A Prospective Randomized Controlled Trial Assessing the Impact of Preoperative Combined with Postoperative Progressive Resistance Training on Muscle Strength, Gait, Balance and Function in Patients Undergoing Total Hip Arthroplasty

Figures & data

Figure 1 Flow diagram of patients’ selection and exclusion.

Figure 2 The enrolled patients underwent muscle strength training and testing, as well as gait and balance assessments. (a-c) Follow-up patients are undergoing Isokinetic Strength Assessment and Gait analysis. (d) Follow-up patients are undergoing Eyes-Closed Single-Leg Standing Balance Test.

Table 1 Demographic Data of the Subjects

Parameter	Pre Group	Post Group	Pre& Post Group	P12 value	P13 value	P23 value
Age (years)	63.1±7.9	61.2±6.8	63.3±7.5	0.798	0.094	1.023
BMI (kg/m2)	23.5±3.7	24.2±2.8	24.6±3.0	1.189	1.790	0.794
Duration of HOA(year)	7.4±1.5	7.2±2.2	7.5±1.7	0.381	0.146	0.471
Gender (male/female)	17/13	16/14	16/14	P=0.956*
Unilateral/Bilateral HOA	16/14	15/15	13/17	P=0.733*

Notes: P₁₂ represents P value of Pre group vs Post group; P₁₃ represents P value of Pre group vs Pre& Post group; P₂₃ represents P value of group Post group vs Pre& Post group; *Denotes the use of the Pearson chi-square test.

Abbreviation: BMI, body mass index.

Table 2 Comparison of HMIT-NBM at Specific Time Points Among 3 Groups

HMIT-NBM (Nm/Kg)	Pre Group	Post Group	Pre& Post Group	P12 value	P13 value	P23 value
Flexion
Pre-2 weeks	0.64 ± 0.12	0.65 ± 0.13	0.63 ± 0.15	0.831	0.688	0.514
Pre-1 day	0.77 ± 0.15	0.63 ± 0.13	0.78 ± 0.13	0.002	0.965	0.002
Post-1 month	0.6 ± 0.14	0.59 ± 0.10	0.70 ± 0.16	0.671	0.014	0.019
Post-3 months	0.69± 0.16	0.87 ± 0.14	1.01 ± 0.14	0.066	0.001	0.001
Post-6 months	1.0 ± 0.13	1.16 ± 0.16	1.26 ± 0.21	0.036	0.001	0.007
Post-12 months	1.12 ± 0.20	1.14 ± 0.15	1.29 ± 0.15	1.000	0.814	0.033
Extension
Pre-2 weeks	0.81 ± 0.16	0.80 ± 0.15	0.83 ± 0.15	0.989	0.964	0.733
Pre-1 day	0.91 ± 0.14	0.81 ± 0.15	0.92 ± 0.13	0.233	0.950	0.197
Post-1 month	0.85 ± 0.17	0.69 ± 0.16	0.80 ± 0.17	0.089	0.151	0.557
Post-3 months	1.05 ± 0.15	1.16 ± 0.14	1.14 ± 0.14	0.176	0.680	0.776
Post-6 months	1.17 ± 0.16	1.46 ± 0.16	1.52 ± 0.16	0.003	0.001	0.001
Post-12 months	1.38 ± 0.22	1.53 ± 0.22	1.55 ± 0.19	0.027	0.005	0.004
Abduction
Pre-2 weeks	0.60 ± 0.16	0.62 ± 0.15	0.61 ± 0.14	0.897	0.942	0.942
Pre-1 day	0.74 ± 0.12	0.59 ± 0.14	0.78 ± 0.14	0.030	0.726	0.012
Post-1 month	0.48 ± 0.17	0.46 ± 0.10	0.72 ± 0.16	0.822	0.018	0.011
Post-3 months	0.65 ± 0.15	0.85 ± 0.15	1.04 ± 0.15	0.005	0.001	0.068
Post-6 months	0.85 ± 0.16	1.02 ± 0.16	1.23 ± 0.14	0.157	0.001	0.002
Post-12 months	0.98 ± 0.21	1.00 ± 0.19	1.30 ± 0.18	0.860	0.007	0.017
Adduction
Pre-2 weeks	0.56 ± 0.15	0.55 ± 0.12	0.57 ± 0.14	0.444	0.416	0.464
Pre-1 day	0.55 ± 0.15	0.55 ± 0.12	0.58 ± 0.14	0.992	0.817	0.703
Post-1 month	0.54 ± 0.15	0.65 ± 0.13	0.85 ± 0.16	0.175	0.001	0.007
Post-3 months	0.68 ± 0.16	0.86 ± 0.15	1.00 ± 0.18	0.007	0.001	0.006
Post-6 months	0.96 ± 0.17	0.94 ± 0.15	1.12 ± 0.20	0.294	0.003	0.003
Post-12 months	0.95 ± 0.17	0.97 ± 0.14	1.21 ± 0.20	0.470	0.002	0.001

