Rehabilitation of revision total hip replacement: A multi‐centre survey of current practice

Newman, Meredith A.; Barker, Karen

doi:10.1002/msc.1187

Cited by 6 publications

(4 citation statements)

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“…In 2016, a national survey of care pathways for patients receiving revision surgery for prosthetic joint infection found that there was a lack of tailored physiotherapy and occupational therapy services for patients [21]. The provision of rehabilitation after revision total hip replacement was evaluated in a national survey in 2016, which found there was considerable variation in service provision and a lack of consensus regarding optimal rehabilitation strategies [15]. Our study adds to this body of evidence, nding that physiotherapy provision for patients undergoing revision TKR is variable and the same as that provided to patients undergoing primary TKR.…”

Section: Discussionmentioning

confidence: 99%

“…Contacts were then e-mailed a link to the online survey, with up to two reminders sent to non-responders. The survey, administered using Online Surveys (www.onlinesurveys.ac.uk), consisted of 27 questions which were developed by the research team, informed by previous national surveys of rehabilitation services for primary TKR [14] and revision hip replacement [15]. The survey questions explored preoperative, in-patient and post-discharge care including pre-operative education, inpatient physiotherapy and occupational therapy, rehabilitation-speci c discharge criteria, and provision of post-discharge rehabilitation.…”

Section: National Survey Of Rehabilitation Provision For Revision Tkrmentioning

confidence: 99%

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Rehabilitation for revision total knee replacement: Survey of current service provision and systematic review

Omar

Kunutsor

Bertram

et al. 2022

Preprint

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Background Approximately 6,000 revision total knee replacements are performed annually in the National Health Service. Revision total knee replacement is a major operation with a long recovery period and many patients report suboptimal outcomes. Rehabilitation has the potential to improve outcomes after revision total knee replacement. The aim of this study was to understand current provision of rehabilitation for revision total knee replacement in England and evaluate the existing evidence. Methods A national survey of education and rehabilitation provision for patients receiving revision total knee replacement was completed by physiotherapy staff at 22 hospitals across England. A systematic review was undertaken to identify studies evaluating rehabilitation programmes for revision joint replacement. Searches were conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane databases from inception to 15th June 2022. Studies were included if they evaluated post-operative rehabilitation interventions for adults undergoing revision joint replacement for any indication. Screening, data extraction and assessment of methodological quality were undertaken by two reviewers. Results Survey: Pre-operative education was provided in most hospitals, which predominately involved a single session delivered by a multidisciplinary team. Inpatient physiotherapy commonly commenced on post-operative day 1 and was provided twice daily, with most hospitals also providing occupational therapy. Rehabilitation was often provided in the first four weeks after hospital discharge, either in an outpatient, community or home setting. In most hospitals, the education and rehabilitation provided to patients receiving revision total knee replacement was the same as that provided to patients undergoing primary total knee replacement. Systematic review: Of the 1,445 articles identified in the searches, three retrospective cohort studies based on hospital records review were eligible for inclusion. The studies evaluated intensive rehabilitation programmes delivered in an inpatient hospital setting, consisting of 2-3 hours of daily supervised group or individual physiotherapy, with additional occupational therapy in one study. All three studies reported improvement in functional outcomes for patients undergoing rehabilitation after revision total knee replacement. Conclusion This study identified the need for future research to develop and evaluate tailored rehabilitation to optimise patient outcomes following revision total knee replacement.

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Section: Discussionmentioning

confidence: 99%

Section: National Survey Of Rehabilitation Provision For Revision Tkrmentioning

confidence: 99%

Rehabilitation for revision total knee replacement: Survey of current service provision and systematic review

Omar

Kunutsor

Bertram

et al. 2022

Preprint

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“…While the benefits of physiotherapy after THA are generally acknowledged [ 1 ], and it frequently takes place in acute care clinics [ 17 , 18 ], there is a lack of consensus on the exact therapy program and only little evidence from controlled clinical trials, as a systematic review of the literature that appeared after 2008 [ 19 ] has shown. Other reviews and meta-analyses confirmed this view [ 19 , 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis

