ESB Clinical Biomechanics Award 2018: Muscle atrophy-related increased joint loading after total hip arthroplasty and their postoperative change from 3 to 50 months

Abstract

Background: Hip joint loading is dominated by muscular activity. Thus, contact forces exceeding many times one's body weight are a consequence of imbalanced muscular activity. The objective was to analyze the influence of muscle atrophy after total hip arthroplasty on in vivo hip joint contact loading initially and long term. We hypothesized that an impaired periarticular muscle will lead to increase in vivo joint load, specifically in the long term.

Methods: Using a group of nine patients with instrumented hip implants, contact forces and muscle status were analyzed one day prior to 3 and 50 months after joint arthroplasty. In vivo load measurements were performed for different activities of daily living (ADL). Pre- and postoperative pelvic CT scans were analyzed to assess the periarticular muscle status. Finally, the muscle morphologies and in vivo contact forces were compared.

Results: At 3 months after total hip arthroplasty we found a significant correlation of lower lean gluteus minimus muscle (GMin) volume with higher loads during all tested activities of daily living. 50 months postoperatively statistical analysis revealed lower lean volume of the gluteus maximus to be correlated with higher joint loads in walking.

Conclusion: Our data generally show a good comparability between muscle status and joint contact forces and thus support our hypothesis that an impairment of periarticular musculature contributes to an increase of the in vivo joint loads after total hip arthroplasty. Effects were most pronounced during stair climbing and sit-down/stand-up from a chair at 3 months and during level walking at 50 months.