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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le vendredi 1 juin 2018
Doi : 10.1016/j.otsr.2018.03.013
Received : 20 September 2017 ;  accepted : 12 Mars 2018
Electromyographic study of hip muscles involved in total hip arthroplasty: Surprising results using the direct anterior minimally invasive approach

Jules Bernard a, Fredson Razanabola b, Julien Beldame c, Stéphane Van Driessche d, Helena Brunel a, Thomas Poirier a, Jean Matsoukis e, Fabien Billuart a,
a Laboratoire d’analyse du mouvement, institut de formation en masso-kinésithérapie « Saint-Michel », 68, rue du Commerce, 75015 Paris, France 
b Département de chirurgie orthopédique, centre hospitalier régional d’Orléans La Source, 45100 Orléans, France 
c Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France 
d Clinique de Montargis, 46, rue de la Quintaine, 45200 Montargis, France 
e Département de chirurgie orthopédique, groupe hospitalier du Havre, BP 24, 76083 Le Havre cedex, France 

Corresponding author.

The functional and clinical benefit of minimally invasive total hip arthroplasty (THA) is well-known, but the literature reports impaired gait and posture parameters as compared to the general population, especially following use of the anterior minimally invasive approach, which has more severe impact on posture than the posterior approach. The reasons for this impairment, however, remain unexplained. We therefore conducted a surface electromyography (sEMG) study of the hip muscles liable to be affected by arthroplasty surgery: gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S). The study addressed the following questions: (1) Is bipodal and unipodal GMed activity greater following anterior THA than in asymptomatic subjects? (2) Is a single manual test sufficient to assess maximal voluntary contraction (MVC) in hip abductors (GMax, GMed, TFL) and flexors (TFL, S)?


Bipodal and unipodal GMed activity is greater following anterior THA than in asymptomatic subjects.


Eleven patients with anterior THA and 11 asymptomatic subjects, matched for age, gender and body-mass index, were included. Subjects underwent 3 postural tests: bipodal, eyes closed (BEC), unipodal on the operated side (UOP), and unipodal on the non-operated side (UnOP), with unipodal results averaged between both sides in the asymptomatic subjects. Data were recorded from 4-channel EMG and a force plate. EMG test activity was normalized as a ratio of MVC activity.


Postural parameters (mean center of pressure displacement speed) were poorer and sEMG activity higher in anterior THA than asymptomatic subjects (p <0.005). On the BEC test, GMax and GMed activity was higher on both operated and non-operated sides than in asymptomatic controls (respectively, 0.15±0.12 and 0.12±0.6 versus 0.07±0.06 for GMax, and 0.13±0.08 and 0.13±0.08 versus 0.08±0.05 for GMed; p <0.05). On unipodal tests, both UOP and UnOP GMed activities were higher than in controls (respectively, 0.51±0.3 and 0.48±0.27 versus 0.28±0.13; p <0.04); GMax and TFL activities were higher than in controls only on the UOP tests (respectively, 0.49±0.43 versus 0.24±0.18, and 0.23±0.17 versus 0.12±0.16; p <0.05).


sEMG activity in the hip abductors, which are the main stabilizing muscles for the pelvis, is increased following anterior THA, in parallel with impaired postural parameters. This finding may be due to intraoperative TFL and S neuromuscular spindle lesion. The present preliminary study is to be followed up by a comparison of all 3 common minimally invasive approaches (anterior, anterolateral and posterior) using the same study protocol.

Level of evidence

III, prospective case-control study.

The full text of this article is available in PDF format.

Keywords : Total hip arthroplasty, Minimally invasive hip approaches, Surface electromyography, Posturology

© 2018  Published by Elsevier Masson SAS.
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