Relationships between Change in Number of Steps and Changes in                        Physical Function, Pain, and Self Efficacy after Hospital Discharge                        Following Total Hip Arthroplasty

Abstract Background Total hip arthroplasty (THA) is a common procedure, yet persistent deficits in functional performance exist after surgery. These deficits may be related to movement compensations observed after THA, which negatively affect quality of life and may increase morbidity and health care utilization, including in the veteran population. However, the best rehabilitative approach to remediating movement compensations and physical function deficits has not been determined. Objective The objective is to determine if a functional strength integration intervention (FSI), as part of a post-THA rehabilitation program, improves movement compensation, physical function, muscle strength, and self-reported outcome measures more than a control group (CON) undergoing a standard of care exercise program. Design This is a 2-arm randomized, controlled clinical trial. Setting The Veteran Affairs outpatient physical therapy clinics and academic research laboratory will be the settings. Participants One hundred veterans undergoing THA for hip osteoarthritis will be included in the study. Interventions Participants will be randomized to either the FSI or CON group and participate in visits of physical therapy over 8 weeks. The FSI protocol will include targeted exercise to improve muscular control and stability around the hip and trunk to minimize movement compensation during daily activity combined with progressive resistance exercise. The CON protocol will include patient education, flexibility activity, and low load resistance exercise. Measurements Functional performance, muscle strength and endurance, and self-reported outcomes will be measured at baseline (prior to surgery), midway through intervention (6 weeks after surgery), at the end of intervention (10 weeks after surgery), and 26 weeks after THA. Limitations The inability to blind treating therapists to study arm allocation is a limitation. Conclusions The proposed study aims to determine if targeted FSI can affect movement compensation to improve functional outcomes after THA more than traditional rehabilitation paradigms.

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Total Hip Arthroplasty Performed for Coxarthrosis Preserves Long-Term Physical Function: A 40-Year Experience

HSS Journal ® ◽

10.1007/s11420-019-09676-0 ◽

2019 ◽

Vol 15 (2) ◽

pp. 122-132

Author(s):

Philip D. Wilson ◽

Leslee Wong ◽

Yuo-Yu Lee ◽

Stephen Lyman ◽

Charles N. Cornell

Keyword(s):

Total Hip Arthroplasty ◽

Physical Function ◽

Hip Arthroplasty ◽

Total Hip

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Anterior versus posterior approach total hip arthroplasty: patient-reported and functional outcomes in the early postoperative period

Hip International ◽

10.1177/1120700019881413 ◽

2019 ◽

Vol 30 (6) ◽

pp. 695-702 ◽

Cited By ~ 2

Author(s):

Alexander Martusiewicz ◽

Dimitri Delagrammaticas ◽

Ryan E Harold ◽

Surabhi Bhatt ◽

Matthew D Beal ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Physical Function ◽

Hip Arthroplasty ◽

Posterior Approach ◽

Assistive Device ◽

Harris Hip Score ◽

Total Hip ◽

Pain Scores ◽

Patient Reported

Purpose: Direct anterior approach total hip arthroplasty (DA THA) has been reported to improve early outcomes compared to posterior approach THA up to 6 weeks postoperatively. Limited weekly outcomes data are available prior to 6 weeks. We evaluate outcomes including when patients first drive a car, leave home, and discontinue their assist device. Methods: Patients undergoing THA for primary osteoarthritis were prospectively enrolled. Outcomes data were collected preoperatively and postoperatively at weekly intervals for 6 weeks. Results: 111 patients (55 DA and 56 posterior approach) were enrolled. There was no significant difference ( p > 0.05) in pre-surgical Patient-Reported Outcomes Measurement Information System (PROMIS) scores or modified Harris Hip Score (mHHS). Postoperatively, the DA THA group had decreased length of stay ( p = 0.0002) and increased distance walked on postoperative day 1 and 2 ( p = 0.011, p = 0.0004). The DA group had lower pain scores ( p < 0.05) and required less day 1 and total narcotics ( p = 0.029, p = 0.01). The DA cohort had improved PROMIS Physical Function scores and mHHS up to 5 weeks postoperatively. DA patients discontinued their assistive device 8 days earlier ( p = 0.01), left home 3 days earlier ( p = 0.001), and drove a car 5 days earlier ( p = 0.01). Conclusions: Patients undergoing DA THA discontinued their assistive device, left their home, and drove a car sooner than posterior approach patients. We found improvement in physical function with DA, and it persisted up to 5 weeks postoperatively. Furthermore, DA patients had significantly shorter length of stay, improved mobilisation, decreased narcotic requirements and improved inpatient pain scores compared to posterior approach THA. Future randomised controlled study should be performed to minimise the biases inherent in this study methodology and confirm the results.

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