Objective: Kinesiophobia that persists in some patients after total hip arthroplasty (THA) is a significant factor hindering functional recovery. Its neural basis is not well understood. This exploratory prospective cohort study aimed to investigate changes in kinesiophobia-related brain activity before and after THA in patients with hip osteoarthritis (HOA) using task-related functional MRI (fMRI) during a motor task.
Methods: Six women (70.8 ± 13.1 years) who underwent THA for left HOA were assessed before and 2 weeks after surgery. Brain activity was measured using block-design fMRI during an active left hip flexion motor task. Clinical assessments included the Tampa Scale for Kinesiophobia short version (TSK-11), Visual Analog Scales (VAS) for kinesiophobia and pain, and gluteus medius muscle activity (% maximum voluntary contraction, %MVC) during the gait stance phase. Brain image analysis was performed using the General Linear Model in MATLAB R2024b and SPM25, with activation regions identified using Montreal Neurological Institute coordinates.
Results: fMRI analysis revealed activity in the anterior cingulate cortex (ACC) and middle cingulate cortex (MCC), both pre- and postoperatively. Postoperatively, TSK-11, kinesiophobia VAS, and pain VAS scores significantly decreased (P < 0.05), while %MVC increased (P < 0.01). Changes in ACC activity showed a positive correlation with changes in TSK-11 and kinesiophobia VAS. Changes in MCC activity showed a negative correlation with changes in pain VAS and %MVC.
Conclusion: These findings suggest that postoperative psychological improvements are associated with neuroplastic changes in the cingulate gyrus, which are associated with functional recovery. This suggests a potential neural mechanism involved in the recovery from kinesiophobia.
Keywords: arthroplasty; central nervous system; gyrus cinguli; hip; kinesiophobia; magnetic resonance imaging; replacement.
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