Sports Therapy Interventions Following Total Hip Replacement

Abstract

steoarthritis is one of the most common conditions in industrialized nations (1). According to a survey of the Robert Koch Institute conducted in 2010, the lifetime prevalence of degenerative joint disease (osteoarthritis), is 27% for women and 18% for men, with the knee and hip joints being the most common sites (2). Joint replacement is indicated in patients with advanced osteoarthritis of the hip in the presence of relevant functional impairments and joint pain when conservative treatment options have failed. Registry studies have shown that total hip replacement resulted in significant pain reduction, improved day-today functioning and better health-related quality of life (3-6). In many patients, decreases in muscle strength are already noted years before surgery. Exercise physio-Summary Background: Sport rehabilitation is a reimbursable intervention assisting reintegration and self-help. In this study, we measured the effects of sport rehabilitation on muscle strength around the hip joint at 1 year after surgery, as well as cardiopulmonary endurance performance and stability of stance, in patients who had undergone a first implantation of a total hip endoprosthesis (total hip replacement, THR) as a treatment for osteoarthritis of the hip. Methods: 160 patients were randomly allotted either to an intervention group with intensive sport rehabilitation for the first year or to a control group. At three time points (baseline, six and twelve months after surgery), measurements were made of muscular strength around the hip joint (with isokinetic dynamometry), stability of stance, and endurance performance. The primary endpoint was the change in strength of the hip extensors, abductors, flexors, and adductors at twelve months after surgery. Results: With respect to the primary endpoint, the results were not significantly better in patients who had received sport rehabilitation than in those who had not. At one year, the patients in the intervention group had less pain as measured by the WOMAC pain score (p = 0.023), though the size of this effect was small (r = 0.27). Health-related quality of life was higher in the intervention group at six months, albeit with a small effect size (p = 0.036, r = 0.25); this was no longer demonstrable at one year. The other parameters studied displayed no significant changes. Conclusion: This trial did not demonstrate any significant benefit of sports rehabilitation on functional outcomes in patients who had undergone total hip replacement. Nonetheless, positive trends after the intervention were seen in some parameters. The unexpectedly high dropout rate had been underestimated in the planning phase of the trial; further trials with larger numbers of patients should be performed.

Clinical and cost-effectiveness of physiotherapy interventions following total hip replacement: a systematic review and meta-analysis

“…Sessions were approximately two and one half hours in durations and included both aquatic and land-based components with a focus on strength and gait retraining Usual care Mean % from 6 weeks to 4 months postoperative Int: hip flexion (SD) = 73.8 (50.1) p = 0.69; hip extension (SD) = 50.5 (26.1); p = 0.78; Cot: hip flexion (SD) = 39.8 (64.1), p = 0.69; hip extension (SD) = 30.5 (67.3), p = 0.78 Nankaku et al [ 33 ]/Japan/4 weeks Total = 28 Int = 14 Cot = 14 Int = 60.5(6.4) Cot = 60.8 (7.5) Int = 50 Cot = 50 Exercise program of hip external rotator was performed and supervised by an experienced physical therapist. Usual care Int, hip pain; p = 0.05; hip flexion angle, p = 0.05; hip abduction angle, p = 0.05 Cot, hip pain; p = 0.05; hip flexion angle, p = 0.05; hip abduction angle, p = 0.05 Beck et al [ 21 ]/Germany/12 months Total = 160 Int = 80 Cot = 80 Int = 59 ® Cot = 61.9 ® Int = 52.5 Cot = 63.8 Intensive exercise therapy: walking slowly in circles, fast walking, leg axis training from various start positions, correct sitting, and team circles games No exercise therapy Int WOMAC (pain) = 100, Cot = 95; p = 0.003 Int EQ-5D (VAS) = 90; Cot = 85; p = 1.00 Int WOMAC (stiffness) = 87.5; Cot = 100; p = 0.373 Maire et al [ 28 ] /France/12 months Total = 14 Int = 7 Cot = 7 N/A N/A Muscular strength, range of motion, aquatics, walking 2 h/day). In addition, this group undertook an arm-interval exercise program with an arm ergometer Muscular strength, range of motion, aquatics, walking, 2 h/day Int: WOMAC (physical function) = 5 (3–15); p < 0.05; Walking distance (m) = 486 (343–584) Cot: WOMAC (physical function) = 14 (4–18); walking distance = 398 (333–482) Galea et al [ 25 ]/Australia/8 weeks Total = 23 Int = 11 Cot = 12 Int = 68.6 (9.7) Cot = 66.6 (7.9) …”

“…Thirteen and 16 out of 18 studies had high risk of bias for treatment allocation and blinding of participants of intervention. Sixteen out of eighteen studies had low risk of bias and two studies [ 20 , 21 ] had unclear risk of bias for blinding outcome assessment. Five of eighteen studies were assigned unclear attrition bias, and the remaining studies had low risk of bias.…”

“…Three studies reported the impact of physiotherapy interventions on health-related quality of life (HRQoL) [ 21 , 24 , 25 ]. The Euroqol visual analogue scale [ 21 , 24 ] and a self-administered HRQoL questionnaire [ 25 ] were used to assess the quality of life of THR patients. The comparative advantage of a targeted home- and centre-based exercise programme over unsupervised home-based exercise group were examined in patients following THR [ 25 ].…”

“…Patients who received the targeted home- and centre-based exercise programme achieved significant improvements ( p < 0.05) in HRQoL. On the other hand, no clinically significant difference was observed between patients following THR in the groups who received inpatient and sports rehabilitation compared with control on HRQoL at 1 year [ 21 , 24 ].…”

Primäre Endoprothetik bei Kox- und Gonarthrose

“…Zur korrekten Durchführung sind evidenzbasierte Therapiemodule der Rentenversicherungsträger etabliert und diese tragen nachweislich zur funktionellen Erholung der Patienten bei. Zusätzlich kann die Reintegration und körperliche Aktivität gerade bei älteren Patienten durch den von Kostenträgern angebotenen Rehabilitationssport unterstützt werden [3]. Aktuell werden auch vermehr Konzepte der "Prähabilitation" diskutiert, nach denen sich eine bereits präoperative Übungsbehandlung und zusätzliche Schulungsmaßnahmen positiv auf den postoperativen Verlauf auswirken können.…”