EVALUATION OF THE EFFECTIVENESS OF THE PHYSICAL THERAPY PROGRAM BASED ON THE RESULTS OF ELECTROMYOGRAPHIC EXAMINATION AND RADIOLOGICAL MARKERS OF MUSCLE TISSUE STATUS IN ELDERLY OBESE PATIENTS WITH THE CONSEQUENCES OF TOTAL HIP ARTHROPLASTY

Abstract

Purpose – to assess the effectiveness of the developed physical therapy program for elderly obese patients with the consequences of total hip arthroplasty in the long-term after endoprosthetics according to the dynamics of electromyographic examination indicators, ultrasound and radiological markers of the state of muscle tissue. Material. During the study, 99 elderly people were examined. The control group consisted of 34 people who did not have a history of total lower limb arthroplasty, with normal body weight. The comparison group consisted of 33 people who had undergone total hip arthroplasty and with normal body weight. The main group consisted of 32 obese people who had undergone arthroplasty. A three-month physical therapy program was developed and implemented for them, using therapeutic exercises on the Redcord NEURAC system, balance exercises on BOSU platforms, massage of the operated lower limb, Proprioceptive Neuromuscular Facilitation, and an educational component. The effectiveness was assessed by the results of electromyography of the thigh and lower leg muscles, ultrasound measurement of the thickness of the upper and lower limbs muscles, determination of the cross-sectional area of the m. psoas using computed tomography, and calculation of the musculoskeletal index. Results. The obese patients were found to have structural and functional signs of muscle dysfunction in the form of changes in the electrical activity of the thigh and lower leg muscles (musculus gluteus maximus, musculus gluteus medius, musculus rectus femoris, musculus biceps femoris, musculus tibialis anterior according to the results of electromyography), a decrease in the thickness of muscle fibers (according to the ultrasound determination of the thickness of the rectus femoris muscle, the muscles of the posterior surface of the lower leg) and their area (according to the results of determining the cross-sectional area of the m. psoas by computed tomography and calculating the musculoskeletal index). The studied electromyographic, ultrasound and tomographic characteristics of muscle tissue in the patients indicated sarcopenia and were mostly worse compared to a similar contingent of patients after total arthroplasty, but with normal body weight. The approved comprehensive physical therapy program revealed an improvement in the patients’ condition due to a normalizing effect on the electrical activity of the muscles, determined by ultrasound, an increase in the thickness of the fibers of the main muscle groups, an increase in the cross-sectional area of the psoas muscle, and a significant increase in the musculoskeletal index compared to baseline (p < 0,05). Conclusions. Physical therapy is advisable to prescribe for the comprehensive correction of electromyographic, ultrasound, and tomographic signs of muscle dysfunction and sarcopenia in elderly obese patients with hip replacement.