Stronger Hands Related to Better Outcomes in THA and TKA
This post comes from Fred Nelson, MD, an orthopaedic surgeon in the Department of Orthopedics at Henry Ford Hospital and a clinical associate professor at Wayne State Medical School. Some of Dr. Nelson’s tips go out weekly to more than 3,000 members of the Orthopaedic Research Society (ORS), and all are distributed to more than 30 orthopaedic residency programs. Those not sent to the ORS are periodically reposted in OrthoBuzz with the permission of Dr. Nelson.
Up to 33% of patients are dissatisfied with their outcome after a knee or hip replacement. It’s evident that successful recovery from lower-limb joint replacement is aided by leg strength and stamina, but handgrip strength has been proposed as a proxy for a person’s overall muscle strength. A recent prospective cohort study1 of 226 patients who underwent total hip arthroplasty (THA) and 246 patients who underwent total knee arthroplasty (TKA) investigated the association between handgrip strength measured preoperatively with a dynamometer and changes in preoperative versus 1-year postoperative patient-reported outcome scores. Researchers analyzed the data after adjusting for sex, body mass index, and baseline scores.
For both THA and TKA patients, handgrip strength was positively associated with most physical function, symptom, and quality-of-life scores measured with HOOS, KOOS, and SF-36 questionnaires. On the other hand, there was no association between grip strength and mental-component scores in either the THA or TKA group.
Based on a review of the literature and this study’s findings, the authors conclude that the association between handgrip strength and THA/TKA outcomes is partly dependent on the joint site. Although the mechanism to explain the association has not been elucidated, translating these findings into an informal dynamometer-based tool could help clinicians counsel prospective joint-replacement patients about the value of preoperative conditioning.
1. Meessen JMTA, Fiocco M, Tordoir RL, Sjer A, Verdegaal SHM, Slagboom PE, Vliet Vlieland TPM, Nelissen RGHH. Association of handgrip strength with patient-reported outcome measures after total hip and knee arthroplasty. Rheumatol Int. 2020 Apr;40(4):565-571. doi: 10.1007/s00296-020-04532-5. Epub 2020 Feb 18. PMID: 32072233