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Formal Physical Therapy After Total Hip Arthroplasty Is Not Required: A Randomized Controlled Trial

Austin, Matthew S. MD1,a; Urbani, Brian T. BS, MS1; Fleischman, Andrew N. MD1; Fernando, Navin D. MD, FRCSC2; Purtill, James J. MD1; Hozack, William J. MD1; Parvizi, Javad MD, FRCS1; Rothman, Richard H. MD, PhD1

Journal of Bone & Joint Surgery - American Volume: 19 April 2017 - Volume 99 - Issue 8 - p 648–655
doi: 10.2106/JBJS.16.00674
Scientific Articles
Disclosures
eLetters

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.

1The Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania

2Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington

E-mail address for M.S. Austin: matt.austin@rothmaninstitute.com

Copyright 2017 by The Journal of Bone and Joint Surgery, Incorporated
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