The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Hip Strengthening After Total Knee Arthroplasty: A Meta-analysis and Systematic Review

Document Type : SYSTEMATIC REVIEW

Authors
Mohammad Daher 1
Michel Estephan 2
Ali Ghoul 1
Jean Tarchichi 1
Jad Mansour 2
1 Hotel Dieu de France, Orthopedics department, Beirut, Lebanon
2 Division of Orthopaedic Surgery and Sports Medicine, McGill University Health Centre, Montreal, Quebec, Canada
10.22038/abjs.2024.76202.3520
Abstract
Objectives: As the population is growing older, incidence of knee osteoarthritis is largely increasing 
and the rate total knee arthroplasty surgery is following that same trend. However, patients postoperatively are retaining weakness in the quadriceps and hip abductors for a period reaching up to 3 
years following surgery. The current literature results on the effectivenes s of rehabilitation programs 
that also includes hip strengthening exercises are still highly contradicting. This meta -analysis studies 
and assesses the efficacy of hip strengthening exercises following total knee arthroplasty surgery.
Methods: PubMed, Embase, Cochrane and Google Scholar (page 1-20) were searched till January 2024. The 
clinical outcomes consisted of the post-operative tests (6MWT, TUG, SLS), pain, and range of motion (flexion and 
extension).
Results: Three randomized clinical studies were included in the meta-analysis. When compared to the standard 
rehabilitation, hip strengthening exercises proved a better improvement of single leg stance with no difference 
observed in the remaining outcomes.
Conclusion: Hip strengthening exercise protocols ensured a better improvement of single leg stance scores. 
However, no difference was observed in the remaining analyzed outcomes. This contradictions between studies 
can be explained by the different physical therapy protocols used. Nevertheless, more randomized controlled studies 
are needed to confirm such results.
 Level of evidence: II
Keywords
Hip abductors
Knee osteoarthritis
Rehabilitation
Total knee arthroplasty
Total knee replacement
Subjects
  1. Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987; 30(8):914-918. doi:10.1002/art.1780300811.
  2. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther. 2005; 35(7):424-436. doi:10.2519/jospt.2005.35.7.424.
  3. Petterson SC, Mizner RL, Stevens JE, et al. Improved function from progressive strengthening interventions after total knee arthroplasty: a randomized clinical trial with an imbedded prospective cohort. Arthritis Rheum. 2009; 61(2):174-183. doi:10.1002/art.24167.
  4. Bade MJ, Kohrt WM, Stevens-Lapsley JE. Outcomes before and after total knee arthroplasty compared to healthy adults. J Orthop Sports Phys Ther. 2010; 40(9):559-567. doi:10.2519/jospt.2010.3317.
  5. Mizner RL, Snyder-Mackler L. Altered loading during walking and sit-to-stand is affected by quadriceps weakness after total knee arthroplasty. J Orthop Res. 2005; 23(5):1083-1090. doi:10.1016/j.orthres.2005.01.021.
  6. Schache MB, McClelland JA, Webster KE. Lower limb strength following total knee arthroplasty: A systematic review. Knee. 2014; 21(1):12-20. doi:10.1016/j.knee.2013.08.002.
  7. Walsh M, Woodhouse LJ, Thomas SG, Finch E. Physical Impairments and Functional Limitations: A Comparison of Individuals 1 Year After Total Knee Arthroplasty With Control Subjects. Phys Ther. 1998; 78(3):248-258. doi:10.1093/ptj/78.3.248.
  8. Alnahdi AH, Zeni JA, Snyder-Mackler L. Hip Abductor Strength Reliability and Association with Physical Function After Unilateral Total Knee Arthroplasty: A Cross-Sectional Study. Phys Ther. 2014; 94(8):1154-1162. doi:10.2522/ptj.20130335.
  9. Loyd BJ, Jennings JM, Judd DL, et al. Influence of Hip Abductor Strength on Functional Outcomes before and After Total Knee Arthroplasty: Post Hoc Analysis of a Randomized Controlled Trial. Phys Ther. 2017; 97(9):896-903. doi:10.1093/ptj/pzx066.
  10. Piva SR, Teixeira PEP, Almeida GJM, et al. Contribution of Hip Abductor Strength to Physical Function in Patients with Total Knee Arthroplasty. Phys Ther. 2011; 91(2):225-233. doi:10.2522/ptj.20100122.
  11. Harikesavan K, Chakravarty RD, Maiya AG, Hegde SP, Y. Shivanna S. Hip Abductor Strengthening Improves Physical Function Following Total Knee Replacement: One-Year Follow-Up of a Randomized Pilot Study. Open Rheumatol J. 2017; 11(1):30-42. doi:10.2174/1874312901711010030.
  12. Do K, Yim J. Effects of muscle strengthening around the hip on pain, physical function, and gait in elderly patients with total knee arthroplasty: A randomized controlled trial. Healthc. 2020; 8(4). doi:10.3390/healthcare8040489.
  13. Schache MB, McClelland JA, Webster KE. Incorporating hip abductor strengthening exercises into a rehabilitation program did not improve outcomes in people following total knee arthroplasty: a randomised trial. J Physiother. 2019; 65(3):136-143. doi:10.1016/j.jphys.2019.05.008.
  14. Sled EA, Khoja L, Deluzio KJ, Olney SJ, Culham EG. Effect of a home program of hip abductor exercises on knee joint loading, strength, function, and pain in people with knee osteoarthritis: a clinical trial. Phys Ther. 2010; 90(6):895-904. doi:10.2522/ptj.20090294.
  15. Minns Lowe CJ, Barker KL, Dewey M, Sackley CM. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: systematic review and meta-analysis of randomised controlled trials. BMJ.

 

2007; 335(7624):812. doi:10.1136/bmj.39311.460093.BE.

  1. Mündermann A, Asay JL, Mündermann L, Andriacchi TP. Implications of increased medio-lateral trunk sway for ambulatory mechanics. J Biomech. 2008; 41(1):165-170. doi:10.1016/j.jbiomech.2007.07.001.
  2. Mündermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. Arthritis Rheum. 2005; 52(9):2835-2844. doi:10.1002/art.21262.
  3. Yamada H, Koshino T, Sakai N, Saito T. Hip adductor muscle strength in patients with varus deformed knee. Clin Orthop Relat Res. 2001 ;( 386):179-185. doi:10.1097/00003086-200105000-00023.
  4. Gottschall JS, Okita N, Sheehan RC. Muscle activity patterns of the tensor fascia latae and adductor longus for ramp and stair walking. J Electromyogr Kinesiol. 2012; 22(1):67-73. doi:10.1016/j.jelekin.2011.10.003.
  5. Henderson KG, Wallis JA, Snowdon DA. Active physiotherapy interventions following total knee arthroplasty in the hospital and inpatient rehabilitation settings: a systematic review and meta-analysis. Physiotherapy. 2018; 104(1):25-35. doi:10.1016/j.physio.2017.01.002.
  6. Bade MJ, Struessel T, Dayton M, et al. Early High-Intensity versus Low-Intensity Rehabilitation after Total Knee Arthroplasty: A Randomized Controlled Trial. Arthritis Care Res (Hoboken). 2017; 69(9):1360-1368. doi:10.1002/acr.23139.

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 6
June 2024
Pages 373-379

  • Receive Date 14 November 2023
  • Revise Date 06 March 2024
  • Accept Date 05 March 2024