Rehabilitation for Total Hip Arthroplasty: A Systematic Review

Abstract

We sought to determine the comparative benefits and harms of rehabilitation interventions for patients who have undergone elective, unilateral THA surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Register of Clinical Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We included randomized controlled trials and adequately adjusted nonrandomized comparative studies of rehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence. Large heterogeneity across evaluated rehabilitation programs limited conclusions. Evidence from 15 studies suggests that diverse rehabilitation programs may not differ in terms of risk of harm or outcomes of pain, strength, activities of daily living, or quality of life (all low strength of evidence). Evidence is insufficient for other outcomes. In conclusion, no differences in outcomes were found between different rehabilitation programs after THA. Further evidence is needed to inform decisions on what attributes of rehabilitation programs are most effective for various outcomes.

Figure 1.. Overview of studies of acute and post-acute rehabilitation interventions versus various controls for total hip arthroplasty

Figure presents categorization of studies that evaluated acute and post-acute rehabilitation programs for THA. The first column lists a novel (more intensive) acute rehabilitation program compared to a different program (first group hypothesized to be better); the second column lists studies with comparatively similar acute rehabilitation programs in both arms that were delivered with different timing or intensity (first group hypothesized to be better); the third column lists a novel (more intensive) post-acute rehabilitation program compared to a different program (first group hypothesized to be better); the fourth column lists studies with comparatively similar rehabilitation programs delivered in different settings or by different personnel Abbreviations: Adj = adjunctive, A = aerobic exercise, B= balance-motor-learning-agility exercise, E = patient education, F = flexibility exercise, S = strengthening exercise, T = task-specific training, THA = total hip arthroplasty. * Intervention included progression which was deemed appropriate

Figure 2.. Goal components strength, aerobic, and flexibility and their specific exercise components for rehabilitation interventions versus various controls for total hip arthroplasty

See Figure 3 for goal components Balance-motor-learning-agility, task specific training, patient education, and adjunctive modalities. The color is added for visual display and does not provide unique information. Group I: kinesiotherapy, low-frequency magnetic field and water exercises; Group II: undergoing kinesiotherapy and low-frequency magnetic field, without water exercises; Group V: awaiting rehabilitation Abbreviations: PRT = progressive resistance training, PT = physical therapy, rehab = rehabilitation; ROM = range of motion, ST = strength training A Task-oriented exercises; encouragement to abandon walking aids. B Open kinetic chain exercises

Figure 3.. Goal components balance-motor-learning-agility, task specific training, patient education, and adjunctive modalities and their specific exercise components for rehabilitation interventions versus various controls for total hip arthroplasty

See Figure 2 for goal components strength, aerobic, and flexibility. The color is added for visual display and does not provide unique information. The color is added for visual display and does not provide unique information.Group I: kinesiotherapy, low-frequency magnetic field and water exercises; Group II: undergoing kinesiotherapy and low-frequency magnetic field, without water exercises; Group V: awaiting rehabilitation Abbreviations: AI = acute inpatient, CAM = complementary and alternative therapies, ed = education, exercises, I = in-person; G = gym/other community center; H = home; O = outpatient physiotherapy center; OIF = other inpatient facility; PRT PT = physical therapy, rehab = rehabilitation; SG = self-guided; ST = strength training. A Task-oriented exercises; encouragement to abandon walking aids B Open kinetic chain exercises C Remote via telephone