title: The Fate of the Iliopsoas Muscle in Long-term Follow-up After Open Reduction With a Medial Approach in Developmental Dysplasia of the Hip. Part 2: Isokinetic Muscle Strength Evaluation.
abstract: BACKGROUND
  The impact on long-term weakness of hip flexion of complete iliopsoas tenotomy during open reduction of developmental hip dysplasia with a medial approach has not yet been fully clarified. The purpose of this study was to investigate the isokinetic muscle strength (IMS) of hip flexor and extensor muscles in these patients and also to analyze the effect of spontaneous reattachment of the iliopsoas muscle on IMS measurements.
  
  
  METHODS
  The study included 20 patients. Earlier magnetic resonance imaging examination of all the patients revealed spontaneous reattachment of the iliopsoas in 18 (90%) patients. IMS measurements were performed at 60 and 150 degrees/s. The peak torque, total work (TW), average power (AP), work fatigue, and agonist to antagonist muscle ratio of the operated and nonoperated hips were recorded separately for flexors and extensors. The effect of iliopsoas reattachment on IMS was also evaluated.
  
  
  RESULTS
  The mean follow-up period was 16.65±2.16 (13 to 20) years. Total work (P=0.013) and average power (P=0.009) of the flexor muscles and work fatigue of the extensor muscles (P=0.030) of the operated hip were significantly decreased when compared with the nonoperated hips at 150 degrees/s. There was no significant difference between the flexor muscles of the operated and nonoperated hips (P<0.05) at 60 degrees/s and extensor muscles (P<0.05) at 150 degrees/s. In addition, patients without reattachment had lower IMS in the operated hips.
  
  
  CONCLUSIONS
  Flexor muscle strength was decreased in the operated hip against low resistance in long-term follow-up after iliopsoas tenotomy. This may reflect that hip muscle strength was decreased after prolonged activities such as sports. However, in forceful activities flexor muscle strength was retained due to iliopsoas reattachment. On the basis of this study we thought that spontaneous reattachment of the iliopsoas tendon substantially preserves muscle strength. Nonetheless possible efforts should be made to surgically reattach the psoas tendon to preserve strength of the muscle.
  
  
  METHODS
  Therapeutic level IV.
authors.affiliation: *Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital †Department of Orthopaedics and Traumatology, Ankara Medical Park Hospital ‡Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Yilmaz
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Aksahin
authors.forename: Murat
authors.initials: M
authors.lastname: Ersoz
authors.forename: Ali
authors.initials: A
authors.lastname: Bicimoglu
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006615:Hip / Q000601:surgery; D006618:Hip Dislocation, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology* / Q000601:surgery; D016658:Psoas Muscles / Q000503:physiopathology / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology*; D013710:Tendons / Q000601:surgery; D058971:Tenotomy / Q000009:adverse effects*; D019415:Torque; D055815:Young Adult