Notes: P₁₂ represents P value of Pre group vs Post group; P₁₃ represents P value of Pre group vs Pre& Post group; P₂₃ represents P value of group Post group vs Pre& Post group.

Abbreviation: HMIT-NBM, hip maximal isokinetic torque normalized for body mass.

Figure 3 (a-d) represent the changing trend of hip maximal isometric torque normalized for body mass(HMIT-NBM) in three groups of patients at different time points. (a) represents flexion HMIT-NBM; (b) represents extension HMIT-NBM; (c) represents abduction HMIT-NBM; (d) represents adduction HMIT-NBM. An asterisk (*) indicates a significant difference compared to the baseline value (pre-2w) within the group. For example, the Blue asterisk (*) denotes a significant difference at this time point compared to the pre-2w baseline value in the pre group.

Table 3 Comparison of SLAR at Specific Time Points Among 3 Groups

SLAR (%)	Pre Group	Post Group	Pre& Post Group	P12 value	P13 value	P23 value
Flexion
Pre-2 weeks	−19.23% ± 2.61%	−22.14% ± 5.65%	−21.73% ± 3.25%	0.420	0.586	0.772
Post-3 months	18.80% ± 4.80%	10.20% ± 2.60%	20.56% ± 5.24%	0.001	0.166	0.001
Post-12 months	13.64% ± 3.16%	8.40% ± 2.12%	36.99% ± 9.42%	0.001	0.001	0.001
Extension
Pre-2 weeks	−9.83% ± 6.06%	−8.63% ± 2.20%	−10.12% ± 1.31%	0.685	0.305	0.162
Post-3 months	−15.28% ± 3.70%	11.56% ± 2.94%	22.60% ± 5.73%	0.001	0.001	0.002
Post-12 months	−10.07% ± 2.98%	9.73% ± 2.46%	27.19% ± 6.86%	0.001	0.001	0.037
Abduction
Pre-2 weeks	−37.60% ± 9.60%	−33.65% ± 6.03%	−32.17% ± 7.07%	0.691	0.546	0.775
Post-3 months	−18.29% ± 4.64%	−5.08% ± 1.31%	45.60% ± 8.52%	0.001	0.001	0.001
Post-12 months	−10.84% ± 2.69%	11.96% ± 3.01%	40.21% ± 7.16%	0.001	0.001	0.001
Adduction
Pre-2 weeks	−17.98% ± 0.67%	−18.80% ± 4.02%	−18.35% ± 5.28%	0.280	0.708	0.648
Post-3 months	15.84% ± 4.02%	16.71% ± 4.23%	31.55% ±6.02%	0.431	0.001	0.001
Post-12 months	23.74% ± 4.47%	25.32% ± 6.39%	40.16% ± 5.88%	0.271	0.001	0.001

Notes: P₁₂ represents P value of Pre group vs Post group; P₁₃ represents P value of Pre group vs Pre& Post group; P₂₃ represents P value of group Post group vs Pre& Post group.

Abbreviation: SLAR: Surgical limb advantage ratio.

Figure 4 The changing trend of Surgical Limb Advantage Ratio (SLAR) in three groups of patients at different time points. (a) represents flexion SLAR; (b) represents extension SLAR; (c) represents abduction SLAR; (d) represents adduction SLAR. An asterisk (*) indicates a significant difference compared to the baseline value (pre-2w) within the group. For example, the Blue asterisk (*) denotes a significant difference at this time point compared to the pre-2w baseline value in the pre group.

