Evaluation of Stiffness in the Tensor Fascia Latae and Iliotibial Band after Total Hip Arthroplasty

Evaluation of Stiffness in the Tensor Fascia Latae and Iliotibial Band after Total Hip Arthroplasty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Evaluation of Stiffness in the Tensor Fascia Latae and Iliotibial Band after Total Hip Arthroplasty Haruki Osanami, Yuki Kitta, Akira Inoue, Takatoshi Kaneko, Yuki Hirai, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7113810/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study aimed to postoperative changes in stiffness of the tensor fascia latae (TFL) and iliotibial band (ITB) after total hip arthroplasty (THA) via the direct anterior approach. The association between changes in hip alignment, pain, and hip range of motion (ROM) was also investigated. Methods Forty-eight patients (64 hips) undergoing primary THA from April to November 2023 were included. Shear wave elastography (SWE) was used to measure TFL and ITB stiffness preoperatively and daily during the first postoperative week. Changes over time were analyzed, and correlations between femoral offset (FO), leg length, pain during gait, and hip ROM were assessed. Results Shear wave elastography values of the TFL and ITB were significantly higher postoperatively compared to those at preoperation ( P < .05). Change in FO correlated with SWE values of the TFL and ITB on postoperative day one ( P < .05). The SWE values of the TFL and ITB correlated with pain during gait on postoperative day 2–7 ( P < .05), and were negatively correlated with ROM of hip adduction and extension ( P < .05). Conclusions Early postoperative TFL and ITB stiffness increased postoperatively compared to those at preoperation, and postoperative TFL and ITB stiffness correlated with changes in FO, pain during gait, hip adduction, and extension ROM. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research total hip arthroplasty ultrasound elastography tensor fascia latae iliotibial band femoral offset Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Total hip arthroplasty (THA) is the most common inpatient surgery performed on patients aged > 65 in the United States, and is a cost-effective treatment 1 . Systematic reviews have reported that the enhanced recovery after surgery (ERAS) program reduces the length of stay for THA, as well as pain reduction and improved ability to gait 2 – 5 . Thus, although the importance of treatment for pain and gait in the early postoperative period of THA has been reported, reports focusing on the relationship with the muscles surrounding the hip joint have not been adequately reviewed. Factors that influence patient dissatisfaction after THA include early postoperative pain, limited range of motion (ROM), leg length and offset discrepancies, and excessive postoperative stiffness of the muscles surrounding the hip joint 6 – 9 . With these considerations in mind, THA adjusts leg length and offset to optimize soft tissue tension. Decreased soft tissue tension after THA is associated with an increased risk of dislocation 10 , 11 . In contrast, excessive leg length and offset have been shown to increase soft tissue tension 12 and cause decreased hip ROM 13 . Biomechanical studies have reported that excessive stiffness of the tensor fascia latae (TFL) and iliotibial band (ITB) is associated with pain in the iliotibial ligaments and lateral thigh 14 . Furthermore, Bhave et al 15 reported that among patients with contractures resistant to physical therapy after postoperative THA, 57% of them had TFL contractures. Therefore, evaluation of TFL and ITB stiffness in the postoperative period may be important in postoperative rehabilitation. In recent years, shear wave elastography (SWE) has attracted attention as a method for objectively evaluating muscle stiffness. Shear wave elastography is an ultrasound imaging technique that can assess tissue stiffness by measuring shear modulus, and has recently been widely used in the field of orthopaedics 16 – 20 . Furthermore, a previous study that investigated early postoperative muscle stiffness using SWE reported changes over time in the shear modulus of the supraspinatus muscle in the early postoperative period after rotator cuff repair 21 . Based on these findings, a quantitative assessment method using SWE can be used to measure changes in muscle stiffness over time in the early postoperative period of THA, and can serve as an indicator for evaluation and treatment. This study aimed to evaluate changes over time in stiffness of the TFL and ITB after THA using SWE and the relationship between early postoperative pain and ROM of the hip joint. Additionally, we examined the relationship between changes in leg length and femoral offset (FO), which may affect TFL and ITB stiffness. We hypothesize that TFL and ITB stiffness will increase early after postoperative THA, and will be associated with pain and ROM of the hip. RESULTS Change over time in SWE values of the TFL and ITB The SWE values of the TFL were significantly higher on postoperative day 1–5 compared to those at preoperation ( P .05). The SWE values of the ITB were significantly higher on postoperative day 1–4 compared to those at preoperation ( P .05) (Table 2 and Fig. 4 ). Table 2 Change over time in SWE values of the TFL and ITB SWE values (kPa) of the TFL SWE values (kPa) of the ITB Pre 4.6 ± 4.4 7.9 ± 4.8 POD 1 16.4 ± 12.1 a 31.4 ± 24.9 a. b. c POD 2 17.1 ± 8.8 a. b 25.4 ± 18.1 a. b POD 3 14.8 ± 7.6 a. b 26.9 ± 19.6 a. b. c POD 4 16.3 ± 11.0 a. b 22.4 ± 13.1 a. b POD 5 16.8 ± 13.6 a. b 22.2 ± 19.5 b POD 6 11.1 ± 9.9 14.4 ± 13.7 POD 7 6.8 ± 6.8 7.7 ± 7.5 Values are presented as means ± standard deviation. The SWE values were calculated as the value with the hip in a neutral position minus the value with the hip in maximum abduction position. Pre, preoperative; POD; postoperative day; TFL, tensor fasciae latae; ITB, iliotibial band; SWE, shear wave elastography a P < .01 vs. Pre; b P < .01 vs. POD 7; c P < .01 vs. POD 6; *Statistically significant ( P < .05). Correlation of SWE values of the TFL and ITB with changes in leg length and FO Preoperative leg length was 30.09 ± 10.83 mm, postoperative leg length was 40.24 ± 7.49 mm, and postoperative day seven was 40.47 ± 7.20 mm. Preoperative FO was 38.47 ± 6.25 mm, postoperative FO was 41.25 ± 5.76 mm, and postoperative day seven was 41.92 ± 6.51 mm. Change in FO correlated with SWE values of the TFL on postoperative day one (r = 0.50, 95% confidence interval [CI]: 0.29–0.67, P < .01). Change in FO on postoperative day seven did not correlate with SWE values of the TFL and ITB on postoperative day seven. Change in leg length did not correlate with SWE values of the TFL and ITB (Table 3 ). Table 3 Correlation between SWE values of the TFL and ITB, limb lengthening, and femoral offset change Limb lengthening change POD 1 Femoral offset change POD 1 SWE values Correlation P value 95% CI (Range) Correlation P value 95% CI (Range) TFL POD 1 0.07 0.55 (-0.17 to 0.31) 0.50 < .001 * (0.29 to 0.67) ITB POD 1 0.16 0.20 (-0.09 to 0.39) 0.41 < .001 * (0.18 to 0.59) Limb lengthening POD 7 Femoral offset POD 7 TFL POD 7 0.05 0.20 (-0.19 to 0.30) -0.03 0.81 (-0.27 to 0.22) ITB POD 7 0.11 0.41 (-0.15 to 0.34) -0.14 0.29 (-0.37 to 0.11) POD, postoperative day; TFL, tensor fasciae latae; ITB, iliotibial band; SWE, shear wave elastography; CI, confidence interval *Statistically significant ( P < .05). Correlation of SWE values of the TFL and ITB with pain during gait The SWE values of the TFL and ITB correlated with pain during gait on postoperative day 2–7 ( P < .01) (Table 4 ). Table 4 Correlation between SWE values of the TFL and ITB and gait during pain Gait during pain Gait during pain SWE values of the TFL Correlation P value 95% CI (Range) SWE values of the ITB Correlation P value 95% CI (Range) Pre 0.03 0.82 (-0.22 to 0.27) Pre 0.07 0.58 (0.18 to 0.31) POD 1 -0.05 0.71 (-0.29 to 0.20) POD 1 0.23 0.07 (-0.02 to 0.45) POD 2 0.54 0.01 * (0.13 to 0.78) POD 2 0.78 0.001 * (0.61 to 0.88) POD 3 0.46 0.001 * (0.13 to 0.70) POD 3 0.59 0.001 * (0.30 to 0.78) POD 4 0.55 0.001 * (0.33 to 0.71) POD 4 0.74 0.001 * (0.59 to 0.84) POD 5 0.70 0.001 * (0.52 to 0.82) POD 5 0.60 0.001 * (0.38 to 0.76) POD 6 0.71 0.001 * (0.52 to 0.84) POD 6 0.64 0.001 * (0.41 to 0.79) POD 7 0.43 0.001 * (0.20 to 0.61) POD 7 0.43 0.001 * (0.20 to 0.61) Pre, preoperative; POD; postoperative day; TFL, tensor fasciae latae; ITB, iliotibial band; SWE, shear wave elastography; CI, confidence interval *Statistically significant ( P < .05). Correlation of SWE values of the TFL and ITB with ROM The SWE values of the TFL correlated with ROM of hip adduction ( P < .01) and extension ( P < .01) on postoperative day five. The SWE values of the ITB correlated with ROM of hip adduction on postoperative day 2–7 ( P < .05). The SWE values of the ITB correlated with ROM of hip extension on postoperative day 2–5 ( P < .05) (Table 5.6). Intraobserver Reliability The ICC for intraobserver reproducibility of the SWE values of the TFL was 0.90 (95% CI: 0.84–0.94), which corresponds to almost perfect. The ICC for intraobserver reproducibility of the SWE values in the ITB was 0.87 (95% CI: 0.78–0.92), which corresponds to almost perfect. DISCUSSION This study aimed to evaluate changes in SWE values of the TFL and ITB over time after THA, and the relationship between early postoperative pain and ROM of the hip joint. Additionally, we examined the relationship between SWE values of the TFL and ITB and amount of changes in leg length and FO. To our knowledge, this is the first study to focus on muscle stiffness in the early