Abstract
BackgroundProlonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR). It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life.Methods/designThis will be a single blind multi centre randomized control trial with two arms. Seventy subjects post primary total hip arthroplasty will be randomized into either an experimental group (n=35), or to a control group (n=35). The experimental group will attend a functional exercise class twice weekly for a six week period from week 12 to week 18 post surgery. The functional exercise group will follow a circuit based functional exercise class supervised by a chartered Physiotherapist. The control group will receive usual care. The principal investigator (BM) will perform blinded outcome assessments on all patients using validated measures for pain, stiffness, and function using the Western Ontario and Mc Master Universities Osteoarthritis index (WOMAC). This is the primary outcome measurement tool. Secondary outcome measurements include Quality of life (SF-36), 6 min walk test, Visual Analogue Scale, and the Berg Balance score. The WOMAC score will be collated on day five post surgery and repeated at week twelve and week eighteen. All other measurements will be taken at week 12 and repeated at week eighteen. In addition a blinded radiologist will measure gluteus medius cross sectional area using real time ultrasound for all subjects at week 12 and at week 18 to determine if the functional exercise programme has any effect on muscle size.DiscussionThis randomised controlled trial will add to the body of evidence on the relationship between muscle size, functional ability, balance, quality of life and time post surgery in patients following total hip arthroplasty. The CONSORT guidelines will be followed to throughout. Ethical approval has been gained from the Ethics committee Health Services Executive Dublin North East.Trial registrationThis trial is registered with ClinicalTrials.gov (a service of the United States National Institutes of Health) identifier NCT01683201
Highlights
Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR)
This randomised controlled trial will add to the body of evidence on the relationship between muscle size, functional ability, balance, quality of life and time post surgery in patients following total hip arthroplasty
This review found there was low grade evidence that late stage rehabilitation demonstrated significant improvement in gait speed indicating improved walking ability in patients post total hip arthroplasty and there was limited low grade evidence for improved hip abduction strength in patients following a programme which included low resistance strength training
Summary
Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR) It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life. Physical impairment, reduced range of motion and reduced muscle strength persisting for one year have been documented in subjects who had received early stage physiotherapy [7] It is currently unclear from the literature which therapeutic exercises performed over what period of time are either effective or necessary to improve muscle strength or ensure optimal return of patient function. Some evidence [9] has demonstrated that an eight week exercise programme with an emphasis on strengthening and stability resulted in a statistically significant improvement in all measurements of self perceived function and muscle strength in patients between four and twelve months post THR. It has been suggested in this study that patients should continue their functional strengthening exercise programme for at least one year and that this programme should be further progressed as their function improved
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