Background

Total hip replacement with minimally invasive direct anterior approach using the “Smith Petersen” interval is an alternative technique to conventional surgery aimed at preserving the integrity of the muscles around the hip joint. This study aimed to observe hip biomechanics, gait variables, hip muscle activation and locomotor performance during three locomotor tasks (forward, lateral, and backward walking), in subjects who undergo total hip arthroplasty with direct anterior approach.

Methods

Fourteen patients with primary osteoarthritis who underwent direct anterior approach were included in the study. The optoelectronic 3-D motion analysis system integrated with an electromyography surface device was used to acquire the biomechanics of patients before surgery and at 3 and 6 months post-surgery. Spatio-temporal, dynamic, and hip muscle electromyographic parameters were analyzed and compared whit those of healthy controls.

Findings

Almost all gait parameters improved after surgery. The majority of gait variables neared to the control group at 6 months, while the hip joint range of motion did not. The abnormally increased activation of the muscles around the hip joint was reduced at 6 months post-surgery during all three locomotor tasks. Conversely, the altered gait phase-related electromyographic pattern did not change after the surgery.

Interpretation

Our results indicate that hip and gait function during several locomotor tasks improved after surgery, while simultaneously either preserve or restore the muscle activation around the hip joint. A full biomechanical evaluation of the hip function during locomotion may aid physicians and surgeons in optimizing the management of patients before and after hip replacement surgery.

中文翻译：

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全髋关节置换术的直接前路入路：三项步行任务中的髋部生物力学和肌肉激活

背景

采用“Smith Petersen”间隔的微创直接前路全髋关节置换术是传统手术的替代技术，旨在保持髋关节周围肌肉的完整性。本研究旨在观察接受直接前路全髋关节置换术的受试者在三种运动任务（向前、侧向和向后行走）期间的髋部生物力学、步态变量、髋部肌肉激活和运动表现。

方法

该研究包括 14 名接受直接前路入路的原发性骨关节炎患者。光电 3-D 运动分析系统与肌电图表面装置相结合，用于在手术前和手术后 3 个月和 6 个月获取患者的生物力学。分析了时空、动态和臀部肌肉肌电参数，并与健康对照组的参数进行了比较。

发现

手术后几乎所有的步态参数都有所改善。大多数步态变量在 6 个月时接近对照组，而髋关节运动范围没有。在所有三项运动任务中，髋关节周围肌肉异常增加的激活在术后 6 个月均减少。相反，改变的步态相关肌电图模式在手术后没有改变。

解释

我们的研究结果表明，在几个运动任务期间，髋关节和步态功能在手术后得到改善，同时保持或恢复髋关节周围的肌肉活动。在运动过程中对髋关节功能进行全面的生物力学评估可以帮助医生和外科医生优化髋关节置换手术前后的患者管理。