Advertisement

Effects of perioperative exercise therapy combined with nutritional supplementation on functional recovery after fast-track total hip arthroplasty

  • Kazunari Ninomiya
    Correspondence
    Corresponding author. Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan. Fax: +81 467-47-2370.
    Affiliations
    Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan

    Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
    Search for articles by this author
  • Naonobu Takahira
    Affiliations
    Department of Orthopaedic Surgery of Clinical Medicine, Rehabilitation Sciences and Functional Restoration, Science of Sensory and Motor Control, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan

    Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
    Search for articles by this author
  • Takashi Ikeda
    Affiliations
    Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan

    School of Nursing and Rehabilitation Sciences, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
    Search for articles by this author
  • Koji Suzuki
    Affiliations
    Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan
    Search for articles by this author
  • Ryoji Sato
    Affiliations
    Department of Rehabilitation, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan
    Search for articles by this author
  • Masahiko Mihara
    Affiliations
    Department of Orthopaedic Surgery, Shonan Kamakura Joint Reconstruction Center, 5-4-17 Dai, Kamakura, Kanagawa 247-0061, Japan
    Search for articles by this author
Published:October 19, 2022DOI:https://doi.org/10.1016/j.jos.2022.09.012

      Abstract

      Background

      The combination of exercise therapy combined with nutritional supplementation (Nutr) is widely used for frail or sarcopenic older persons. However, the effects of Nutr in elderly patients after fast-track total hip arthroplasty (THA) are unknown. This study examined the effects of perioperative Nutr on muscle strength, functional performance, and quality of life (QOL) in frail elderly women after fast-track THA.

      Methods

      A total of 58 frail elderly women aged 65–80 years scheduled for unilateral primary THA were randomly allocated to two groups: the physical exercise (Ex) combined with Nutr (Ex + Nutr; n = 29) group, and the Ex alone (Ex; n = 29) group. Protein and vitamin D supplements were provided daily from 4 weeks preoperatively to 8 weeks postoperatively (12 weeks) to the patients in the Ex + Nutr group, whereas the Ex group did not receive any supplements. Surgery and postoperative rehabilitation programmes during intervention were identical in both groups.
      Hip abductor and knee extensor muscle strength, functional performance (Timed Up & Go test, Harris Hip Score), and QOL (Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire) were assessed at baseline and at 12 weeks (8 weeks postoperatively).

      Results

      After the intervention, hip abductor muscle strength on the contralateral leg and knee extensor muscle strength on both sides significantly improved in the Ex + Nutr group compared to the Ex group (p = 0.03, 0.01, and 0.01, respectively). However, hip abductor muscle strength on the operated side did not differ significantly between the groups (p = 0.23). There were no significant differences in functional performance and QOL.

      Conclusion

      Ex + Nutr does not have an additional effect on the improvement of hip abductor strength, functional performance, and QOL compared to Ex alone after fast-track THA. However, significant improvements were observed in the strength of some muscles after fast-track THA.

      Trial registration

      UMIN 000042964.

      The IRB approval

      This study was approved by the Mirai Iryo Reesearch Center (approval number TGE1602-115).

