Evaluation of Exercise Interventions and Outcomes After Hip Arthroplasty

Abstract

IMPORTANCE Preoperative and postoperative exercise interventions are commonly used in patients with total hip arthroplasty despite a lack of established efficacy. OBJECTIVE To explore clinical outcomes associated with exercise training before and after hip arthroplasty. DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and Google Scholar were searched from their inception to March 2020. Reference lists of included trials and related reviews were also searched. STUDY SELECTION Randomized clinical trials of land-based exercise interventions before or after total hip arthroplasty were included. DATA EXTRACTION AND SYNTHESIS This systematic review and meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was independently performed in duplicate. Random-effects meta-analyses with restricted maximum likelihood were performed for pooling the data. MAIN OUTCOMES AND MEASURES The primary prespecified outcome was self-reported physical function. Secondary prespecified outcomes were self-reported pain intensity, quality of life, gait speed, lower body muscle strength, lower body flexibility, anxiety, hospital length of stay, and adverse events. RESULTS A total of 32 randomized clinical trials with 1753 patients were included in the qualitative synthesis, and 26 studies with 1004 patients were included in the meta-analysis. Compared with usual care or no or minimal intervention, postoperative exercise training was not associated with improved self-reported physical function, with a moderate level of certainty, at 4 weeks

Reducing patient–staff contact in fast-track total hip arthroplasty has no effect on patient-reported outcomes, but decreases satisfaction amongst patients with self-perceived complications: analysis of 211 patients

“…Similarly, we did not find longer lasting postoperative face-to-face consultation to be superior to telephone consultation regarding PROs. Our results are congruent with the literature on conventional THA, where the benefits of PPE have been shown to be unsure, and the effects of pre-and postoperative exercise interventions on recovery appear trivial at best (14,15,17).…”

“…From this perspective, it is surprising that there have been no studies directly comparing the effect of different fast-track THA pathways seen from the patient's perspective. Although there have been qualitative studies into pathway optimization (10)(11)(12)(13), their recommendations of enhancing preoperative patient education (PPE) and increasing patient-staff contact after discharge are inconsistent with the literature on conventional THA (14,15).…”

Measurement properties of New Mobility Score to evaluate functional recovery in the elderly following total hip arthroplasty

“…The primary outcome was changed in the lower limbs' hip function and physical performances, assessed by Harris Hip Score (HHS) and New Mobility Score (NMS), from baseline and after 3 months. The Harris Hip Score is a multidimensional assessment of the results of hip surgery [2,13]. The domains covered by the HHS are pain and daily living activities, and hip function assessment (limping), absence of deformity, and range of motion.…”

“…With the projected increase in the number of the elderly undergoing THA over the next two decades, it becomes even more critical to develop effective rehabilitation strategies, individually adapted, which can contribute most benefit. Surgery alone fails to fully restore physical function and address longstanding impairments associated with chronic joint disease [2,3].…”

The Effects of Visuomotor Training on the Functional Recovery of Post-Surgery Musculoskeletal Conditions: A Randomized Controlled Trial

“…This method is resource-intensive. Post-surgery rehabilitation typically consists of physical therapy aimed at mechanically restoring the functionality of the musculoskeletal system and gait abilities by integrating passive and active limb movements [12][13][14][15][16]. 2…”