Introduction: Total hip arthroplasty (THA) is a highly successful surgical treatment for hip osteoarthritis (OA), especially in terms of pain reduction and improved patient mobility. Despite standard postoperative rehabilitation, functional limitations related to impaired muscle strength of the operated hip may persist even after 1 year. Therefore, early strength training is starting to be included in postoperative protocols. We designed a new rehabilitation protocol that integrates early muscle strength training and sensory-motor training (VMS) and compared it with existing therapeutic exercise after THA using an anterior approach in patients with primary hip OA. In this study, we investigated 1) whether early VMS can accelerate postoperative rehabilitation and improve final clinical outcomes; 2) whether early VMS is safe; and 3) whether our measurements are reliable with respect to repeatability testing.
Methods: This was a prospective randomized study in two institutions: the General Hospital Novo mesto (SBNM) and the Orthopaedic Hospital Valdoltra (OBV). According to the power analysis, 124 subjects were planned to be enrolled in each institution and preoperatively allocated by computer randomization into intervention (IS) and control (KS) groups. The inclusion criteria were as follows: primary OA of one hip, age over 60 years, ASA 1–3, signed consent to participate in the study, and no dementia or terminal illnesses that would preclude participation in rehabilitation. All patients underwent THA with an anterior approach to the hip, one surgeon in SB NM, and four in OBV. If, at the discretion of the surgeon, there were any abnormalities during surgery that would have prevented them from participating adequately in exercise, they were excluded from the study. During hospitalization, all patients performed exercise according to the existing coordinated protocol. Before discharge, physiotherapists additionally taught the IS patients early VMS exercises. Patients in both groups received exercise videos and written instructions, as well as an exercise diary to record exercise performance. The occurrence of any problems, completion of the exercise diary and understanding of the exercises were monitored by telephone. All subjects underwent an orthopaedic examination with assessment of clinical status, maximal isometric muscle contraction measurements and functional tests (timed-up-and-go TUG test, 6 m walk test), the Harris Hip Score (HHS) and the SF-36 quality of life questionnaire preoperatively and at 1, 3 and 12 months after surgery. The occurrence of exercise side effects or complications was recorded.
Results: During the entire follow-up period, we did not detect clinically significant statistical differences between the two groups. We also did not detect an increased incidence of side effects or complications. Patients with worse baseline values progressed better. The value of the two-way mixed-effects intraclass coefficient with perfect matching were >0,9 for maximal voluntary isometric muscle contraction measurement, the TUG test and the 6 m walk test.
Conclusions: 1) Using early VMS, patients recovered comparably fast in the early postoperative period up to 3 months after surgery. Patients with poorer baseline status had a greater improvement in HHS and gait speed. 2) The use of early VMS in patients after THA with an anterior approach is safe. 3) The ICC coefficient values were >0,9.
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