目的:全髋关节置换术(THA)后,作为严重髋关节骨性关节炎的一部分的肌肉缺陷可能持续长达两年。迄今为止,尚无研究详细评估改良的术后增强恢复(ERAS)概念对髋关节肌肉力量的中期益处。我们(1)研究了原发性THA的改良ERAS概念是否可以改善肌肉力量的中期康复,并且(2)使用经过验证的临床评分比较了临床结果。
方法:在前瞻性中,单盲,随机对照试验我们比较了在术后3个月和1年接受改良ERAS概念的原发性THA(n=12,ERAS组)和接受常规THA(n=12,非ERAS)的患者.为了评估等速肌力,使用了Biodex-测功机(峰值扭矩,总工作量,power).通过使用临床评分(患者相关结果测量(PROM),WOMAC指数(西安大略省和麦克马斯特大学骨关节炎指数),HHS(Harris-Hip-评分)和EQ-5D-3L评分。
结果:术后3个月,等速强度(峰值扭矩,总工作量,功率)和活动范围在改良ERAS组中明显更好。术后一年,屈曲总功明显高于非ERAS组,而峰值扭矩和功率没有显着差异。临床评分的评估显示两组在两个时间点都有出色的结果。然而,在临床结局方面,我们未发现两组间有任何显著差异.
结论:关于肌肉力量,本研究支持对原发性THA实施ERAS概念.与修改后的ERAS概念相结合,可在术后一年内实现更快的康复,反映在显著较高的肌肉力量(峰值扭矩,总工作量,power).可能,因为普通分数不够敏感,结果未反映在临床结局中.长期评估还需要更多更大规模的随机对照试验。
OBJECTIVE: Muscular deficits as part of severe osteoarthritis of the hip may persist for up to two years following total hip arthroplasty (THA). No
study has evaluated the mid-term benefit of a modified enhanced-recovery-after-surgery (ERAS) concept on muscular strength of the hip in detail thus far. We (1) investigated if a modified ERAS-concept for primary THA improves the mid-term rehabilitation of muscular strength and (2) compared the clinical outcome using validated clinical scores.
METHODS: In a prospective, single-blinded, randomized controlled
trial we compared patients receiving primary THA with a modified ERAS concept (n = 12, ERAS-group) and such receiving conventional THA (n = 12, non-ERAS) at three months and one year postoperatively. For assessment of isokinetic muscular strength, a Biodex-Dynamometer was used (peak-torque, total-work, power). The clinical outcome was evaluated by using clinical scores (Patient-Related-Outcome-Measures (PROMs), WOMAC-index (Western-Ontario-and-McMaster-Universities-Osteoarthritis-Index), HHS (Harris-Hip-Score) and EQ-5D-3L-score.
RESULTS: Three-months postoperatively, isokinetic strength (peak-torque, total-work, power) and active range of motion was significantly better in the modified ERAS group. One year postoperatively, the total work for flexion was significantly higher than in the Non-ERAS group, whilst peak-torque and power did not show significant differences. Evaluation of clinical scores revealed excellent results at both time points in both groups. However, we could not detect any significant differences between both groups in respect of the clinical outcome.
CONCLUSIONS: With regard to muscular strength, this
study supports the implementation of an ERAS concept for primary THA. The combination with a modified ERAS concept lead to faster rehabilitation for up to one-year postoperatively, reflected by significant higher muscular strength (peak-torque, total-work, power). Possibly, because common scores are not sensitive enough, the results are not reflected in the clinical outcome. Further larger randomized controlled trials are necessary for long-term evaluation.