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Lower-Limb Pain, Disease, and Injury Burden as Determinants of Muscle Strength Deficit After Hip Fracture
Erja Portegijs, PhD1; Taina Rantanen, PhD1; Mauri Kallinen, MD, PhD2; Ari Heinonen, PhD1; Markku Alen, MD, PhD3; Ilkka Kiviranta, MD, PhD4; Sarianna Sipilä, PhD5
1 Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FI-40014 Jyväskylä, Finland. E-mail address for E. Portegijs: erja.portegijs@jyu.fi
2 GeroCenter Foundation for Research and Development, Parantolantie 24, rak.1, 40930 Kinkomaa, Finland
3 Department of Medical Rehabilitation, Oulu University Hospital, P.O. Box 25, 90029 Oulu, Finland
4 Department of Orthopaedics and Traumatology, University of Helsinki, Topeliuksenkatu 5 B, 00260 Helsinki, Finland
5 Finnish Centre for Interdisciplinary Gerontology, University of Jyväskylä, P.O. Box 3 (viv), FL-40014 Jyväskylä, Finland
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Juho Vainio Foundation, Finnish Cultural Foundation, and Ministry of Education. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the University of Jyväskylä and the Central Finland Health Care District, Jyväskylä, Finland

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jul 01;91(7):1720-1728. doi: 10.2106/JBJS.G.01675
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Background: Hip fracture may result in an asymmetrical lower-limb strength deficit. The deficit may be related to the trauma, surgical treatment, pain, or disuse of the fractured limb. However, disease and injury burden or musculoskeletal pain in the other limb may reduce muscle strength on that side, reducing the asymmetrical deficit. The aim of our study was to explore the asymmetrical strength deficit and to determine the potential underlying factors in patients from six months to seven years after a hip fracture.

Methods: The asymmetrical deficit was calculated ([fractured limb/sum of both lower limbs] x 100%) for isometric knee extension torque, rate of force development during isometric testing, and leg extension power. The asymmetrical measures for lower-limb muscle mass (fractured limb — nonfractured limb), and that of lower-limb pain and disease and injury burden (nonfractured limb — fractured limb), were calculated.

Results: Half of the participants had no consistent asymmetrical deficit on the fractured side. Regression analyses showed that asymmetrical measures of lower-limb pain, muscle mass, and disease and injury burden predicted asymmetrical deficit in knee extension torque (R2 = 0.43) and in the rate of force development (R2 = 0.36). More intense pain and disease and injury burden affecting the nonfractured limb and smaller muscle mass relative to the fractured limb were associated with a smaller asymmetrical deficit.

Conclusions: Following a hip fracture, the prevention of decreases in muscle strength and power as well as a large asymmetrical deficit by the use of targeted pain management and rehabilitation may help to reduce the risk of subsequent mobility limitations and falls.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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