Article

Minimally invasive total hip arthroplasty (THA) is presumed to
provide functional and clinical benefits, whereas in fact the literature reveals
that gait and posturographic parameters following THA do not recover values found
in the general population.
There is a significant disturbance of postural sway in
THA patients, regardless of the surgical approach, although with some differences
between approaches compared to controls: the anterior and anterolateral minimally
invasive approaches seem to be more disruptive of postural parameters than the posterior approach. Electromyographic (EMG) study of the hip muscles involved in
surgery [gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae
(TFL), and sartorius (S)] could shed light, the relevant literature involves
discordant methodologies. We developed a methodology to assess EMG activity
during maximal voluntary contraction (MVC) of the GMax, GMed, TFL and sartorius
muscles as a reference for normalization. A prospective study aimed to assess
whether hip joint positioning and the learning curve on an MVC test affect the
EMG signal during a maximal voluntary contraction. HYPOTHESIS: Hip positioning
and the learning curve on an MVC test affect EMG signal during MVC of GMax, GMed,
TFL and S. METHODS: Thirty young asymptomatic subjects participated in the study.
Each performed 8 hip muscle MVCs in various joint positions recorded with surface
EMG sensors. Each MVC was performed 3 times in 1 week, with the same schedule
every day, controlling for activity levels in the preceding 24h.
EMG activity
during MVC was expressed as a ratio of EMG activity during unipedal stance.
Non-parametric tests were applied. RESULTS: Statistical analysis showed no
difference according to hip position for abductors or flexors in assessing EMG
signal during MVC over the 3 sessions. Hip abductors showed no difference between
abduction in lateral decubitus with hip straight versus hip flexed: GMax
(19.8+/-13.7 vs. 14.5+/-7.8, P=0.78), GMed (13.4+/-9.0 vs. 9.9+/-6.6, P=0.21) and
TFL (69.5+/-61.7 vs. 65.9+/-51.3, P=0.50). Flexors showed no difference between
hip flexion/abduction/lateral rotation performed in supine or sitting position:
TFL (70.6+/-45.9 vs. 61.6+/-45.8, P=0.22) and S (101.1+/-67.9 vs. 72.6+/-44.6,
P=0.21). The most effective tests to assess EMG signal during MVC were for the
hip abductors: hip abduction performed in lateral decubitus (36.7% for GMax,
76.7% for GMed), and for hip flexors: hip flexion/abduction/lateral rotation
performed in supine decubitus (50% for TFL, 76.7% for S). DISCUSSION: The study
hypothesis was not confirmed, since hip joint positioning and the learning curve
on an MVC test did not affect EMG signal during MVC of GMax, GMed, TFL and S
muscles. Therefore, a single session and one specific test is enough to assess
MVC in hip abductors (abduction in lateral decubitus) and flexors (hip flexion/abduction/lateral rotation in supine position).
This method could be
applied to assess muscle function after THA, and particularly to compare
different approaches.
LEVEL OF EVIDENCE : III,
case-matched study.
CI - Copyright (c) 2017 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS