Evidence based rehabilitation after hip arthroplasty.
Colibazzi Virginia,Coladonato Adriano,Zanazzo Milco,Romanini Emilio
Hip international : the journal of clinical and experimental research on hip pathology and therapy
BACKGROUND:Hip arthroplasty is considered the treatment of choice to improve the quality of life of patients affected by degenerative arthritis. The post-op rehabilitation regimen, however, is still a matter of debate. The goal of this study was to perform a systematic review of the available best evidence to provide recommendations for rehabilitation after hip arthroplasty. MATERIALS AND METHODS:Biomedical databases were accessed to identify guidelines, systematic reviews and randomised controlled trials addressing rehabilitation after hip arthroplasty published between 2004 and 2019. Studies were selected and extracted by two independent evaluators with standardised tools. RESULTS:1 guideline, 8 systematic reviews and 5 randomised controlled trials were included. All included papers were organised according the available evidence of clinical course chronology both in pre- and post-operation rehabilitation up to 6 weeks and thereafter. Although the value of a rehabilitation program after hip arthroplasty is universally recognised, the exact timing and number of sessions is still unknown. A solid literature review allows us to partially answer to this question. CONCLUSIONS:Evidence-based rehabilitation recommendations are proposed according to literature research findings. Clinical practice is still somewhat dependent on dogma and traditions, highlighting the need for additional high-quality clinical studies to address areas of uncertainty.
Incorporating hip abductor strengthening exercises into a rehabilitation program did not improve outcomes in people following total knee arthroplasty: a randomised trial.
Schache Margaret B,McClelland Jodie A,Webster Kate E
Journal of physiotherapy
QUESTION:In adults following primary total knee arthroplasty, does the incorporation of hip abductor strengthening exercises into a 6-week rehabilitation program improve muscle strength, functional performance and patient-reported outcomes at the end of rehabilitation and at 26 weeks? DESIGN:Randomised controlled trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS:One hundred and five adults admitted to an inpatient rehabilitation facility immediately following total knee arthroplasty. INTERVENTION:Participants in both groups attended 12 days of inpatient physiotherapy followed by 6 weeks of outpatient physiotherapy, which aimed to improve knee range of movement, strength and mobility. The experimental group completed a standard rehabilitation protocol with the addition of hip abductor strengthening. The control group completed the same standard rehabilitation protocol, with the addition of 15 minutes of general functional exercises. OUTCOME MEASURES:Primary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS) and isometric hip abductor muscle strength normalised to body mass index. Secondary outcome measures included the stair climb test, 6-minute walk test, Timed Up and Go test, 40-m fast-paced walk test, 30-second chair stand test, step test, isometric quadriceps muscle strength, Lower Extremity Functional Scale, and Short Form-12. RESULTS:The experimental intervention did not result in significantly greater improvements in hip strength, KOOS or any of the secondary outcome measures than the control intervention at 6 weeks or 26 weeks. CONCLUSION:Similar improvements in muscle strength, functional performance and patient-reported outcomes were observed whether specific hip-strengthening exercises were incorporated or general functional exercises were continued instead as part of a postoperative rehabilitation program for participants after total knee arthroplasty. REGISTRATION:ANZCTR 12615000863538.