Moderate evidence supports the use of post-operative physical therapy because it could improve early function to a greater extent than no physical therapy management for patients with symptomatic osteoarthritis of the hip who have undergone total hip arthroplasty.

Rationale

There were 2 high quality and 2 moderate quality studies that evaluated the effect of pre-operative physical therapy on post-operative outcomes with conflicting results causing this recommendation to be of limited strength (Villadsen et al, Rooks et al, Ferrara et al, Vukomanovik et al). There was a trend that pre-operative physical therapy improved short term post-operative outcomes. One moderate study demonstrated a reduced risk of needing inpatient rehabilitation after THA (Rooks et al) and another high quality study found improved early recovery (less than 3 months) after THA in the group that received pre-operative physical therapy (Villadsen et al). One high quality study found no benefit of pre-operative physical therapy on most post-operative outcomes with the exception of range of motion and pain at 3 months (Ferrara), while another high quality study found no functional benefit of pre-operative rehabilitation on outcomes 3 months after THA (Vukomanovik et al).

Five studies evaluated the effect of post-operative physical therapy on outcomes. Three of the high quality studies revealed a benefit of post-operative physical therapy (Mikkelson et al, Heiberg et al, Umpierres et al), although one of these studies only found a significant benefit for secondary outcomes of walking speed and stair performance, while the primary outcome of leg strength was not different between groups. One of these studies demonstrated only a short term benefit at 15 days after THA (Umpierres et al), while another found a persistent benefit at one year for one of the functional measures (Heiberg et al). Two studies showed no benefit to post-operative physical therapy (Galea et al, Heiberg et al), although one of these studies was a 5-year follow-up of the original clinical trial (Heiberg et al).

While there were 13 high quality studies and 4 moderate quality studies that were initially identified in the search, several were excluded. Studies were excluded because they were feasibility studies (Hoogenboom et al, Jepson et al), did not include a passive or unsupervised control group to which physical therapy was compared (Hesse et al, Husby et al, Husby et al, Liebs et al, Giaquinto et al, Monticone et al) or did not include a post-operative assessment (Villadsen et al).

  1. Villadsen,A.; Overgaard,S.; Holsgaard-Larsen,A.; Christensen,R.; Roos,E.M. Postoperative effects of neuromuscular exercise prior to hip or knee arthroplasty: a randomised controlled trial. Ann Rheum.Dis; 2014/6: 6
  2. Rooks,D.S.; Huang,J.; Bierbaum,B.E.; Bolus,S.A.; Rubano,J.; Connolly,C.E.; Alpert,S.; Iversen,M.D.; Katz,J.N. Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum.; 2006/10/15: 5
  3. Ferrara,P.E.; Rabini,A.; Maggi,L.; Piazzini,D.B.; Logroscino,G.; Magliocchetti,G.; Amabile,E.; Tancredi,G.; Aulisa,A.G.; Padua,L.; Aprile,I.; Bertolini,C. Effect of pre-operative physiotherapy in patients with end-stage osteoarthritis undergoing hip arthroplasty. Clin Rehabil; 2008/10: 10
  4. Vukomanovic,A.; Popovic,Z.; Durovic,A.; Krstic,L. The effects of short-term preoperative physical therapy and education on early functional recovery of patients younger than 70 undergoing total hip arthroplasty. Vojnosanit.Pregl.; 2008/4: 4
  5. Mikkelsen,L.R.; Mechlenburg,I.; Soballe,K.; Jorgensen,L.B.; Mikkelsen,S.; Bandholm,T.; Petersen,A.K. Effect of early supervised progressive resistance training compared tounsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations. A single-blinded randomised controlled trial. Osteoarthritis Cartilage; 2014: 12
  6. Heiberg,K.E.; Bruun-Olsen,V.; Ekeland,A.; Mengshoel,A.M. Effect of a walking skill training program in patients who have undergone total hip arthroplasty: Followup one year after surgery. Arthritis Care Res (Hoboken); 2012/3: 3
  7. Heiberg,K.E.; Figved,W. Physical functioning and prediction of physical activity after total hip arthroplasty. 5-year follow-up of a randomized controlled trial. Arthritis Care Res (Hoboken); 2015/8/3: 0
  8. Umpierres,C.S.; Ribeiro,T.A.; Marchisio,A.E.; Galvao,L.; Borges,I.N.; Macedo,C.A.; Galia,C.R. Rehabilitation following total hip arthroplasty evaluation over short follow-up time: randomized clinical trial. J Rehabil Res Dev; 2014: 10
  9. Galea,M.P.; Levinger,P.; Lythgo,N.; Cimoli,C.; Weller,R.; Tully,E.; McMeeken,J.; Westh,R. A targeted home- and center-based exercise program for people after total hip replacement: A randomized clinical trial. Arch.Phys.Med.Rehabil.; 2008/8: 8