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Factors Influencing Early Rehabilitation After THA: A Systematic Review

  • Symposium: Advanced Techniques for Rehabilitation after Total Hip and Knee Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

A wide variation exists in rehabilitation after total hip arthroplasty (THA) in part due to a paucity of evidence-based literature. We asked whether a minimally invasive surgical approach, a multimodal approach to pain control with revised anesthesia protocols, hip restrictions, or preoperative physiotherapy achieved a faster rehabilitation and improved immediate short-term outcome. We conducted a systematic review of 16 level I and II studies after a strategy-based search of English literature on OVID Medline, PubMed, CINAHL, Cochrane, and EMBASE databases. We defined the endpoint of assessment as independent ambulation and ability to perform activities of daily living. Literature supports the use of a multimodal pain control to improve patient compliance in accelerated rehabilitation. Multimodal pain control with revised anesthesia protocols and accelerated rehabilitation speeds recovery after minimally invasive THA compared to the standard approach THA, but a smaller incision length or minimally invasive approach does not demonstrably improve the short-term outcome. Available studies justify no hip restrictions following an anterolateral approach but none have examined the question for a posterior approach. Preoperative physiotherapy may facilitate faster postoperative functional recovery but multicenter and well-designed prospective randomized studies with outcome measures are necessary to confirm its efficacy.

Level of Evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Elizabeth Fine, MLIS (reference and instruction librarian, Biomedical Library, University of Minnesota) for her assistance with literature search and Paul Lender (Department of Orthopaedic Surgery, University of Minnesota) for his assistance with figures and tables.

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  1. Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, R 200, Minneapolis, MN, 55454, USA

    Vivek Sharma MD, Patrick M. Morgan MD & Edward Y. Cheng MD

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  1. Vivek Sharma MD
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  2. Patrick M. Morgan MD
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Correspondence to Edward Y. Cheng MD.

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Appendices

Appendix 1 The search strategy terms for OVID Medline database
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Appendix 2 The search strategy terms for EMBASE database
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Sharma, V., Morgan, P.M. & Cheng, E.Y. Factors Influencing Early Rehabilitation After THA: A Systematic Review. Clin Orthop Relat Res 467, 1400–1411 (2009). https://doi.org/10.1007/s11999-009-0750-9

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