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Katano H.
        • Ozeki N.
        • Kohno Y.
        • Nakagawa Y.
        • Koga H.
        • Watanabe T.
        • et al.
        Trends in arthroplasty in Japan by a complete survey, 2014–2017.
        J Orthop Sci. 2021 Sep; 26: 812-822
        • Johnson R.L.
        • Abdel M.P.
        • Frank R.D.
        • Chamberlain A.M.
        • Habermann E.B.
        • Mantilla C.B.
        • et al.
        Impact of frailty on outcomes after primary and revision total hip arthroplasty.
        J Arthroplasty. 2019 Jan; 34: 56-64
        • Pepper A.M.
        • Novikov D.
        • Cizmic Z.
        • Barrett J.T.
        • Collins M.
        • Iorio R.
        • et al.
        Age and frailty influence hip and knee arthroplasty reimbursement in a bundled payment care improvement initiative.
        J Arthroplasty. 2019 Jul; 34: S80-S83
        • Cinnamon C.C.
        • Longworth J.A.
        • Brunner J.H.
        • Chau V.K.
        • Ryan C.A.
        • Dapiton K.R.
        • et al.
        Static and dynamic abductor function are both associated with physical function 1 to 5 years after total hip arthroplasty.
        Clin Biomech. 2019 Jul; 67: 127-133
        • García-Rey E.
        • García-Cimbrelo E.
        Abductor biomechanics clinically impact the total hip arthroplasty dislocation rate: a prospective long-term study.
        J Arthroplasty. 2016 Feb; 31: 484-490
        • Dreyer H.C.
        • Owen E.C.
        • Strycker L.A.
        • Smolkowski K.
        • Muyskens J.B.
        • Kirkpatrick T.K.
        • et al.
        Essential amino acid supplementation mitigates muscle atrophy after total knee arthroplasty: a randomized, double-blind, placebo-controlled trial.
        JB JS Open Access. 2018 Jun; 3e0006
        • Ueyama H.
        • Kanemoto N.
        • Minoda Y.
        • Taniguchi Y.
        • Nakamura H.
        Perioperative essential amino acid supplementation suppresses rectus femoris muscle atrophy and accelerates early functional recovery following total knee arthroplasty.
        Bone Joint Lett J. 2020 Jun; 102 -B: 10-18
        • Muyskens J.B.
        • Foote D.M.
        • Bigot N.J.
        • Strycker L.A.
        • Smolkowski K.
        • Kirkpatrick T.K.
        • et al.
        Cellular and morphological changes with EAA supplementation before and after total knee arthroplasty.
        J Appl Physiol. 2019 Aug; 127: 531-545
        • Ikeda T.
        • Matsunaga Y.
        • Kanbara M.
        • Kamono A.
        • Masuda T.
        • Watanabe M.
        • et al.
        Effect of exercise therapy combined with branched-chain amino acid supplementation on muscle strength in elderly women after total hip arthroplasty: a randomized controlled trial.
        Asia Pac J Clin Nutr. 2019; 28: 720-726
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • Newman A.B.
        • Hirsch C.
        • Gottdiener J.
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001 Mar; 56: M146-M156
        • Berger R.A.
        Mini-incision total hip replacement using an anterolateral approach: technique and results.
        Orthop Clin N Am. 2004 Apr; 35: 143-151
        • Bertin K.C.
        • Röttinger H.
        Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach.
        Clin Orthop Relat Res. 2004 Dec; 429: 248-255
        • Chodzko-Zajko W.J.
        • Proctor D.N.
        • Fiatarone Singh M.A.
        • Minson C.T.
        • Nigg C.R.
        • Salem G.J.
        • et al.
        American College of Sports Medicine position stand. Exercise and physical activity for older adults.
        Med Sci Sports Exerc. 2009 Jul; 41: 1510-1530
        • Schoenfeld B.J.
        • Grgic J.
        • Ogborn D.
        • Krieger J.W.
        Strength and hypertrophy adaptations between low- vs. high-load resistance training: a systematic review and meta-analysis.
        J Strength Condit Res. 2017 Dec; 31: 3508-3523
        • Ninomiya K.
        • Takahira N.
        • Ikeda T.
        • Suzuki K.
        • Sato R.
        • Kazuo H.
        Prevalence of frailty and associated factors among community-dwelling older adults after total hip arthroplasty.
        Hip Int. 2021 Sep; (in press)
        • Akazawa N.
