10/10/2022
ท่าออกกำลังกายมีหลากหลายแบบ
แบบไหนที่เหมาะกับคุณ มาปรึกษาได้ที่คลินิกนะคะ
Early Abductor muscle strengthening 💪 💪 in Total Hip Arthroplasty (THA) in patients operated with minimally-invasive anterolateral approach for developmental hip dysplasia
📌 A latest study shows that regardless of the surgical approach, a muscle whose tendon is detached from its insertion during hip replacement surgery is likely to demonstrate persistent atrophy 6 months following THA. https://pubmed.ncbi.nlm.nih.gov/36192819/
👉 Benedetti and colleagues conducted a multicentre, prospective, randomised clinical trial in 110 patients with developmental hip dysplasia (DDH) after total hip replacement with a minimally-invasive anterolateral approach (reattachment of gluteus medius and minimum, cementless implantation). https://pubmed.ncbi.nlm.nih.gov/31544524/
👉 All patients underwent a period of standard early postoperative rehabilitation in agreement with the evidence (included ankle pumps, quadriceps and gluteal strengthening, active exercises for hip range of motion, early mobilisation including transfer training (bed-to-standing and toilet transfer), gait training, and education in daily living activities). https://pubmed.ncbi.nlm.nih.gov/19238130/, https://pubmed.ncbi.nlm.nih.gov/24172644/
👉 In addition to the standard postoperative treatment, the Study Group performed a 2-week daily rehabilitation training as outpatients in the second postoperative period (once the orthopaedic surgeon authorised full weight-bearing on the operated limb), aimed exclusively at strengthening the abductor muscles. (s. figure). https://pubmed.ncbi.nlm.nih.gov/21566069/, https://pubmed.ncbi.nlm.nih.gov/23770355/, https://pubmed.ncbi.nlm.nih.gov/24648642/
⏳ Phase 1 (1st week)
🚶♀ Walking on treadmill with 5% inclination: Recommended 5 minutes of walking at 2 km/hour.
🏋♂ Double leg bridge: Exercise in 3 series, with 8 repetitions each. Each time the pelvis is raised, it is held in place by a 5-second isometric contraction.
🏋♂ Traditional clamshell: Exercise in 3 series, with 8 repetitions each. Each time the limb is abducted, it is held in place by a 5-second isometric contraction.
🏋♂ Clamshell with hips extended: Exercise in 3 series, with 8 repetitions each. Each time the limb is abducted, it is held in place by a 5-second isometric contraction.
🏋♂ Single leg stance: Exercise with 3 repetitions, with maintenance of the monopodal position for 20 seconds.
🏋♂ Hip extension while prone: Exercise in 3 series, with 12 repetitions each. Each time the limb is extended, it is held in place by a 2-second isometric contraction. During exercise the leg must be maintained perpendicular to the work surface.
🏋♂ External rotation of the hip while on a stool: Exercise in 3 series, with 12 repetitions each. Each time the limb is rotated externally, it is held in place by a 2-second isometric contraction.
⏳ Phase 2 (2nd week)
🚶♀Walking on treadmill with 5% inclination: Recommended 7 minutes of walking at 2 km/hour.
🏋♀ Single leg bridge on operated limb: Exercise in 3 series, with 8 repetitions each. Each time the pelvis is raised, it is held in place by a 5-second isometric contraction.
🏋♀ Abductor wall stretch: Exercise in 3 series, with 8 repetitions each. Each time the limb is abducted, it is held in place by a 2-second isometric contraction. The hip is kept in neutral rotation.
🏋♀ Abductor wall stretch with internal and external rotations: Exercise in 3 series, with 8 repetitions each. Each time the limb is abducted, it is held in place by a 2-second isometric contraction. The exercise is repeated twice, 1 with external rotated hip and 1 with internal rotated hip.
🏋♀ Quadrupled forearm/leg lift: Exercise in 3 series, with 8 repetitions each. Starting from a quadrupedal position, for each repetition the opposite upper and lower limbs extended. Position held with a 2-second isometric contraction. During exercise, the legs and arms must be maintained perpendicular to the work surface.
🏋♀ External rotation of the hip on a stool (with resistance band): Exercise in 3 sets, with 12 repetitions each. Each time the limb is rotated externally, it is held in place by a 2-second isometric contraction.
🏋♀ Prone heel squeeze: Exercise in 3 sets, with 12 repetitions each. Each time the limbs are rotated externally, they are held in place by a 2-second isometric contraction.
📈 Results: All clinical variables assessed 3 and 6 months postoperatively (hip ROM, 10 Metre Walk Test, Harris Hip Score, WOMAC, SF-12) showed a greater improvement in the Study group. In particular, abductor strength at 6 months post-op improved by 92.5% with respect to 35.7% in the Control Group.
📣 In conclusion, in addition to a standard rehabilitation, an optimal rehabilitation program for strengthening the gluteal muscles for pelvis stabilisation in patients with DDH who have undergone arthroplasty, determines an increase in muscle strength that improves functional performance and patient satisfaction.