postoperative period of THA using SWE. In this study, SWE values of the TFL and ITB increased in the early postoperative period, and there was a significant correlation between SWE values of the TFL and ITB and pain during gait and ROM of the hip joint. Additionally, we found a positive correlation between SWE values of the TFL and ITB and amount of change in FO in the immediate postoperative period. It has been reported that pain and limited ROM in the early postoperative THA period are directly related to patient dissatisfaction 6 – 9 , and early physical therapy has been shown to be effective in reducing pain and improving ROM 5 . In addition to surgical intervention, changes in muscle and ligament stiffness due to changes in leg length and FO are also important factors that affect pain and ROM limitation. However, reports investigating changes in muscle stiffness of muscles and ligament after THA have not been thoroughly reviewed. Previous studies on soft tissue muscle stiffness in artificial joints revealed scattered reports evaluating the deltoid muscle after reverse shoulder arthroplasty (RSA) surgery using SWE 22 – 24 . Reverse shoulder arthroplasty results in distalization and medialization of the center of rotation, lengthening of the deltoid by 10–20%, and an increased deltoid wrapping angle 25 . In contrast, increased deltoid muscle stiffness has been reported to be significantly correlated with increased pain levels 22 . Therefore, it is important to evaluate deltoid muscle stiffness using SWE after RSA. Takao et al 12 reported that an increase in postoperative offset affects increase in soft tissue tension after THA. Additionally, it has been reported that advanced preoperative hip deformity increases postoperative soft tissue stiffness around the hip joint 26 . Furthermore, there was a positive correlation between the amount of change in the TFL and ITB stiffness and amount of change in FO on the postoperative day, suggesting that intraoperative alignment changes may have increased muscle stiffness. No correlation was observed between the change in TFL and ITB stiffness and the change in FO postoperative day 7, which is likely a result of improvement in TFL and ITB stiffness. The present study suggested that TFL and ITB muscle stiffness increased by postoperative day 5. Although FO and SWE values showed correlation at postoperative day 1 there was no correlation at postoperative day 7. Earlier studies have shown that muscle stiffness as indicated by SWE values has been reported to be associated by tissue oedema 27 , 28 . A review of SWE Value and Pain reported that involved muscle stiffness in symptomatic individuals is partially higher 29 . In this study, a direct anterior approach to the intermuscular plane between the TFL and the suture muscle was used, which may promote edema of the TFL. In addition, Prior studies have reported that SWE values reflect muscle contraction 30 . Therefore, the increase in SWE values may be due to postoperative swelling and associated involuntary contractions. The decrease in SWE values after postoperative day 6 may represent a reduction in postoperative swelling and pain. Since Increased swelling leads to increased SWE values, increased pain during gait, and decreased hip ROM, so it is important to common interventions against swelling for up to postoperative day 5. In this study, there was a negative correlation between SWE values of the TFL and ITB and ROM of hip adduction and extension, indicating that the higher the muscle stiffness, the more restricted the ROM. This can be understood from the similarity with the Ober’s test position (hip extension and adduction) used to measure the stiffness of the TFL and ITB 31 . In the relationship between SWE values of the TFL and ITB and walking pain, this study showed a significant positive correlation on postoperative day 2–7, with higher muscle stiffness resulting in more pain during gait. It is important to ensure ROM of hip adduction and extension during gait, and in healthy adults, the hip adduction angle during gait is reported to be 0 ± 6° 32 and ROM of extension is 13.5 ± 3.2° 33 . In the present results, we observed cases in which the ROM of the hip joint did not reach the ROM that would allow normal gait, especially on postoperative day 2–7, when the pain during gait was particularly severe. From these findings, it was inferred that increased TFL and ITB stiffness may lead to greater stretching during gait, leading to increased pain. No correlation between TFL and ITB stiffness and pain and ROM of hip on postoperative day 1 may be because the patient self-administered analgesics only on postoperative day 1. A previous systematic review reported a decrease in hip adduction and extension angles during gait postoperative THA compared to that of healthy individuals 34 . This suggests the need for early postoperative physical therapy for TFL and ITB stiffness, with the aim of improving the ROM of hip adduction and extension. This study has several limitations. First, this study was a prospective correlational study conducted at a single institution, and may not be generalizable to other surgeons or institutions. Multicenter randomized controlled trials are needed to confirm the generalizability of our results. Second, this study focused on changes in SWE values on day 1–7 after THA, and did not provide data beyond 1 week. In the future, long-term clinical data should be provided. Third, soft tissue stiffness other than the TFL and ITB is not taken into account. Other soft tissues may have different results with increased leg length and FO. Willett et al reported 35 that ITB stiffness also affects the stiffness structures proximal to the hip joint, such as the gluteus medius and minimus muscles and the hip joint capsule, and it is necessary to capture the entire proximal hip structure in correlation with ROM. Other soft tissues may have influenced ROM of hip adduction and extension. In the future, other soft tissues should also be measured. Fourth, the causal relationship with pain and ROM is unknown because only correlations were investigated in this study. There are multiple confounding that could affect postoperative pain that were not considered. For example, the amount of preoperative analgesics the patient was taking and pain catabolism. Nor has postoperative edema been quantified. In the future, factors affecting pain and ROM should be investigated. MATERIALS AND METHODS Participants Forty-eight patients with 64 hips who underwent primary THA by direct anterior approach between April 2023 and November 2023 (men: 16, women: 32, mean age: 68.05 ± 10.03 years; height: 156.97 ± 8.74 cm; weight: 59.16 ± 10 .38 kg; and body mass index: 23.93 ± 3.24 kg/m 2 ) (Table 1 ). Exclusion criteria were previous hip surgery, rheumatoid arthritis 36 , previous neurological involvement, HbA1c > 7.5% 37 , trochanteric bursitis and ITB friction syndrome in preoperative. According to the Tönnis classification system 38 , 10 hips were grade 2 and 54 were grade 3. This study was a prospective correlational study conducted at a single institution, with surgery and rehabilitation performed by one orthopedic surgeon and one physical therapist, respectively. Postoperative protocol consisted of gait and ROM training using a walker on the first postoperative day, which continued until two weeks postoperatively. Common interventions such as ice application were consistently applied to all patients. Postoperative pain management consisted of intravenous patient-controlled analgesics on postoperative day one only, followed by oral non-steroidal anti-inflammatory drugs and acetaminophen. Table 1 Demographic Data of the Study Population. Value Number of patients 48patient, 64hip Age (y) 68.1(Range, 40–83) BMI (kg/m2) 23.9(Range, 17.0-31.1) Gender Male Female 16 32 Tönnis classification system Grade0 Grade1 Grade2 Grade3 0 0 10 54 Surgical approach Direct anterior approach 64 Surgical time Unilateral THA (minutes) Bilateral THAs (minutes) 29 ± 5 69 ± 13 BMI, body mass index. Table 5 Correlation between SWE values of the TFL and ITB and range of motion of hip adduction and extension SWE values of the TFL SWE values of the ITB ROM of hip adduction ROM of hip extension ROM of hip adduction ROM of hip extension Correlation P value 95% CI (Range) Correlation P value 95% CI (Range) Correlation P value 95% CI (Range) Correlation P value 95% CI (Range) Pre 0.01 0.92 (-0.24 to 0.27) 0.11 0.54 (-0.23 to 0.43) -0.14 0.29 (-0.38 to 0.12) 0.06 0.74 (-0.28 to 0.39) POD 1 -0.10 0.45 (-0.33 to 0.15) -0.23 0.15 (-0.51 to 0.09) -0.08 0.54 (-0.31 to 0.17) -0.30 0.06 (-0.57 to 0.01) POD 2 -0.05 0.83 (-0.47 to 0.39) -0.68 0.14 (-0.96 to 0.29) -0.33 0.04 * (-0.59 to -0.01) -0.55 0.01 * (-0.80 to -0.14) POD 3 0.22 0.23 (-0.15 to 0.53) -0.69 0.06 (-0.94 to 0.04) -0.39 0.03 * (-0.65 to -0.04) -0.80 0.02 * (-0.96 to -0.23) POD 4 -0.10 0.48 (-0.35 to 0.18) 0.05 0.78 (-0.31 to 0.41) -0.35 0.008 * (-0.56 to -0.10) -0.35 0.04 * (-0.62 to -0.01) POD 5 -0.44 0.002 * (-0.64 to -0.17) -0.47 0.02 * (-0.73 to -0.09) -0.51 0.001 * (-0.69 to -0.27) -0.40 0.04 * (-0.68 to -0.03) POD 6 -0.29 0.07 (-0.54 to 0.03) -0.03 0.91 (-0.49 to 0.45) -0.43 0.006 * (-0.65 to -0.13) -0.15 0.54 (-0.58 to 0.34) POD 7 -0.19 0.14 (-0.42 to 0.07) -0.18 0.26 (-0.47 to 0.14) -0.31 0.01 * (-0.51 to -0.06) -0.19 0.25 (-0.48 to 0.13) Pre, preoperative; POD; postoperative day; TFL, tensor fasciae latae; ITB, iliotibial band; SWE, shear wave elastography; ROM, range of motion; CI, confidence interval *Statistically significant ( P < .05). Table 6 Changes over time in gait during pain and range of motion of hip