Formal Physical Therapy After Total Hip Arthroplasty Is Not Required: A Randomized Controlled Trial.
Publication/Presentation Date
4-19-2017
Abstract
BACKGROUND: The value of formal physical therapy after total hip arthroplasty is unknown. With substantial changes that have occurred in surgical and anesthesia techniques, self-directed therapy may be efficacious in restoring function to patients undergoing total hip arthroplasty.
METHODS: We conducted a single-center, randomized trial of 120 patients undergoing primary, unilateral total hip arthroplasty who were eligible for direct home discharge. The experimental group followed a self-directed home exercise program for 10 weeks. The control group received the standard protocol for physical therapy that included in-home visits with a physical therapist for the first 2 weeks followed by formal outpatient physical therapy for 8 weeks. Functional outcomes were measured using validated instruments including the Harris hip score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 Health Survey (SF-36) preoperatively, at 1 month postoperatively, and at 6 to 12 months postoperatively.
RESULTS: Of 120 randomized patients, 108 were included in the final analysis. Ten patients (19%) were randomized to unsupervised home exercise and 20 patients (37%) were randomized to formal outpatient therapy crossed over between groups. There was no significant difference in any of the measured functional outcomes between patients receiving formal therapy (n = 54) and those participating in unsupervised home exercise (n = 54) at any time point (HHS, p = 0.82; WOMAC, p = 0.80; and SF-36 physical health, p = 0.90).
CONCLUSIONS: This randomized trial suggests that unsupervised home exercise is both safe and efficacious for a majority of patients undergoing total hip arthroplasty, and formal physical therapy may not be required.
LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Volume
99
Issue
8
First Page
648
Last Page
655
ISSN
1535-1386
Published In/Presented At
Austin, M. S., Urbani, B. T., Fleischman, A. N., Fernando, N. D., Purtill, J. J., Hozack, W. J., Parvizi, J., & Rothman, R. H. (2017). Formal Physical Therapy After Total Hip Arthroplasty Is Not Required: A Randomized Controlled Trial. The Journal of bone and joint surgery. American volume, 99(8), 648–655. https://doi.org/10.2106/JBJS.16.00674
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
28419032
Department(s)
Administration and Leadership
Document Type
Article