Quadriceps muscle wasting persists 5 months after total hip arthroplasty for osteoarthritis of the hip: a pilot study

Aims: To determine whether additional muscle fibre wasting of the ipsilateral vastus lateralis muscle occurs in the early postoperative period after total hip arthroplasty for osteoarthritis of the hip and whether there is an improvement in preoperative measures of quadriceps muscle thickness, strength, pain and function over a 5-month postoperative period. Methods: Twelve patients had ipsilateral needle quadriceps biopsy for muscle morphology and bilateral quadriceps muscle thickness ultrasound preoperatively, 5 days and 4 weeks postoperatively and a further muscle thickness measurement at 5 months. Seven additional patients and five age-matched control subjects had bilateral quadriceps muscle ultrasound thickness preoperatively, 6 weeks and 5 months postoperatively, with assessment of quadriceps muscle dynamometry, pain scores and Timed Up and Go (TUG) test. Results: Preoperatively, all 19 patients demonstrated significant atrophy of the ipsilateral compared with the contralateral quadriceps muscle (P = 1.8 x 10(-7)) on muscle ultrasound, which persisted at 5 months follow up (P = 0.009). Muscle morphology preoperatively showed type 2A and 2B muscle fibre atrophy on needle muscle biopsy, with further atrophy of all three fibre types (P = 0.029) at 5 days postoperatively associated with a fibre type shift from type I to 2A fibres (P = 0.0011) at 1 month. There was improvement in hip pain postoperatively and a significant improvement in the TUG test (P = 0.007). However, there was no improvement in muscle strength on dynamometry. Conclusions: There is significant ipsilateral quadriceps atrophy and weakness with 2A and 2B fibre atrophy preoperatively in patients with osteoarthritis of the hip with exacerbation and further atrophy of all three fibre types 5 days postoperatively. Postoperative follow up showed that the reduction in ipsilateral quadriceps muscle thickness persisted at 5 months despite physical rehabilitation. Patients did note significant improvement in pain postoperatively and improvement on functional assessment with the TUG test. Other therapeutic strategies may have to be developed to reverse disuse muscle atrophy.