adduction and extension Gait during pain (Range) ROM of hip adduction (Range) ROM of hip extension (Range) Pre 5.6 ± 2.4 (0 to 10) 13.7 ± 5.0 (2 to 25) -0.2 ± 0.3 (-10 to 15) POD 1 5.4 ± 2.8 (0 to 10) 6.5 ± 4.0 (0 to 20) -0.3 ± 0.2 (-16 to 5) POD 2 4.2 ± 2.0 (1 to 8) 8.1 ± 4.2 (2 to 20) 0.1 ± 0.8 (-10 to 7) POD 3 4.1 ± 2.3 (1 to 10) 8.6 ± 4.3 (1 to 16) 0.1 ± 0.7 (-12 to 10) POD 4 3.7 ± 2.2 (0 to 9) 8.4 ± 4.4 (0 to 17) 0.3 ± 0.7 (-10 to 11) POD 5 3.4 ± 1.8 (0 to 9) 9.1 ± 3.8 (0 to 17) 0.5 ± 0.8 (-20 to 9) POD 6 2.8 ± 1.8 (0 to 7) 11.0 ± 3.9 (2 to 21) 0.5 ± 0.8 (-5 to 13) POD 7 2.2 ± 1.5 (0 to 6) 12.1 ± 4.5 (3 to 21) 0.2 ± 0.6 (-5 to 15) Values are presented as means ± standard deviation. Pre, preoperative; POD, postoperative day; ROM, range of motion. Ethical approval for this study was obtained from the institutional review board (IRB) (approval number: 3518). All procedures were performed in accordance with the ethical standards of the Declaration of Helsinki. All participants received a thorough explanation of the study and provided written informed consent before enrollment. Surgical Technique All procedures were performed under general anesthesia with the patient in the supine position. A direct anterior approach was employed in all cases to access the intermuscular plane between the tensor fasciae latae and sartorius muscles. The conjoined external rotator tendon was generally preserved. Surgical time averaged 29 ± 5 minutes for unilateral THA and 69 ± 13 minutes for bilateral THAs. Measurements Muscle stiffness measurements were performed by a single experienced musculoskeletal sonographer using an ultrasound (LOGIQ S8, GE Healthcare, Tokyo, Japan) equipped with a 9L-D linear transducer 39 . To ensure proper contact, ample ultrasound gel was used between the probe and skin surface. The measurer was careful when applying constant pressure at the lowest level at which ultrasound could be visualized 40 . In previous studies, the SWE test measured SWE values (kPa) of the TFL and ITB 41 , 42 . Since shear wave velocity correlates with the tissue’s elastic modulus, the system automatically calculates Young’s modulus from the wave speed 43 , 44 . A higher modulus value indicates increased tissue stiffness 45 , 46 . The measurement site of the TFL was set at the midpoint between the anterior superior iliac spine and greater trochanter of the femur 41 , and the measurement site for ITB was 2 cm proximal to the lateral femoral epicondyle (Figs. 1 and 2 ) 42 . The region of interest was positioned centrally within the muscle belly of the TFL and across the thickness of the ITB. Two measurements were taken at each location, and their mean was used for analysis. Measurements were performed twice at each test site (the TFL and ITB), and the average value was calculated. SWE measurements were conducted in two different hip positions: one with the subject lying supine and the hip in a neutral alignment, and the other in maximum abduction. Differences in stiffness were calculated by subtracting the SWE values measured during maximum hip abduction from that measured in the neutral hip position. To prevent changes in muscle hardness due to measurement time, each measurement was obtained within 15 s 47 . The measurements were performed preoperatively and from postoperative day one to seven. Alignment, leg length, and FO were assessed using preoperative, immediate postoperative, and postoperative day seven radiographs, respectively. In previous studies, leg length was measured as the distance from the pelvis from the lower edge of the teardrop to the apex of the lesser trochanter, and FO was measured as the distance between the femoral head center and femoral shaft axis 8 , 48 . Leg length and FO were measured preoperatively, immediately postoperative, and postoperative day seven to determine the amount of change in leg length and FO (Fig. 3 ). All the patients underwent pain assessment and hip ROM measurements. To assess pain, the numeric rating scale was used to rate anterolateral thigh pain during gait on a scale of 0 to 10 49 . Pain was assessed one side at a time to account for contralateral hip effects. To assess ROM, the todai goniometer (TTM-KO, Sakai Medical, Japan) was used to measure the ROM of hip adduction and extension. Pain and ROM were evaluated at the same times as the SWE examination, preoperatively and from postoperative day one to seven, respectively. Data Analyses Statistical analyses consisted of separate, single-factor (time) repeated-measure analysis of variance for SWE values of the TFL and ITB over time. For multiple comparisons, P -values were adjusted using the Holm’s step-down procedure. The Pearson correlations were performed to investigate the association between SWE values of the TFL and ITB, pain, and ROM at preoperation and postoperative day 1–7. Finally, the Pearson correlations were performed to investigate the association between changes in the TFL and ITB and changes in leg length and FO. In order to assess the intraobserver reliability of the SWE values of the TFL and ITB, the trials were performed twice more than without any knowledge of the observer’s own previous measurements. Intraobserver reliabilities were determined with an intraobserver correlation coefficient (ICC [1, 1]). The Landis scoring system was used for the analysis (almost perfect: >0.81, substantial: 0.61–0.80, moderate: 0.41–0.60, fair: 0.21–0.40, and slight: 0.0–0.20) 50 . All analyses were performed using R (version 2.8.1), and statistical significance was set at P < .05. CONCLUSIONS Tensor fascia latae and ITB stiffness increased at early postoperative THA and positively correlated with changes in FO. Additionally, TFL and ITB stiffness correlated with pain during gait and hip ROM. These results suggest the importance of physical therapy for the TFL and ITB in the early postoperative period of THA. Declarations Ethical approval The study protocol complied with the principles outlined in the Declaration of Helsinki and was approved by the Ethics Review Board Committee of Keiyu Orthopaedic Hospital (approval number: 3518). Competing Interests The authors declare that they have no conflicts of interest related to this study. Funding This research received no financial support from agencies in the public, commercial, or not-for-profit sectors. Author Contribution H.O. designed the study, collected and analyzed data, and drafted the manuscript. Y.K. participated in study design and data collection. T.K. assisted with data collection and critically revised the manuscript. Y.H. and A.I. contributed important revisions to the manuscript. K.U. supervised the study, analyzed and interpreted data, and reviewed the manuscript. All authors have reviewed and approved the final manuscript. Data Availability The data supporting the findings of this study are available from the corresponding author upon reasonable request. References Jenkins, P. J. et al. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. Bone Joint J 95-B , 115-121, doi:10.1302/0301-620X.95B1.29835 (2013). Singh, J. A., Yu, S., Chen, L. & Cleveland, J. D. Rates of Total Joint Replacement in the United States: Future Projections to 2020-2040 Using the National Inpatient Sample. J Rheumatol 46 , 1134-1140, doi:10.3899/jrheum.170990 (2019). Wainwright, T. W. et al. 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J Shoulder Elbow Surg 25 , 581-588, doi:10.1016/j.jse.2015.09.015 (2016). Qian, H. et al. Total Hip Arthroplasty in Patients with Crowe III/IV Developmental Dysplasia of the Hip: Acetabular Morphology and Reconstruction Techniques. Orthop Surg 15 , 1468-1476, doi:10.1111/os.13733 (2023). Polat, A. V. et al. Efficacy of Ultrasound and Shear Wave Elastography for the Diagnosis of Breast Cancer-Related Lymphedema. J Ultrasound Med 39 , 795-803, doi:10.1002/jum.15162 (2020). Fu, C., Xia, Y., Wang, B., Zeng, Q. & Pan, S. MRI T2 mapping and shear wave elastography for identifying main pain generator in delayed-onset muscle soreness: muscle or fascia? Insights Imaging 15 , 67, doi:10.1186/s13244-024-01619-6 (2024). Haueise, A., Le Sant, G., Eisele-Metzger, A. & Dieterich, A. V. Is musculoskeletal pain associated with increased muscle stiffness? Evidence map and critical appraisal of muscle measurements using shear wave elastography. 