        • Okawa N.
        • Tamura K.
        • Moriyama H.
        Relationships between intramuscular fat, muscle strength and gait independence in older women: a cross-sectional study.
        Geriatr Gerontol Int. 2017 Oct; 17: 1683-1688
        • Söderman P.
        • Malchau H.
        Is the Harris hip score system useful to study the outcome of total hip replacement?.
        Clin Orthop Relat Res. 2001 Mar; : 189-197
        • Matsumoto T.
        • Kaneuji A.
        • Hiejima Y.
        • Sugiyama H.
        • Akiyama H.
        • Atsumi T.
        • et al.
        Japanese orthopaedic association hip disease evaluation Questionnaire (JHEQ): a patient-based evaluation tool for hip-joint disease. The subcommittee on hip disease evaluation of the clinical outcome committee of the Japanese orthopaedic association.
        J Orthop Sci. 2012 Jan; 17: 25-38
        • Ikeda T.
        • Jinno T.
        • Masuda T.
        • Aizawa J.
        • Ninomiya K.
        • Suzuki K.
        • et al.
        Effect of exercise therapy combined with branched-chain amino acid supplementation on muscle strengthening in persons with osteoarthritis.
        Hong Kong Physiother J. 2018 Jun; 38: 23-31
        • Agten C.A.
        • Sutter R.
        • Dora C.
        • Pfirrmann C.W.
        MR imaging of soft tissue alterations after total hip arthroplasty: comparison of classic surgical approaches.
        Eur Radiol. 2017 Mar; 27: 1312-1321
        • Freeman S.
        • Mascia A.
        • McGill S.
        Arthrogenic neuromusculature inhibition: a foundational investigation of existence in the hip joint.
        Clin Biobech. 2013 Feb; 28: 171-177
        • Ismailidis P.
        • Kvarda P.
        • Vach W.
        • Cadosch D.
        • Appenzeller-Herzog C.
        • Mündermann A.
        Abductor muscle strength deficit in patients after total hip arthroplasty: a systematic review and meta-analysis.
        J Arthroplasty. 2021 Aug; 36: 3015-3027
        • Klausmeier V.
        • Lugade V.
        • Jewett B.A.
        • Collis D.K.
        • Chou L.S.
        Is there faster recovery with an anterior or anterolateral THA? A pilot study.
        Clin Orthop Relat Res. 2010 Feb; 468: 533-541
        • Ikeda T.
        • Jinno T.
        • Aizawa J.
        • Masuda T.
        • Hirakawa K.
        • Ninomiya K.
        • et al.
        Effects of perioperative factors and hip geometry on hip abductor muscle strength during the first 6 months after anterolateral total hip arthroplasty.
        J Phys Ther Sci. 2017 Feb; 29: 295-300
        • Benedetti M.G.
        • Cavazzuti L.
        • Amabile M.
        • Tassinari E.
        • Valente G.
        • Zanotti G.
        • et al.
        Abductor muscle strengthening in THA patients operated with minimally-invasive anterolateral approach for developmental hip dysplasia.
        Hip Int. 2021 Jan; 31: 66-74
        • Dorhout B.G.
        • Doets E.L.
        • van Dongen E.J.I.
        • de Groot L.C.P.G.M.
        • Haveman-Nies A.
        In-depth analyses of the effects of a diet and resistance exercise intervention in older adults: who benefits most from ProMuscle in Practice?.
        J Gerontol A Biol Sci Med Sci. 2021 Nov; 76: 2204-2212
        • Beelen J.
        • de Roos N.M.
        • de Groot L.C.P.G.M.
        A 12-week intervention with protein-enriched foods and drinks improved protein intake but not physical performance of older patients during the first 6 months after hospital release: a randomised controlled trial.
        Br J Nutr. 2017 Jun; 117: 1541-1549
        • Krumholz H.M.
        Post-hospital syndrome--an acquired, transient condition of generalized risk.
        N Engl J Med. 2013 Jan; 368: 100-102
        • Smith-Ryan A.E.
        • Hirsch K.R.
        • Saylor H.E.
        • Gould L.M.
        • Blue M.N.M.
        Nutritional considerations and strategies to facilitate injury recovery and rehabilitation.
        J Athl Train. 2020 Sep; 55: 918-930
        • Frost R.
        • Belk C.
        • Jovicic A.
        • Ricciardi F.
        • Kharicha K.
        • Gardner B.
        • et al.
        Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis.
        BMC Geriatr. 2017 Jul 20; 17: 157