We humans are complicated. We are a sometimes baffling mix of physical, genetic and psychological factors which makes us repond in unpredictable ways to the things that happen to us. One of the great things about being a specialist hip surgeon for 20 years is that it has given me a great deal of experience in dealing with people, understanding what they want and how how they react to surgery. Careful patient selection helps us to tailor the treatment to the individual, which should make everyone happy!
Researchers at the University of Illinois at Chicago studied 124 individuals before and one year after total hip arthroplasty. The subjects had an average age of 61 and an average body-mass index of 29, and 64 were female. They analyzed the patients’ walking mechanics using gait analysis, hip abductor strength through manual muscle testing, and function and pain using the Harris Hip Score. The researchers looked for statistical relationships between improvements in pain and function scores, and improvements in walking mechanics and muscle strength. Men and women were analyzed separately, and the results were compared.
Their analysis showed that the biomechanical factors associated with pain and function improvements were different in men and women. Women who reported better functional recovery (for example, ability to walk without a limp or put on socks and shoes with no difficulty) had more abductor strength improvement and better abductor function during walking. They did not see these associations in men, but a few gait variables were associated with pain relief.
“We found that pre- to post-op changes in pain and function have different impact on abductor strength and gait mechanics in men and women,” says Dr. Foucher. The finding that was most interesting was that hip abductor strength and function were associated with improved, self-reported function in women, but not men, she said. “It’s very important to note that we can’t determine cause and effect from this study design. But this is a hint that perhaps rehabilitation priorities should be different in men and women. It is possible that more focus on hip abductor strengthening will improve function in women, but may not be as critical in men. More studies are needed to establish cause and effect before we can make clinical recommendations.”
Dr. Foucher and her colleagues would like to do follow-up prospective studies to try to replicate and expand on these findings for deeper understanding of why men and women have different post-surgical outcomes.
“The long-term goal is to see whether or not we can use this knowledge to help improve surgical planning or rehabilitation,” she said. “We see this work as complementing other researchers’ efforts to develop decision aids, prediction tools, and patient education to reduce disparities and improve care for both men and women.”