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Mendiolagoitia, L., Rodríguez, M., Crespo, I., Del Valle, M. & Olmedillas, H. Kinematic Gait Analysis After Primary Total Hip Replacement: A Systematic Review: Gait After Total Hip Replacement: A Systematic Review. Indian J Orthop 54 , 767-775, doi:10.1007/s43465-020-00101-x (2020). Willett, G. M., Keim, S. A., Shostrom, V. K. & Lomneth, C. S. An Anatomic Investigation of the Ober Test. Am J Sports Med 44 , 696-701, doi:10.1177/0363546515621762 (2016). Kawasaki, M., Hasegawa, Y., Okura, T., Ochiai, S. & Fujibayashi, T. Muscle Damage After Total Hip Arthroplasty Through the Direct Anterior Approach for Developmental Dysplasia of the Hip. J Arthroplasty 32 , 2466-2473, doi:10.1016/j.arth.2017.03.043 (2017). Shohat, N. et al. All Patients Should Be Screened for Diabetes Before Total Joint Arthroplasty. J Arthroplasty 33 , 2057-2061, doi:10.1016/j.arth.2018.02.047 (2018). Kovalenko, B., Bremjit, P. & Fernando, N. Classifications in Brief: Tönnis Classification of Hip Osteoarthritis. Clin Orthop Relat Res 476 , 1680-1684, doi:10.1097/01.blo.0000534679.75870.5f (2018). Osanami, H. et al. Validation of anterior ankle soft tissue dynamics and shear modulus for anterior ankle impingement syndrome after ankle fracture surgery. Sci Rep 14 , 5863, doi:10.1038/s41598-024-56671-5 (2024). Inoue, A. et al. Evaluation of hypervascularity in synovitis of the shoulder using ultrasound: comparison of preoperative ultrasound findings and intraoperative arthroscopic findings. JSES Int 6 , 473-478, doi:10.1016/j.jseint.2021.12.002 (2022). Umehara, J. et al. Effect of hip and knee position on tensor fasciae latae elongation during stretching: An ultrasonic shear wave elastography study. Clin Biomech (Bristol, Avon) 30 , 1056-1059, doi:10.1016/j.clinbiomech.2015.09.007 (2015). Klauser, A. S. et al. Intraobserver Assessment of Shear Wave Elastography in Tensor Fasciae Latae and Gluteus Maximus Muscle: The Importance of the Hip Abductor Muscles in Runners Knee Compared to Healthy Controls. J Clin Med 11 , doi:10.3390/jcm11133605 (2022). Bolboacă, S. D. et al. Shear-Wave Elastography Variability Analysis and Relation with Kidney Allograft Dysfunction: A Single-Center Study. Diagnostics (Basel) 10 , doi:10.3390/diagnostics10010041 (2020). Kato, T. et al. Quantifying the shear modulus of the adductor longus muscle during hip joint motion using shear wave elastography. Sci Rep 13 , 9510, doi:10.1038/s41598-023-36698-w (2023). Kellis, E., Kekelekis, A. & Drakonaki, E. E. Is thoracolumbar fascia shear-wave modulus affected by active and passive knee flexion? J Anat 244 , 438-447, doi:10.1111/joa.13977 (2024). Miyasaka, H., Ebihara, B., Fukaya, T. & Mutsuzaki, H. Relationship between the Young's Modulus of the Achilles Tendon and Ankle Dorsiflexion Angle at Maximum Squat Depth in Healthy Young Males. Medicina (Kaunas) 59 , doi:10.3390/medicina59061105 (2023). Nakamura, M., Ikezoe, T., Takeno, Y. & Ichihashi, N. Time course of changes in passive properties of the gastrocnemius muscle-tendon unit during 5 min of static stretching. Man Ther 18 , 211-215, doi:10.1016/j.math.2012.09.010 (2013). Hirano, Y. et al. The association of postoperative global femoral offset with total hip arthroplasty outcomes. Sci Rep 13 , 1621, doi:10.1038/s41598-023-28863-y (2023). Dahmen, J., Rikken, Q., Stufkens, S. A. S. & Kerkhoffs, G. Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC): Two-Year Prospective Results of a Novel Press-Fit Surgical Technique for Large, Complex Osteochondral Lesions of the Medial Talus. J Bone Joint Surg Am 105 , 1318-1328, doi:10.2106/jbjs.22.01322 (2023). Landis, J. R. & Koch, G. G. The measurement of observer agreement for categorical data. Biometrics 33 , 159-174 (1977). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7113810","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":491396151,"identity":"9c8e815b-4ffe-443d-b0fe-e3907d397119","order_by":0,"name":"Haruki Osanami","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIie2RsUrDQBiA/3BwXf7oepKir3ASuFJ69F1KoC4VulvoQSBToWsy+QqKL2A4iEtwLkRQ6doho0MqnqGTeK1uIveN//Hxf3cH4HD8QXhn+RIAstNj5ql2QHcnxKpgCQF0ZXiS/lhhE6PI8ehmtRscDOvBZV5NJ9q7q+KkrptheATI4W0GnZ5F6avHaJCWmoinPM6yJBLUKN6iANJXlrBcicBfaCpWo5j4ikh6tuHgKyD83qJoMMq7xjA1CjZz2W7Z7lMKFAHimHH2qVDdhpG9W0oaDRAlZybMy5KHkAKd6m7B7Hd5XucVIpsv04s11M3V+bUit6+bmYxsL/Y9JolFh3/oK8PfKw6Hw/FP+QCBpFF7KViX3QAAAABJRU5ErkJggg==","orcid":"","institution":"Keiyu Orthopedic Hospital","correspondingAuthor":true,"prefix":"","firstName":"Haruki","middleName":"","lastName":"Osanami","suffix":""},{"id":491396152,"identity":"8610435c-a55b-45df-b2bf-85b9c64240e9","order_by":1,"name":"Yuki Kitta","email":"","orcid":"","institution":"Keiyu Orthopedic Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuki","middleName":"","lastName":"Kitta","suffix":""},{"id":491396153,"identity":"6361b930-1808-4b1f-b442-32e97d67ebc1","order_by":2,"name":"Akira Inoue","email":"","orcid":"","institution":"Keiyu Orthopedic Hospital","correspondingAuthor":false,"prefix":"","firstName":"Akira","middleName":"","lastName":"Inoue","suffix":""},{"id":491396154,"identity":"56b19be0-87ae-429a-bdac-59d845e43ce4","order_by":3,"name":"Takatoshi Kaneko","email":"","orcid":"","institution":"Keiyu Orthopedic Hospital","correspondingAuthor":false,"prefix":"","firstName":"Takatoshi","middleName":"","lastName":"Kaneko","suffix":""},{"id":491396155,"identity":"28962623-3a82-4aa6-9906-7b1969e5c2a8","order_by":4,"name":"Yuki Hirai","email":"","orcid":"","institution":"Keiyu Orthopedic Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yuki","middleName":"","lastName":"Hirai","suffix":""},{"id":491396156,"identity":"353258cb-742e-4a16-8ae9-28851a85a2dc","order_by":5,"name":"Koji Ugai","email":"","orcid":"","institution":"Keiyu Orthopedic Hospital","correspondingAuthor":false,"prefix":"","firstName":"Koji","middleName":"","lastName":"Ugai","suffix":""},{"id":491396157,"identity":"ac048ae3-7b6b-4b54-82d7-37f285833c76","order_by":6,"name":"Eiki Tsushima","email":"","orcid":"","institution":"Hirosaki University","correspondingAuthor":false,"prefix":"","firstName":"Eiki","middleName":"","lastName":"Tsushima","suffix":""}],"badges":[],"createdAt":"2025-07-13 14:23:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7113810/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7113810/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87769281,"identity":"09ab3e4e-e881-4e79-b7fa-fb2b194f99e7","added_by":"auto","created_at":"2025-07-28 19:13:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":697239,"visible":true,"origin":"","legend":"\u003cp\u003eShear modulus measurement of the TFL\u003c/p\u003e\n\u003cp\u003eTFL, tensor fasciae latae\u003c/p\u003e","description":"","filename":"Figure11.png","url":"https://assets-eu.researchsquare.com/files/rs-7113810/v1/168d04713cdb521977314084.png"},{"id":87769282,"identity":"4c7d1c98-104d-49e9-a5e0-f1dc2d78dfc7","added_by":"auto","created_at":"2025-07-28 19:13:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":714257,"visible":true,"origin":"","legend":"\u003cp\u003eShear modulus measurement of the ITB\u003c/p\u003e\n\u003cp\u003eITB, iliotibial band\u003c/p\u003e","description":"","filename":"Figure21.png","url":"https://assets-eu.researchsquare.com/files/rs-7113810/v1/19821c95b462aaf51c859c29.png"},{"id":87769283,"identity":"01a06907-cfe7-4b65-962f-f876feda9ce1","added_by":"auto","created_at":"2025-07-28 19:13:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":506943,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of hip joint length and femoral offset on (a) preoperative and (b) postoperative radiographs\u003c/p\u003e\n\u003cp\u003e(A) Hip length was defined as the vertical distance between the teardrop-trans-teardrop line and apex of the lesser trochanter. (B) Femoral offset was measured as the distance between the center of the femoral head and femoral diaphyseal axis. The difference between preoperative and postoperative hip length and femoral offset was defined as lower extremity extension and femoral offset\u003c/p\u003e","description":"","filename":"Figure31.png","url":"https://assets-eu.researchsquare.com/files/rs-7113810/v1/0de495969879de13a30d9eb7.png"},{"id":87769605,"identity":"4a7711d5-e540-455d-bc9c-03caa25a713e","added_by":"auto","created_at":"2025-07-28 19:21:08","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":46763,"visible":true,"origin":"","legend":"\u003cp\u003eChronologic changes in shear wave elastography (SWE) values\u003c/p\u003e\n\u003cp\u003e(a) Tensor fasciae latae. (B) Iliotibial band. ＊ P \u0026lt; .01 vs. Pre; ★ P \u0026lt; .01 vs. POD 7; ☆ P \u0026lt; .01 vs. POD 6\u003c/p\u003e","description":"","filename":"Figure41.png","url":"https://assets-eu.researchsquare.com/files/rs-7113810/v1/10f087b2775fddff7ef36daf.png"},{"id":89387661,"identity":"59f17b4c-868e-4c94-a046-9f35398a8bc5","added_by":"auto","created_at":"2025-08-19 12:38:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3358179,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7113810/v1/b8919607-b8b5-4f01-8551-71dc785e1fb7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of Stiffness in the Tensor Fascia Latae and Iliotibial Band after Total Hip Arthroplasty","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTotal hip arthroplasty (THA) is the most common inpatient surgery performed on patients aged\u0026thinsp;\u0026gt;\u0026thinsp;65 in the United States, and is a cost-effective treatment \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Systematic reviews have reported that the enhanced recovery after surgery (ERAS) program reduces the length of stay for THA, as well as pain reduction and improved ability to gait \u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Thus, although the importance of treatment for pain and gait in the early postoperative period of THA has been reported, reports focusing on the relationship with the muscles surrounding the hip joint have not been adequately reviewed.\u003c/p\u003e\u003cp\u003eFactors that influence patient dissatisfaction after THA include early postoperative pain, limited range of motion (ROM), leg length and offset discrepancies, and excessive postoperative stiffness of the muscles surrounding the hip joint \u003csup\u003e\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. With these considerations in mind, THA adjusts leg length and offset to optimize soft tissue tension. Decreased soft tissue tension after THA is associated with an increased risk of dislocation \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. In contrast, excessive leg length and offset have been shown to increase soft tissue tension \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e and cause decreased hip ROM \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Biomechanical studies have reported that excessive stiffness of the tensor fascia latae (TFL) and iliotibial band (ITB) is associated with pain in the iliotibial ligaments and lateral thigh \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Furthermore, Bhave et al \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e reported that among patients with contractures resistant to physical therapy after postoperative THA, 57% of them had TFL contractures. Therefore, evaluation of TFL and ITB stiffness in the postoperative period may be important in postoperative rehabilitation.