Effect of Stepped Rehabilitation Training on Hip Joint Function and Bone Metabolism Markers in Patients Undergoing Hip Arthroplasty.

Abstract

Aim: This study investigates the effects of stepped rehabilitation training on hip joint function and bone metabolism markers in patients undergoing hip arthroplasty (HA).

Methods: This retrospective analysis included 97 patients who underwent HA in our hospital between December 2021 and December 2023. The patients were divided into a control group (52 cases) and an observation group (45 cases) based on different rehabilitation training approaches. The control group received routine nursing and rehabilitation exercises, while the observation group underwent stepped rehabilitation training in addition to the standard care. The surgery-related indicators, hip joint function, bone metabolism-related markers, and quality of life at 1, 2, and 4 weeks of training were compared between the two groups. Repeated-measures analysis of variance (ANOVA) was applied to explore the changes in hip function indexes and bone metabolism-related markers at different time points, and their interactions with the groups were examined. The association between changes in bone metabolism-related markers from baseline to week 4 and corresponding changes in Harris hip scores over the same period was assessed using locally weighted regression scatterplot smoothing (LOWESS) method.

Results: The hip joint range of motion, hip abduction strength arm, Harris hip score, levels of serum bone alkaline phosphatase (BALP), type I collagen amino-terminal lengthening peptide (PINP) and osteocalcin, Barthel index score, and 36-Item Short Form Health Survey (SF-36) scores sequentially increased in both groups at weeks 1, 2, and 4 of the training, with the observation group exhibiting higher values than the control group (p < 0.05). Levels of type I collagen carboxy-terminal peptide (CTX), intact parathyroid hormone (iPTH), and tartrate-resistant acid phosphatase 5b (TRACP-5b) decreased sequentially in both groups at weeks 1, 2, and 4 of the training, with the observation group demonstrating lower levels than the control group (p < 0.05). Furthermore, significant differences were observed in the time, inter-group, and interaction effects of hip joint function and bone metabolization-related markers between the two groups during the training period (p < 0.05). Moreover, a nonlinear association was found between the changes in bone metabolism-related markers from baseline to week 4 and the corresponding changes in Harris hip scores over the same time points. Additionally, there was no statistically significant difference in the total postoperative complication rate between the observation group (6.67%) and the control group (15.38%) (p = 0.177).

Conclusions: Stepped rehabilitation training can promote hip joint function recovery in patients undergoing hip arthroplasty, improve bone metabolic balance through upregulating osteogenic markers and suppressing osteoclastic activity, and ultimately enhance quality of life.