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Scott Cheatham, Monique Mokha and Matt Lee

Context:

Hip-resurfacing arthroplasty (HRA) has become a popular procedure in the treatment of hip-joint arthritis in individuals under the age of 65 y. Although the body of literature examining operative procedures has grown, there is a lack of consistent reporting of the effectiveness of an HRA postoperative rehabilitation program. To date, no systematic reviews have evaluated the available evidence on postoperative rehabilitation programs.

Objective:

To evaluate the available evidence on postoperative rehabilitation programs after HRA.

Evidence Acquisition:

A systematic review was conducted according to the PRISMA guidelines. A search of PubMed, CINAHL, SPORTDiscus, ProQuest, and Google Scholar was conducted in April 2014 using the following keywords alone and in combination: postoperative, postsurgical, rehabilitation, physical therapy, programs, hip resurfacing, arthroplasty, and metal-on-metal. The grading of studies was conducted using the PEDro and Oxford Centre for Evidence-Based Medicine scales.

Evidence Synthesis:

The authors identified 648 citations, 4 of which met the inclusion criteria. The qualifying studies yielded 1 randomized control trial, 2 case reports, and 1 case series, for a total of 90 patients. Patients were mostly male (n = 86), had a mean age of 48 ± 5.47 y, and had been physically active before HRA. Postoperative rehabilitation programs varied in length (range 8–24 wk) and consisted of at least 3 phases. The methodology to assess program effects varied, but all 4 studies did measure a combination of function, pain, and quality of life using written questionnaires, with follow-up ranging from 9 mo to 1 y. The most common questionnaire was the Harris Hip Score.

Conclusion:

This review found postoperative rehabilitation programs after HRA to be underinvestigated. Limited results indicate that postoperative rehabilitation programs may be effective in improving gait (stride length, velocity, and cadence), hip range of motion, and pain and function, as measured by questionnaires, but not hip strength.

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Scott R. Brown, Matt Brughelli and Lee A. Bridgeman

Context:

Muscle imbalances aid in the identification of athletes at risk for lower-extremity injury. Little is known regarding the influence that leg preference or playing position may have on lower-extremity muscle strength and asymmetry.

Purpose:

To investigate lower-extremity strength profiles in rugby union athletes and compare isokinetic knee- and hip-strength variables between legs and positions.

Methods:

Thirty male academy rugby union athletes, separated into forwards (n = 15) and backs (n = 15), participated in this cross-sectional analysis. Isokinetic dynamometry was used to evaluate peak torque, angle of peak torque, and strength ratios of the preferred and nonpreferred legs during seated knee extension/flexion and supine hip extension/flexion at 60°/s.

Results:

Backs were older (ES = 1.6) but smaller in stature (ES = –0.47) and body mass (ES = –1.3) than the forwards. The nonpreferred leg was weaker than the preferred leg for forwards during extension (ES = –0.37) and flexion (ES = –0.21) actions and for backs during extension (ES = –0.28) actions. Backs were weaker at the knee than forwards in the preferred leg during extension (ES = –0.50) and flexion (ES = –0.66) actions. No differences were observed in strength ratios between legs or positions. Backs produced peak torque at longer muscle lengths in both legs at the knee (ES = –0.93 to –0.94) and hip (ES = –0.84 to –1.17) than the forwards.

Conclusions:

In this sample of male academy rugby union athletes, the preferred leg and forwards displayed superior strength compared with the nonpreferred leg and backs. These findings highlight the importance of individualized athletic assessments to detect crucial strength differences in male rugby union athletes.

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Harry E. Routledge, Jill J. Leckey, Matt J. Lee, Andrew Garnham, Stuart Graham, Darren Burgess, Louise M. Burke, Robert M. Erskine, Graeme L. Close and James P. Morton

Purpose: To better understand the carbohydrate (CHO) requirement of Australian Football (AF) match play by quantifying muscle glycogen utilization during an in-season AF match. Methods: After a 24-h CHO-loading protocol of 8 and 2 g/kg in the prematch meal, 2 elite male forward players had biopsies sampled from m. vastus lateralis before and after participation in a South Australian Football League game. Player A (87.2 kg) consumed water only during match play, whereas player B (87.6 kg) consumed 88 g CHO via CHO gels. External load was quantified using global positioning system technology. Results: Player A completed more minutes on the ground (115 vs 98 min) and covered greater total distance (12.2 vs 11.2 km) than player B, although with similar high-speed running (837 vs 1070 m) and sprinting (135 vs 138 m). Muscle glycogen decreased by 66% in player A (pre: 656 mmol/kg dry weight [dw], post: 223 mmol/kg dw) and 24% in player B (pre: 544 mmol/kg dw, post: 416 mmol/kg dw). Conclusion: Prematch CHO loading elevated muscle glycogen concentrations (ie, >500 mmol/kg dw), the magnitude of which appears sufficient to meet the metabolic demands of elite AF match play. The glycogen cost of AF match play may be greater than in soccer and rugby, and CHO feeding may also spare muscle glycogen use. Further studies using larger sample sizes are now required to quantify the interindividual variability of glycogen cost of match play (including muscle and fiber-type-specific responses), as well examining potential metabolic and ergogenic effects of CHO feeding.