeks (POST1), intervention end-point, 8 weeks (POST2) (primary endpoint) and late recovery, 26 weeks (POST3).