Effects of social isolation associated with the COVID-19 pandemic on hip muscle strength, hip joint pain, and walking ability in patients with osteoarthritis of the hip joint

The COVID-19 pandemic has caused millions of deaths and represents a global health crisis. To reduce the spread of the Sars-CoV-2 virus, governments in many countries adopted a social isolation and lockdown strategy. In Japan, the COVID-19 epidemic began in March 2020, and the Japanese government soon recommended that people avoid others and stay at home. Social isolation may adversely affect people's health, e.g., by decreasing the muscle function of lower limbs and physical activity levels in general1 and increasing mental stress, vascular events, and body weight.1, 2, 3 Furthermore, social isolation may have a greater impact on patients with impaired lower extremity function, such as osteoarthritis of the hip joint, and the COVID-19 lockdown was reported to have a significant impact on pain, joint function, and physical function and activity in patients with end-stage hip and knee osteoarthritis (OA).4 Evidence that social isolation associated with the COVID-19 pandemic worsened the condition of patients with severe hip OA would indicate that patients with impaired lower limb function require interventional measures if their outdoor activities are restricted, e.g., because of epidemics or other issues.

Generally, total hip arthroplasty (THA) is performed to relieve symptoms in patients with severe hip OA, and after THA, patients are able to regain mobility similar to that of a healthy person of equivalent age.5 However, no studies have examined the effects of the COVID-19 pandemic on walking ability and lower extremity muscle strength in patients after THA. In older adults and other people with OA of the hip joint, knee extension muscle strength is important for maintaining physical activity.5, 6, 7, 8, 9 Although past studies investigated the effects of social isolation, such as lock down, on lower limb muscle strength by interviewing participants, none measured the actual changes in lower limb muscle strength.

On the background of the above findings, we hypothesized that social isolation due to the COVID-19 pandemic had a greater impact on patients with severe hip OA than on those already receiving THA, resulting in decreased lower extremity function and increased hip joint pain in those with severe hip OA. Therefore, we evaluated the longitudinal changes of measured hip muscle strength, walking ability, and hip joint pain from before to one year after the start of the COVID-19 pandemic in patients with OA of the hip joint and patients who underwent THA.

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