Table 4 Comparison of Gait Parameters at Specific Time Points Among 3 Groups

Gait Parameters	Pre Group	Post Group	Pre& Post Group	P12 value	P13 value	P23 value
Velocity (cm/s)
Pre-2 weeks	66.25 ± 8.75	71.30 ± 20.27	70.58 ± 12.16	0.227	0.112	0.868
Pre-1 day	68.50 ± 10.24	67.32 ± 14.95	79.01 ± 18.62	0.722	0.012	0.011
Post-1 month	87.32 ± 16.11	80.12 ± 19.62	110.25 ± 16.32	0.129	0.001	0.001
Post-3 months	108.55 ± 17.66	99.80 ± 23.93	129.63 ± 27.60	0.116	0.001	0.001
Post-6 months	120.27 ± 18.70	129.15 ± 15.80	128.69 ± 14.47	0.051	0.052	0.127
Post-12 months	123.35 ± 15.35	125.10 ± 22.09	126.75 ± 21.86	0.713	0.494	0.770
Cadence (steps/min)
Pre-2 weeks	60.35 ± 10.37	62.03 ± 10.54	59.58 ± 10.16	0.537	0.774	0.379
Pre-1 day	62.50 ± 7.01	59.83 ± 9.76	61.39 ± 8.06	0.216	0.559	0.497
Post-1 month	64.92 ± 11.50	65.80 ± 10.30	73.55 ± 14.73	0.750	0.017	0.026
Post-3 months	63.02 ± 10.72	69.78 ± 14.03	83.61 ± 12.36	0.045	0.001	0.001
Post-6 months	82.46 ± 14.12	84.20 ± 14.37	84.24 ± 15.63	0.639	0.639	0.991
Post-12 months	81.55 ± 12.53	83.18 ± 12.52	86.35 ± 14.32	0.594	0.175	0.366

Notes: P₁₂ represents P value of Pre group vs Post group; P₁₃ represents P value of Pre group vs Pre& Post group; P₂₃ represents P value of group Post group vs Pre& Post group.

Figure 5 The changing trends of gait, balance indicators, and HHS scores in three groups of patients at different time points. (a) represents velocity; (b) represents cadence; (c) represents duration; (d) represents distance; (e) represents area; (f) represents HHS scores. An asterisk (*) indicates a significant difference compared to the baseline value (pre-2w) within the group. For example, the Blue asterisk (*) denotes a significant difference at this time point compared to the pre-2w baseline value in the pre group.

Table 5 Comparison of Balance Parameters and HHS Scores at Specific Time Points Among 3 Groups

Parameter	Pre Group	Post Group	Pre& Post Group	P12 value	P13 value	P23 value
Duration (s)
Pre-2 weeks	0.75 ± 0.14	0.72 ± 0.13	0.75 ± 0.14	0.547	0.993	0.465
Post-3 months	1.42 ± 0.27	1.48 ± 0.36	2.72 ± 0.49	0.178	0.001	0.001
Post-12 months	2.31 ± 0.44	2.61 ± 0.35	3.75 ± 0.67	0.001	0.001	0.001
Distance (cm/s)
Pre-2 weeks	20.89 ± 3.02	21.63 ± 3.95	21.87 ± 4.12	0.28	0.104	0.772
Post-3 months	12.34 ± 1.07	8.66 ± 0.74	8.19 ± 1.17	0.001	0.001	0.446
Post-12 months	8.40 ± 1.21	8.51 ± 1.46	8.32 ± 1.50	0.467	0.805	0.602
Area (cm2/s)
Pre-2 weeks	19.56 ± 2.21	19.12 ± 2.52	19.67 ± 2.81	0.452	0.077	0.097
Post-3 months	12.6 ± 1.36	10.02 ± 1.13	6.97 ± 0.64	0.001	0.001	0.001
Post-12 months	7.92 ± 1.03	6.45 ± 0.55	4.03 ± 0.36	0.001	0.001	0.001
HHS scores
Pre-2 weeks	50.73 ± 3.86	52.82 ± 6.60	52.35 ± 7.09	0.209	0.411	0.858
Post-3 months	69.17 ± 5.25	71.82 ± 9.60	79.46 ± 10.64	0.185	0.001	0.001
Post-12 months	82.25 ± 6.24	80.90 ± 9.71	90.58 ± 12.02	0.338	0.001	0.001

Notes: P₁₂ represents P value of Pre group vs Post group; P₁₃ represents P value of Pre group vs Pre& Post group; P₂₃ represents P value of group Post group vs Pre& Post group.