\u003c/p\u003e\u003cp\u003eIn recent years, shear wave elastography (SWE) has attracted attention as a method for objectively evaluating muscle stiffness. Shear wave elastography is an ultrasound imaging technique that can assess tissue stiffness by measuring shear modulus, and has recently been widely used in the field of orthopaedics\u003csup\u003e\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Furthermore, a previous study that investigated early postoperative muscle stiffness using SWE reported changes over time in the shear modulus of the supraspinatus muscle in the early postoperative period after rotator cuff repair \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Based on these findings, a quantitative assessment method using SWE can be used to measure changes in muscle stiffness over time in the early postoperative period of THA, and can serve as an indicator for evaluation and treatment.\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate changes over time in stiffness of the TFL and ITB after THA using SWE and the relationship between early postoperative pain and ROM of the hip joint. Additionally, we examined the relationship between changes in leg length and femoral offset (FO), which may affect TFL and ITB stiffness. We hypothesize that TFL and ITB stiffness will increase early after postoperative THA, and will be associated with pain and ROM of the hip.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cb\u003eChange over time in SWE values of the TFL and ITB\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe SWE values of the TFL were significantly higher on postoperative day 1\u0026ndash;5 compared to those at preoperation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01), and were comparable to those at preoperation and postoperative day six (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05). The SWE values of the ITB were significantly higher on postoperative day 1\u0026ndash;4 compared to those at preoperation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01), and were comparable to those at preoperation and postoperative day five (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChange over time in SWE values of the TFL and ITB\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSWE values (kPa) of the TFL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSWE values (kPa) of the ITB\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.1 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.4\u0026thinsp;\u0026plusmn;\u0026thinsp;24.9 \u003csup\u003ea. b. c\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 \u003csup\u003ea. b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.4\u0026thinsp;\u0026plusmn;\u0026thinsp;18.1 \u003csup\u003ea. b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6 \u003csup\u003ea. b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.9\u0026thinsp;\u0026plusmn;\u0026thinsp;19.6 \u003csup\u003ea. b. c\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0 \u003csup\u003ea. b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1 \u003csup\u003ea. b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6 \u003csup\u003ea. b\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.2\u0026thinsp;\u0026plusmn;\u0026thinsp;19.5 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;13.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eValues are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The SWE values were calculated as the value with the hip in a neutral position minus the value with the hip in maximum abduction position.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003ePre, preoperative; POD; postoperative day; TFL, tensor fasciae latae; ITB, iliotibial band; SWE, shear wave elastography\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003ea\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01 vs. Pre; \u003csup\u003eb\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01 vs. POD 7; \u003csup\u003ec\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01 vs. POD 6; *Statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCorrelation of SWE values of the TFL and ITB with changes in leg length and FO\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePreoperative leg length was 30.09\u0026thinsp;\u0026plusmn;\u0026thinsp;10.83 mm, postoperative leg length was 40.24\u0026thinsp;\u0026plusmn;\u0026thinsp;7.49 mm, and postoperative day seven was 40.47\u0026thinsp;\u0026plusmn;\u0026thinsp;7.20 mm. Preoperative FO was 38.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25 mm, postoperative FO was 41.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.76 mm, and postoperative day seven was 41.92\u0026thinsp;\u0026plusmn;\u0026thinsp;6.51 mm. Change in FO correlated with SWE values of the TFL on postoperative day one (r\u0026thinsp;=\u0026thinsp;0.50, 95% confidence interval [CI]: 0.29\u0026ndash;0.67, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01). Change in FO on postoperative day seven did not correlate with SWE values of the TFL and ITB on postoperative day seven. Change in leg length did not correlate with SWE values of the TFL and ITB (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation between SWE values of the TFL and ITB, limb lengthening, and femoral offset change\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eLimb lengthening change POD 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eFemoral offset change POD 1\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSWE values\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI (Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95% CI (Range)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTFL POD 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.17 to 0.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.29 to 0.67)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eITB POD 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.09 to 0.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(0.18 to 0.59)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eLimb lengthening POD 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eFemoral offset POD 7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTFL POD 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.19 to 0.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.27 to 0.22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eITB POD 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.15 to 0.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.37 to 0.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003ePOD, postoperative day; TFL, tensor fasciae latae; ITB, iliotibial band; SWE, shear wave elastography; CI, confidence interval\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCorrelation of SWE values of the TFL and ITB with pain during gait\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe SWE values of the TFL and ITB correlated with pain during gait on postoperative day 2\u0026ndash;7 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation between SWE values of the TFL and ITB and gait during pain\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eGait during pain\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e\u003cp\u003eGait during pain\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSWE values of the TFL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI (Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSWE values of the ITB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e95% CI (Range)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.22 to 0.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.18 to 0.31)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.29 to 0.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePOD 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(-0.02 to 0.45)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.01 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.13 to 0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePOD 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.61 to 0.88)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.13 to 0.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePOD 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.30 to 0.78)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.33 to 0.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePOD 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.59 to 0.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.52 to 0.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePOD 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.38 to 0.76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.52 to 0.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePOD 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.41 to 0.79)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(0.20 to 0.