Röhner

Mayfarth²,

Sternitzke³

et al. 2021

JCM

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There are multiple attempts to decrease costs in the healthcare system while maintaining a high treatment quality. Digital therapies receive increasing attention in clinical practice, mainly relating to home-based exercises supported by mobile devices, eventually in combination with wearable sensors. The aim of this study was to determine if patients following total hip arthroplasty (THA) could benefit from gait training on crutches conducted by a mobile robot in a clinical setting. Method: This clinical trial was conducted with 30 patients following total hip arthroplasty. Fifteen patients received the conventional physiotherapy program in the clinic (including 5 min of gait training supported by a physiotherapist). The intervention group of 15 patients passed the same standard physiotherapy program, but the 5-min gait training supported by a physiotherapist was replaced by 2 × 5 min of gait training conducted by the robot. Length of stay of the patients was set to five days. Biomechanical gait parameters of the patients were assessed pre-surgery and upon patient discharge. Results: While before surgery no significant difference in gait parameters was existent, patients from the intervention group showed a significant higher absolute walking speed (0.83 vs. 0.65 m/s, p = 0.029), higher relative walking speed (0.2 vs. 0.16 m/s, p = 0.043) or shorter relative cycle time (3.35 vs. 3.68 s, p = 0.041) than the patients from the control group. Conclusion: The significant higher walking speed of patients indicates that such robot-based gait training on crutches may shorten length of stay (LOS) in acute clinics. However, the number of patients involved was rather small, thus calling for further studies.

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“…Nevertheless, a registry‐based analysis demonstrated poorer clinical outcomes on hip pain and function for patients after revision THR than following primary THR (Stisen et al., 2022). Evidence on revision THR in terms of the effectiveness of pain relief and functional improvement is sparse (Singh & Lewallen, 2013), and no consensus exists on optimal rehabilitation after revision THR (Newman & Barker, 2017). This calls for research exploring different rehabilitation approaches to improve clinical outcomes for patients after revision THR.…”

Section: Introductionmentioning

confidence: 99%

Effect of an exercise intervention targeting hip strengthening in patients undergoing revision total hip replacement—A study protocol for a multicenter randomized controlled trial

Stisen,

Pedersen,

Kjeldsen

et al. 2024

Physiotherapy Res Intl

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BackgroundLimited evidence exists regarding the effectiveness of pain relief and functional improvement in patients undergoing revision total hip replacement (THR). Furthermore, there are no clinical guidelines or consensus on optimal rehabilitation after revision THR.PurposeThe primary aim of this study was to compare the effectiveness of an exercise intervention targeting hip strengthening with standard community‐based rehabilitation in patients undergoing revision THR.MethodsThis multicenter randomized controlled assessor‐blinded trial will be conducted at eight hospitals and multiple municipality rehabilitation centers in Denmark. A total of 84 patients undergoing revision THR are estimated to be allocated to either an exercise intervention targeting hip strengthening (NEMEX‐STR) or standard community‐based rehabilitation (Usual care). Recruitment was initiated in November 2022 and is expected to be completed by June 2024. The primary outcome is change in functional performance measured by the 30 s chair stand test, from baseline to 4 months after the start of intervention. Secondary outcomes include hip disability and osteoarthritis outcome score; 40 m fast‐paced walk test; 9‐step timed stair climb test; leg extensor muscle power; global perceived effect; and adverse events. Other outcomes include The International Physical Activity Questionnaires, pain intensity, and European quality of life—5 dimensions. An intention‐to‐treat approach will be used for analyzing changes in primary and secondary outcome measures. The trial was approved by the Central Denmark Region Committees on Health Research Ethics (Journal No 1‐10‐72‐134‐22) and registered on the Central Denmark Regions' internal list of research projects (Journal No 1‐16‐02‐285‐22).DiscussionTo our knowledge, this study is the first to explore different rehabilitation programs after revision THR through a randomized controlled trial. The results will provide clinically relevant evidence for optimal rehabilitation after revision THR for improving functional performance, physical function, and quality of life, with great importance for patients, relatives, physiotherapists, and decision‐makers.ClinicalTrial.govNCT05657054.

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Rehabilitation of revision total hip replacement: A multi‐centre survey of current practice

Abstract: This survey adds to sparse information about rehabilitation RTHR. No consensus emerged about optimal rehabilitation. The diversity in approach and lack of clear structure suggests work is needed to develop rehabilitation interventions that are tailored to this population.

Cited by 6 publications

References 73 publications

Rehabilitation for revision total knee replacement: Survey of current service provision and systematic review

Rehabilitation for revision total knee replacement: Survey of current service provision and systematic review

Mobile Robot-Based Gait Training after Total Hip Arthroplasty (THA) Improves Walking in Biomechanical Gait Analysis

Effect of an exercise intervention targeting hip strengthening in patients undergoing revision total hip replacement—A study protocol for a multicenter randomized controlled trial

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