An appraisal of rehabilitation regimes used for improving functional outcome after total hip replacement surgery

Abstract

This study aimed to systematically review the literature with regards to studies of rehabilitation programmes that have tried to improve function after total hip replacement (THR) surgery. 15 randomised controlled trials were identified of which 11 were centre-based, 2 were home based and 2 were trials comparing home and centre based interventions. The use of a progressive resistance training (PRT) programme led to significant improvement in muscle strength and function if the intervention was carried out early (< 1 month following surgery) in a centre (6/11 centre-based studies used PRT), or late (> 1 month following surgery) in a home based setting (2/2 home based studies used PRT). In direct comparison, there was no difference in functional measures between home and centre based programmes (2 studies), with PRT not included in the regimes prescribed. A limitation of the majority of these intervention studies was the short period of follow up. Centre based program delivery is expensive as high costs are associated with supervision, facility provision, and transport of patients. Early interventions are important to counteract the deficit in muscle strength in the affected limb, as well as persistent atrophy that exists around the affected hip at 2 years post-operatively. Studies of early home-based regimes featuring PRT with long term follow up are needed to address the problems currently associated with rehabilitation following THR.

What does standard rehabilitation practice after total hip replacement in the UK entail? results of a mixed methods study

“…Recent systematic reviews have looked at programmes and interventions to improve functional outcome in this group of patients, [19-21] and a common observation made is the variety in the ‘standard’ or control regimes that are used for comparison. With the inpatient stay reduced to an average of 4 days as reported by a majority of the physiotherapists surveyed in this study, intervening following patient discharge from hospital is increasingly important if the persisting functional deficits typical of these patients are to be resolved.…”

“…PRT in rehabilitation following THR has been shown to significantly enhance muscle strength and function, [16-18] with PRT being the main factor in achieving significant functional improvements in rehabilitation regimes used after home or centre based regimes used after THR, [19]. Although a plethora of studies exist testing different rehabilitation protocols (including PRT) against ‘standard’ practice, [20,21] no explicit definition is made as to what ‘standard practice’ entails.…”

Rehabilitation following total hip arthroplasty evaluation over short follow-up time: Randomized clinical trial

“…Patients who received THA without a rehabilitation program will develop functional limitations within 1 yr after surgery [13][14], and physiotherapy plays an important role in the care of these patients. Physiotherapy can improve strength and gait speed after THA [15] and help prevent frequent complications, which include luxation and thromboembolic disease [16][17].…”

Rehabilitation of revision total hip replacement: A multi‐centre survey of current practice

“…Assessments of impairments after RTHR are missing, although studies in primary THR populations point out following surgery there is an early and significant loss of strength in both hip and knee muscles, which contributes to impaired function (Judd et al, ; Winther et al, ). Reductions in strength can persist and affect function late after surgery (Okoro, Lemmey, Maddison, & Andrew, ). Immediately following surgery most respondents in this survey would use NWB, active range of movement exercises with RTHR patients.…”