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePOD 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e(0.20 to 0.61)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003ePre, preoperative; POD; postoperative day; TFL, tensor fasciae latae; ITB, iliotibial band; SWE, shear wave elastography; CI, confidence interval\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"9\"\u003e*Statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eCorrelation of SWE values of the TFL and ITB with ROM\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe SWE values of the TFL correlated with ROM of hip adduction (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01) and extension (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01) on postoperative day five. The SWE values of the ITB correlated with ROM of hip adduction on postoperative day 2\u0026ndash;7 (\u003cem\u003eP\u003c/em\u003e \u0026lt; .05). The SWE values of the ITB correlated with ROM of hip extension on postoperative day 2\u0026ndash;5 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) (Table\u0026nbsp;5.6).\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntraobserver Reliability\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe ICC for intraobserver reproducibility of the SWE values of the TFL was 0.90 (95% CI: 0.84\u0026ndash;0.94), which corresponds to almost perfect. The ICC for intraobserver reproducibility of the SWE values in the ITB was 0.87 (95% CI: 0.78\u0026ndash;0.92), which corresponds to almost perfect.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study aimed to evaluate changes in SWE values of the TFL and ITB over time after THA, and the relationship between early postoperative pain and ROM of the hip joint. Additionally, we examined the relationship between SWE values of the TFL and ITB and amount of changes in leg length and FO. To our knowledge, this is the first study to focus on muscle stiffness in the early postoperative period of THA using SWE. In this study, SWE values of the TFL and ITB increased in the early postoperative period, and there was a significant correlation between SWE values of the TFL and ITB and pain during gait and ROM of the hip joint. Additionally, we found a positive correlation between SWE values of the TFL and ITB and amount of change in FO in the immediate postoperative period.\u003c/p\u003e\u003cp\u003eIt has been reported that pain and limited ROM in the early postoperative THA period are directly related to patient dissatisfaction \u003csup\u003e\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, and early physical therapy has been shown to be effective in reducing pain and improving ROM \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. In addition to surgical intervention, changes in muscle and ligament stiffness due to changes in leg length and FO are also important factors that affect pain and ROM limitation. However, reports investigating changes in muscle stiffness of muscles and ligament after THA have not been thoroughly reviewed. Previous studies on soft tissue muscle stiffness in artificial joints revealed scattered reports evaluating the deltoid muscle after reverse shoulder arthroplasty (RSA) surgery using SWE \u003csup\u003e\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Reverse shoulder arthroplasty results in distalization and medialization of the center of rotation, lengthening of the deltoid by 10\u0026ndash;20%, and an increased deltoid wrapping angle \u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. In contrast, increased deltoid muscle stiffness has been reported to be significantly correlated with increased pain levels \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Therefore, it is important to evaluate deltoid muscle stiffness using SWE after RSA. Takao et al \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e reported that an increase in postoperative offset affects increase in soft tissue tension after THA. Additionally, it has been reported that advanced preoperative hip deformity increases postoperative soft tissue stiffness around the hip joint \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Furthermore, there was a positive correlation between the amount of change in the TFL and ITB stiffness and amount of change in FO on the postoperative day, suggesting that intraoperative alignment changes may have increased muscle stiffness. No correlation was observed between the change in TFL and ITB stiffness and the change in FO postoperative day 7, which is likely a result of improvement in TFL and ITB stiffness.\u003c/p\u003e\u003cp\u003eThe present study suggested that TFL and ITB muscle stiffness increased by postoperative day 5. Although FO and SWE values showed correlation at postoperative day 1 there was no correlation at postoperative day 7. Earlier studies have shown that muscle stiffness as indicated by SWE values has been reported to be associated by tissue oedema \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. A review of SWE Value and Pain reported that involved muscle stiffness in symptomatic individuals is partially higher \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. In this study, a direct anterior approach to the intermuscular plane between the TFL and the suture muscle was used, which may promote edema of the TFL. In addition, Prior studies have reported that SWE values reflect muscle contraction \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Therefore, the increase in SWE values may be due to postoperative swelling and associated involuntary contractions. The decrease in SWE values after postoperative day 6 may represent a reduction in postoperative swelling and pain. Since Increased swelling leads to increased SWE values, increased pain during gait, and decreased hip ROM, so it is important to common interventions against swelling for up to postoperative day 5.\u003c/p\u003e\u003cp\u003eIn this study, there was a negative correlation between SWE values of the TFL and ITB and ROM of hip adduction and extension, indicating that the higher the muscle stiffness, the more restricted the ROM. This can be understood from the similarity with the Ober\u0026rsquo;s test position (hip extension and adduction) used to measure the stiffness of the TFL and ITB \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. In the relationship between SWE values of the TFL and ITB and walking pain, this study showed a significant positive correlation on postoperative day 2\u0026ndash;7, with higher muscle stiffness resulting in more pain during gait. It is important to ensure ROM of hip adduction and extension during gait, and in healthy adults, the hip adduction angle during gait is reported to be 0\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u0026deg; \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e and ROM of extension is 13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u0026deg; \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. In the present results, we observed cases in which the ROM of the hip joint did not reach the ROM that would allow normal gait, especially on postoperative day 2\u0026ndash;7, when the pain during gait was particularly severe. From these findings, it was inferred that increased TFL and ITB stiffness may lead to greater stretching during gait, leading to increased pain. No correlation between TFL and ITB stiffness and pain and ROM of hip on postoperative day 1 may be because the patient self-administered analgesics only on postoperative day 1. A previous systematic review reported a decrease in hip adduction and extension angles during gait postoperative THA compared to that of healthy individuals \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. This suggests the need for early postoperative physical therapy for TFL and ITB stiffness, with the aim of improving the ROM of hip adduction and extension.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, this study was a prospective correlational study conducted at a single institution, and may not be generalizable to other surgeons or institutions. Multicenter randomized controlled trials are needed to confirm the generalizability of our results. Second, this study focused on changes in SWE values on day 1\u0026ndash;7 after THA, and did not provide data beyond 1 week. In the future, long-term clinical data should be provided. Third, soft tissue stiffness other than the TFL and ITB is not taken into account. Other soft tissues may have different results with increased leg length and FO. Willett et al reported \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e that ITB stiffness also affects the stiffness structures proximal to the hip joint, such as the gluteus medius and minimus muscles and the hip joint capsule, and it is necessary to capture the entire proximal hip structure in correlation with ROM. Other soft tissues may have influenced ROM of hip adduction and extension. In the future, other soft tissues should also be measured. Fourth, the causal relationship with pain and ROM is unknown because only correlations were investigated in this study. There are multiple confounding that could affect postoperative pain that were not considered. For example, the amount of preoperative analgesics the patient was taking and pain catabolism. Nor has postoperative edema been quantified. In the future, factors affecting pain and ROM should be investigated.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eForty-eight patients with 64 hips who underwent primary THA by direct anterior approach between April 2023 and November 2023 (men: 16, women: 32, mean age: 68.05\u0026thinsp;\u0026plusmn;\u0026thinsp;10.03 years; height: 156.97\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74 cm; weight: 59.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10 .38 kg; and body mass index: 23.