Improving Rehabilitation Outcomes After Total Hip Arthroplasty

目前，美国每年进行的全髋关节成形术(THA)超过230,000例 减轻与骨关节炎(OA)相关的疼痛和残疾。然而，肌肉力量的完全恢复和 髋关节置换术后的功能仍然是一个主要的挑战。影响体能完全恢复的主要因素 功能是慢性运动补偿的存在，这可能是最大的康复 挑战之后。这些运动补偿反映了未能完全弥补由此造成的力量损失 髋关节骨关节炎和全髋关节置换术，以及未能将肌肉力量增加整合到功能性运动中。 功能性任务执行过程中的功能力量整合指的是身体 产生稳定、协调的动作。在髋关节周围，最佳的功能力量整合在很大程度上 依赖于髋部外展肌肉产生髋部外展瞬间的能力，这可以稳定骨盆 在单边姿态任务中。因此，在功能性任务中不能整合髋外展肌力量会导致 功能任务中髋关节外展程度较低，导致骨盆稳定性和运动性较差 补偿。这种功能强度整合的缺乏可能解释了功能上挥之不去的缺陷 术后恢复正常。然而，目前的康复做法并不以整合力量和 功能性运动以解决运动补偿，以改善身体功能。 强调全髋关节置换术后功能力量整合的康复计划有可能 通过改善大髋关节的运动补偿显著改善术后身体功能 功能过程中的外展肌力量和招募，提供更好的骨盆控制和运动质量。 因此，拟议的研究涉及一项随机对照试验，以确定为期8周的 功能力量整合(FSI)计划改善身体功能和肌肉表现超过 对照干预(CON)在单侧全髋关节置换术中的应用。次要目标是确定FSI是否 改善功能性活动(步行和爬楼梯)时的运动补偿。 功能和生物力学结果将在术前(前)和术后三个月进行评估 时间点：干预中点，4周(POST1)，干预终点，8周(POST2)(主要 终点)和后期恢复，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).