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Scott Cheatham, Monique Mokha and Matt Lee


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.


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.


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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Satoshi Hamai, Ken Okazaki, Satoru Ikebe, Koji Murakami, Hidehiko Higaki, Hiroyuki Nakahara, Takeshi Shimoto, Hideki Mizu-uchi, Yukio Akasaki and Yukihide Iwamoto

The purpose of this study was to investigate in vivo kinematics in healthy and osteoarthritic (OA) knees during stepping using image-matching techniques. Six healthy volunteers and 14 patients with a medial OA knee before undergoing total knee arthroplasty performed stepping under periodic anteroposterior radiograph images. We analyzed the three-dimensional kinematic parameters of knee joints using radiograph images and CT-derived digitally reconstructed radiographs. The average extension/flexion angle ranged 6°/53° and 16°/44° in healthy and OA knees, with significant difference in extension (P = .02). The average varus angle was –2° and 6° in healthy and OA knees, with a significant difference (P = .03). OA knees showed 1.7° of significantly larger varus thrust (P = .04) and 4.2 mm of significantly smaller posterior femoral rollback (P = .04) compared with healthy knees. Coronal limb alignment in OA knees significantly correlated with varus thrust (R 2 = .36, P = .02) and medial shift of the femur (R 2 = .34, P = .03). Both normal and OA knees showed no transverse plane instability, including anteroposterior, mediolateral directions, or axial rotation. In conclusion, OA knees demonstrated different kinematics during stepping from normal knees: less knee extension, larger varus thrust, less posterior translation, and larger medial shift.

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Cody B. Bremner, William R. Holcomb, Christopher D. Brown and Melanie E. Perreault

Clinical Scenario:

Orthopedic knee conditions are regularly treated in sports-medicine clinics. Rehabilitation protocols for these conditions are often designed to address the associated quadriceps strength deficits. Despite these efforts, patients with orthopedic knee conditions often fail to completely regain their quadriceps strength. Disinhibitory modalities have recently been suggested as a clinical tool that can be used to counteract the negative effects of arthrogenic muscle inhibition, which is believed to limit the effectiveness of therapeutic exercise. Neuromuscular electrical stimulation (NMES) is commonly accepted as a strengthening modality, but its ability to simultaneously serve as a disinhibitory treatment is not as well established.

Clinical Question:

Does NMES effectively enhance quadriceps voluntary activation in patients with orthopedic knee conditions?

Summary of Key Findings:

Four randomized controlled trials (RCTs) met the inclusion criteria and were included. Of those, 1 reported statistically significant improvements in quadriceps voluntary activation in the intervention group relative to a comparison group, but the statistical significance was not true for another study consisting of the same sample of participants with a different follow-up period. One study reported a trend in the NMES group, but the between-groups differences were not statistically significant in 3 of the 4 RCTs.

Clinical Bottom Line:

Current evidence does not support the use of NMES for the purpose of enhancing quadriceps voluntary activation in patients with orthopedic knee conditions.

Strength of Recommendation:

There is level B evidence that the use of NMES alone or in conjunction with therapeutic exercise does not enhance quadriceps voluntary activation in patients with orthopedic knee conditions (eg, anterior cruciate ligament injuries, osteoarthritis, total knee arthroplasty).

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Brian D. Street and William Gage

authors have no conflicts of interest to disclose. References 1. Finch E , Walsh M , Thomas SG , Woodhouse LJ . Functional ability perceived by individuals following total knee arthroplasty compared to age-matched individuals without knee disability . J Orthop Sports Phys Ther . 1998 ; 27

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Kate N. Jochimsen, Margaret R. Pelton, Carl G. Mattacola, Laura J. Huston, Emily K. Reinke, Kurt P. Spindler, Christian Lattermann and Cale A. Jacobs

preoperative scores on the PCS have been linked to more intense 27 , 28 and persistent 29 postoperative pain following total knee arthroplasty, in our acute ACL injury population, preoperative PCS scores were not related with 6-month outcomes. Similar to our results, Chmielewski et al 12 found that PCS

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Dimitrios-Sokratis Komaris, Cheral Govind, Andrew Murphy, Alistair Ewen and Philip Riches

.09.005 10.1016/j.clinbiomech.2015.09.005 5. Hicks-Little CA , Peindl RD , Fehring TK , Odum SM , Hubbard TJ , Cordova ML . Temporal-spatial gait adaptations during stair ascent and descent in patients with knee osteoarthritis . J Arthroplasty . 2012 ; 27 ( 6 ): 1183 – 1189 . PubMed doi

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James A. Ashton-Miller and Ronald F. Zernicke

replacements and total knee replacements, the health care system in Alberta was failing to provide optimal arthroplasty surgeries for its citizens. Most patients had to wait more than 85 weeks for their arthroplasties, and during that extended wait, they frequently experienced decreased quality of life, high

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Cameron J. Powden, Matthew C. Hoch and Johanna M. Hoch

the pain domain of the ASES. No response shift occurred in the functional ability domain. Razmjou et al 7 236 patients (82 males; 67 ± 10 y) Inclusion: candidates for total knee replacement arthroplasty Total knee replacement arthroplasty Baseline, 6 mo, and 1 y Then-test (6 mo and 1 y) WOMAC, SF36

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Ibrahim M. Altubasi

of association between the self-selected 10-m walking speed and NSA asymmetry. The clinical significance of the asymmetry of the femoral NSA between both sides might be in the preoperative planning of the magnitude of the angle between the neck and stem of the prosthesis in total hip arthroplasty

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Abbey C. Thomas, Janet E. Simon, Rachel Evans, Michael J. Turner, Luzita I. Vela and Phillip A. Gribble

. Hoxie SC , Dobbs RE , Dahm DL , Trousdale RT . Total knee arthroplasty after anterior cruciate ligament reconstruction . J Arthroplasty . 2008 ; 23 ( 7 ): 1005 – 1008 . PubMed ID: 18534505 doi:10.1016/j.arth.2007.08.017 10.1016/j.arth.2007.08.017 18534505 32. Magnussen RA , Demey G