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24 kg/m\u003csup\u003e2\u003c/sup\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Exclusion criteria were previous hip surgery, rheumatoid arthritis \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e, previous neurological involvement, HbA1c\u0026thinsp;\u0026gt;\u0026thinsp;7.5% \u003csup\u003e37\u003c/sup\u003e, trochanteric bursitis and ITB friction syndrome in preoperative. According to the T\u0026ouml;nnis classification system \u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e, 10 hips were grade 2 and 54 were grade 3. This study was a prospective correlational study conducted at a single institution, with surgery and rehabilitation performed by one orthopedic surgeon and one physical therapist, respectively. Postoperative protocol consisted of gait and ROM training using a walker on the first postoperative day, which continued until two weeks postoperatively. Common interventions such as ice application were consistently applied to all patients. Postoperative pain management consisted of intravenous patient-controlled analgesics on postoperative day one only, followed by oral non-steroidal anti-inflammatory drugs and acetaminophen.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Data of the Study Population.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48patient, 64hip\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68.1(Range, 40\u0026ndash;83)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.9(Range, 17.0-31.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003cp\u003eMale\u003c/p\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e16\u003c/p\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT\u0026ouml;nnis classification system\u003c/p\u003e\u003cp\u003eGrade0\u003c/p\u003e\u003cp\u003eGrade1\u003c/p\u003e\u003cp\u003eGrade2\u003c/p\u003e\u003cp\u003eGrade3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e0\u003c/p\u003e\u003cp\u003e10\u003c/p\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical approach\u003c/p\u003e\u003cp\u003eDirect anterior approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical time\u003c/p\u003e\u003cp\u003eUnilateral THA (minutes)\u003c/p\u003e\u003cp\u003eBilateral THAs (minutes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cp\u003e29\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\u003cp\u003e69\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"2\"\u003eBMI, body mass index.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelation between SWE values of the TFL and ITB and range of motion of hip adduction and extension\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e\u003cp\u003eSWE values of the TFL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"6\" nameend=\"c14\" namest=\"c9\"\u003e\u003cp\u003eSWE values of the ITB\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eROM of hip adduction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eROM of hip extension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003eROM of hip adduction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c14\" namest=\"c12\"\u003e\u003cp\u003eROM of hip extension\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI \u003c/p\u003e\u003cp\u003e(Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003cp\u003e (Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003cp\u003e (Range)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e95% CI \u003c/p\u003e\u003cp\u003e(Range)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.24 to 0.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.23 to 0.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(-0.38 to 0.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e(-0.28 to 0.39)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.33 to 0.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.51 to 0.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(-0.31 to 0.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e(-0.57 to 0.01)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.47 to 0.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.96 to 0.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.04 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(-0.59 to -0.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.01 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e(-0.80 to -0.14)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.15 to 0.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.94 to 0.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.03 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(-0.65 to -0.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.02 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e(-0.96 to -0.23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.35 to 0.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.31 to 0.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.008 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(-0.56 to -0.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.04 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e(-0.62 to -0.01)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.002 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.64 to -0.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.02 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.73 to -0.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.001 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(-0.69 to -0.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.04 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e(-0.68 to -0.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.54 to 0.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.49 to 0.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.006 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(-0.65 to -0.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e(-0.58 to 0.34)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e(-0.42 to 0.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e(-0.47 to 0.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.01 *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e(-0.51 to -0.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e-0.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e(-0.48 to 0.13)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003ePre, preoperative; POD; postoperative day; TFL, tensor fasciae latae; ITB, iliotibial band; SWE, shear wave elastography; ROM, range of motion; CI, confidence interval\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"14\"\u003e*Statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges over time in gait during pain and range of motion of hip adduction and extension\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGait during pain (Range)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eROM of hip adduction (Range)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eROM of hip extension (Range)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.6\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 (0 to 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0 (2 to 25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 (-10 to 15)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8 (0 to 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0 (0 to 20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 (-16 to 5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0 (1 to 8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2 (2 to 20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 (-10 to 7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3 (1 to 10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 (1 to 16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 (-12 to 10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 (0 to 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 (0 to 17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 (-10 to 11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 (0 to 9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 (0 to 17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 (-20 to 9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 (0 to 7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 (2 to 21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 (-5 to 13)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePOD 7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 (0 to 6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5 (3 to 21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 (-5 to 15)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eValues are presented as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. Pre, preoperative; POD, postoperative day; ROM, range of motion.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003efor this study was obtained from the institutional review board (IRB) (approval number: 3518). All procedures were performed in accordance with the ethical standards of the Declaration of Helsinki. All participants received a thorough explanation of the study and provided written informed consent before enrollment.