Abstract
Introduction Standard physiotherapy rehabilitation fails to restore normal levels of muscle mass, strength and physical function in patients following elective total hip arthroplasty for osteoarthritis. Consequently, more intense forms of exercise rehabilitation have been advocated for these patients. The aim of this article was to review the controlled trials that have evaluated post-total-hip-arthroplasty exercise interventions aimed at improving function. Materials and methods The electronic databases MEDLINE and CINAHL were searched using the following terms: �total hip arthroplasty/replacement�, �exercise�, �rehabilitation� and �function�. This search was expanded by hand-checking the reference lists of the studies and reviews identified by electronic scanning. Results Thirteen appropriate studies (18 papers) were identified, comprising 8 �early� intervention studies (<5 weeks from surgery) and 5 �delayed� intervention studies. Conclusion The studies reviewed suggest that centre-based, but not home-based, exercise rehabilitation are effective in restoring muscle mass, strength and function in total hip arthroplasty patients during the immediate post-surgery phase, and that the efficacy of the centre-based interventions is most likely due to higher training intensity that is facilitated by supervision and access to specialised equipment and facilities. When commencement of training is delayed, however, both home- and centre-based training programs provide significant improvements in patient strength and function.
Highlights
Standard physiotherapy rehabilitation fails to restore normal levels of muscle mass, strength and physical function in patients following elective total hip arthroplasty for osteoarthritis
Studies were initially identi ied by searching MEDLINE and CINAHL databases using a set created with the terms: ‘total hip arthroplasty/ replacement’, ‘exercise’, ‘rehabilitation’ and ‘function’
Husby et al.7,17 showed that 4 weeks of unilateral high-intensity progressive resistance training (PRT; leg press and hip abduction, progressed to loads of 85% 1-repetition maximum [1-RM]), initiated during the irst week of recovery, improved leg strength and reduced cardio-respiratory strain during a sub-maximal walk test, relative to standard physiotherapy rehabilitation, and that these effects were generally maintained at 12 months
Summary
Standard physiotherapy rehabilitation fails to restore normal levels of muscle mass, strength and physical function in patients following elective total hip arthroplasty for osteoarthritis. Materials and methods The electronic databases MEDLINE and CINAHL were searched using the following terms: ‘total hip arthroplasty/replacement’, ‘exercise’, ‘rehabilitation’ and ‘function’ This search was expanded by hand-checking the reference lists of the studies and reviews identi ied by electronic scanning. Standard physiotherapy rehabilitation programs for post-THA patients, though varying from centre to centre, are usually based on hip range-of-movement (ROM) exercises and functional activities, typically without external loading. Suetta et al. found that, despite uncomplicated recovery and 12 weeks of standard rehabilitation following THA, maximal voluntary knee extensor strength on the operated side was reduced by 30% relative to the healthy contralateral leg.
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