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical Technique\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll procedures were performed under general anesthesia with the patient in the supine position. A direct anterior approach was employed in all cases to access the intermuscular plane between the tensor fasciae latae and sartorius muscles. The conjoined external rotator tendon was generally preserved. Surgical time averaged 29\u0026thinsp;\u0026plusmn;\u0026thinsp;5 minutes for unilateral THA and 69\u0026thinsp;\u0026plusmn;\u0026thinsp;13 minutes for bilateral THAs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasurements\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMuscle stiffness measurements were performed by a single experienced musculoskeletal sonographer using an ultrasound (LOGIQ S8, GE Healthcare, Tokyo, Japan) equipped with a 9L-D linear transducer \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. To ensure proper contact, ample ultrasound gel was used between the probe and skin surface. The measurer was careful when applying constant pressure at the lowest level at which ultrasound could be visualized \u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. In previous studies, the SWE test measured SWE values (kPa) of the TFL and ITB \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSince shear wave velocity correlates with the tissue\u0026rsquo;s elastic modulus, the system automatically calculates Young\u0026rsquo;s modulus from the wave speed \u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e,\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e. A higher modulus value indicates increased tissue stiffness \u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e,\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e. The measurement site of the TFL was set at the midpoint between the anterior superior iliac spine and greater trochanter of the femur \u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e, and the measurement site for ITB was 2 cm proximal to the lateral femoral epicondyle (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e) \u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. The region of interest was positioned centrally within the muscle belly of the TFL and across the thickness of the ITB. Two measurements were taken at each location, and their mean was used for analysis. Measurements were performed twice at each test site (the TFL and ITB), and the average value was calculated. SWE measurements were conducted in two different hip positions: one with the subject lying supine and the hip in a neutral alignment, and the other in maximum abduction. Differences in stiffness were calculated by subtracting the SWE values measured during maximum hip abduction from that measured in the neutral hip position. To prevent changes in muscle hardness due to measurement time, each measurement was obtained within 15 s \u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. The measurements were performed preoperatively and from postoperative day one to seven.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAlignment, leg length, and FO were assessed using preoperative, immediate postoperative, and postoperative day seven radiographs, respectively. In previous studies, leg length was measured as the distance from the pelvis from the lower edge of the teardrop to the apex of the lesser trochanter, and FO was measured as the distance between the femoral head center and femoral shaft axis \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. Leg length and FO were measured preoperatively, immediately postoperative, and postoperative day seven to determine the amount of change in leg length and FO (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAll the patients underwent pain assessment and hip ROM measurements. To assess pain, the numeric rating scale was used to rate anterolateral thigh pain during gait on a scale of 0 to 10 \u003csup\u003e49\u003c/sup\u003e. Pain was assessed one side at a time to account for contralateral hip effects. To assess ROM, the todai goniometer (TTM-KO, Sakai Medical, Japan) was used to measure the ROM of hip adduction and extension. Pain and ROM were evaluated at the same times as the SWE examination, preoperatively and from postoperative day one to seven, respectively.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Analyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStatistical analyses consisted of separate, single-factor (time) repeated-measure analysis of variance for SWE values of the TFL and ITB over time. For multiple comparisons, \u003cem\u003eP\u003c/em\u003e-values were adjusted using the Holm\u0026rsquo;s step-down procedure. The Pearson correlations were performed to investigate the association between SWE values of the TFL and ITB, pain, and ROM at preoperation and postoperative day 1\u0026ndash;7. Finally, the Pearson correlations were performed to investigate the association between changes in the TFL and ITB and changes in leg length and FO.\u003c/p\u003e\u003cp\u003eIn order to assess the intraobserver reliability of the SWE values of the TFL and ITB, the trials were performed twice more than without any knowledge of the observer\u0026rsquo;s own previous measurements. Intraobserver reliabilities were determined with an intraobserver correlation coefficient (ICC [1, 1]). The Landis scoring system was used for the analysis (almost perfect: \u0026gt;0.81, substantial: 0.61\u0026ndash;0.80, moderate: 0.41\u0026ndash;0.60, fair: 0.21\u0026ndash;0.40, and slight: 0.0\u0026ndash;0.20) \u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. All analyses were performed using R (version 2.8.1), and statistical significance was set at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eTensor fascia latae and ITB stiffness increased at early postoperative THA and positively correlated with changes in FO. Additionally, TFL and ITB stiffness correlated with pain during gait and hip ROM. These results suggest the importance of physical therapy for the TFL and ITB in the early postoperative period of THA.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthical approval\u003c/h2\u003e\u003cp\u003e The study protocol complied with the principles outlined in the Declaration of Helsinki and was approved by the Ethics Review Board Committee of Keiyu Orthopaedic Hospital (approval number: 3518).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no conflicts of interest related to this study.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no financial support from agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eH.O. designed the study, collected and analyzed data, and drafted the manuscript. Y.K. participated in study design and data collection. T.K. assisted with data collection and critically revised the manuscript. Y.H. and A.I. contributed important revisions to the manuscript. K.U. supervised the study, analyzed and interpreted data, and reviewed the manuscript. All authors have reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJenkins, P. J.\u003cem\u003e et al.\u003c/em\u003e Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. \u003cem\u003eBone Joint J\u003c/em\u003e \u003cstrong\u003e95-B\u003c/strong\u003e, 115-121, doi:10.1302/0301-620X.95B1.29835 (2013).\u003c/li\u003e\n\u003cli\u003eSingh, J. A., Yu, S., Chen, L. \u0026amp; Cleveland, J. D. 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The measurement of observer agreement for categorical data. \u003cem\u003eBiometrics\u003c/em\u003e\u003cstrong\u003e33\u003c/strong\u003e, 159-174 (1977).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"total hip arthroplasty, ultrasound, elastography, tensor fascia latae, iliotibial band, femoral offset","lastPublishedDoi":"10.21203/rs.3.rs-7113810/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7113810/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eThis study aimed to postoperative changes in stiffness of the tensor fascia latae (TFL) and iliotibial band (ITB) after total hip arthroplasty (THA) via the direct anterior approach. The association between changes in hip alignment, pain, and hip range of motion (ROM) was also investigated.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eForty-eight patients (64 hips) undergoing primary THA from April to November 2023 were included. Shear wave elastography (SWE) was used to measure TFL and ITB stiffness preoperatively and daily during the first postoperative week. Changes over time were analyzed, and correlations between femoral offset (FO), leg length, pain during gait, and hip ROM were assessed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eShear wave elastography values of the TFL and ITB were significantly higher postoperatively compared to those at preoperation (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05). Change in FO correlated with SWE values of the TFL and ITB on postoperative day one (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05). The SWE values of the TFL and ITB correlated with pain during gait on postoperative day 2\u0026ndash;7 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05), and were negatively correlated with ROM of hip adduction and extension (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eEarly postoperative TFL and ITB stiffness increased postoperatively compared to those at preoperation, and postoperative TFL and ITB stiffness correlated with changes in FO, pain during gait, hip adduction, and extension ROM.\u003c/p\u003e","manuscriptTitle":"Evaluation of Stiffness in the Tensor Fascia Latae and Iliotibial Band after Total Hip Arthroplasty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-28 19:13:03","doi":"10.21203/rs.3.rs-7113810/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1dec767-f2cc-47fd-9c95-4bec228c2a44","owner":[],"postedDate":"July 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52174915,"name":"Health sciences/Diseases"},{"id":52174916,"name":"Health sciences/Health care"},{"id":52174917,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-08-19T12:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-28 19:13:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7113810","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7113810","identity":"rs-7113810","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}