Article metrics

  • citations in SCindeks: [3]
  • citations in CrossRef:0
  • citations in Google Scholar:[=>]
  • visits in previous 30 days:18
  • full-text downloads in 30 days:5
article: 4 from 5  
Back back to result list
Vojnosanitetski pregled
2008, vol. 65, iss. 4, pp. 291-297
article language: English
document type: Original Paper
published on: 07/07/2008
doi: 10.2298/VSP0804291V
The effects of short-term preoperative physical therapy and education on early functional recovery of patients younger than 70 undergoing total hip arthroplasty
aMilitary Medical Academy, Clinic of Physical Medicine and Rehabilitation, Belgrade
bMilitary Medical Academy, Clinic for Orthopedic Surgery and Traumatology, Belgrade



Background/Aim. Hip arthroplasty is a routine operation which relieves pain in patients with osteoarthritis. The role of physical therapy after hip arthroplasty was recognized, but the importance of preoperative physical therapy and education is still to be judged. The aim of this paper was to investigate the effect of short-term preoperative program of education and physical therapy on patients' early functional recovery immediately after total hip arthroplasty (THA). Methods. This prospective study included 45 patients with hip osteoarthritis scheduled to undergo primary THA and admitted to the Department of Orthopedics of Military Medical Academy. They were randomized into 2 groups: study and control one (with and without preoperative education and physical therapy). Preoperative education was conducted through conversation (1 appointment with physiatrist) and brochure. The study group was instructed to perform exercises and basic activities from the postoperative rehabilitation program (2 practical classes with physiotherapist). Effects were measured with questionnaires (Harris, Oxford and Japanese Orthopaedic Association (JOA) hip scores), range of motion and visual analog scale of pain. Marks showing ability to perform basic activities and endurance were from 0 (did not perform activity) to 5 (independent and secure). Analyses examined differences between the groups over the preoperative and immediate postoperative periods and 15 months after the operation. Results. There were no differences between the groups at discharge according to pain, range of motion, Harris hip score and JOA hip score. Oxford hip score did not differ between the groups 15 months after the operation. The groups started to walk at the same time, but the study group walked up and down stairs (3.7±1.66 vs 5.37±1.46, p ≤ 0.002), used toilet (2.3±0.92 vs 3.2±1.24, p ≤ 0.02) and chair (2.2±1.01 vs 3.25±1.21, p ≤ 0.006) significantly earlier than the control group. On the third day after the operation the study group was significantly more independent than the control one while performing any basic activities (changing position in bed from supine to side lying, from supine to sitting on the edge of the bed, from sitting to standing, from standing to lying in the bad, standing, walking, using toilet and chair). At discharge the patients from the control group still needed the therapist help for walking up and down stairs (3±1.26), while the patients from the study group performed there activities independently (4.85±0.37) (p ≤ 0.000). Endurance while walking was significantly better in the study group than in the control one. The length of hospital stay after the operation was similar for both groups, but the patients from the study group needed significantly less classes with the therapist (5.2±2.35 vs 6.85±1.14, p ≤ 0.02) during hospital stay. Conclusion. The short-term preoperative program of education with the elements of physical therapy accelerated early functional recovery of patients (younger than 70) immediately after THA and we recommend it for routine use.



Ackerman, I.N., Bennell, K.L. (2004) Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery?: A systematic review. Aust J Physiother, 50(1): 25-30
Berend, K.R., Lombardi, A.V., Mallory, T.H. (2004) Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients. Surg Technol Int, 13: 239-47
Bitar, A.A., Kaplan, R.J., Stitik, T.P., Shih, V.C., vo Andrew, N., Kamen, L.B. (2005) Rehabilitation of orthopedic and rheumatologic disorders, 3: Total hip arthroplasty rehabilitation. Arch Phys Med Rehabil, 86(3 Suppl 1): S56-60
Brunenberg, D.E., Steyn, M.J., Sluimer, J.C., Bekebrede, L.L., Bulstra, S.K., Joore, M.A. (2005) Joint recovery programme versus usual care: An economic evaluation of a clinical pathway for joint replacement surgery. Med Care, 43(10): 1018-26
Crowe, J., Henderson, J. (2003) Pre-arthroplasty rehabilitation is effective in reducing hospital stay. Can J Occup Ther, 70(2): 88-96
Dawson, J., Fitzpatrick, R., Carr, A., Murray, D. (1996) Questionnaire on the perceptions of patients about total hip replacement. J Bone Joint Surg Br, 78(2): 185-90
Fisher, D.A., Trimble, S., Clapp, B., Dorsett, K. (1997) Effect of a patient management system on outcomes of total hip and knee arthroplasty. Clin Orthop Relat Res, (345): 155-60
Gajdosik, R.L., Bohannon, R.W. (1987) Clinical measurement of range of motion: Review of goniometry emphasizing reliability and validity. Phys Ther, 67(12): 1867-72
Gilbey, H.J., Ackland, T.R., Wang, A.W., Morton, A.R., Trouchet, T., Tapper, J. (2003) Exercise improves early functional recovery after total hip arthroplasty. Clin Orthop Relat Res, (408): 193-200
Giraudet-Le, Q.J., Coste, J., Vastel, L., Pacault, V., Jeanne, L., Lamas, J., Kerboull, L., Fougeray, M., Conseiller, C., Kahan, A., Courpied, J. (2003) Positive effect of patient education for hip surgery: A randomized trial. Clin Orthop Relat Res, (414): 112-20
Gocen, Z., Sen, A., Unver, B., Karatosun, V., Gunal, I. (2004) The effect of preoperative physiotherapy and education on the outcome of total hip replacement: A prospective randomized controlled trial. Clin Rehabil, 18(4): 353-8
Harris, W.H. (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: Treatment by mold arthroplasty: An end-result study using a new method of result evaluation. J Bone Joint Surg Am, 51(4): 737-55
Johansson, K., Nuutila, L., Virtanen, H., Katajisto, J., Salantera, S. (2005) Preoperative education for orthopaedic patients: Systematic review. J Adv Nurs, 50(2): 212-23
Liang, M.H., Cullen, K.E., Larson, M.G., Thompson, M.S., Schwartz, J.A., Fossel, A.H., Roberts, W.N., Sledge, C.B. (1986) Cost-effectiveness of total joint arthroplasty in osteoarthritis. Arthritis Rheum, 29(8): 937-43
McDonald, S., Hetrick, S., Green, S. (2004) Pre-operative education for hip or knee replacement. Cochrane Database Syst Rev, (1): CD003526
McGregor, A.H., Rylands, H., Owen, A., Dore, C.J., Hughes, S.P.F. (2004) Does preoperative hip rehabilitation advice improve recovery and patient satisfaction?. J Arthroplasty, 19(4): 464-8
Rooks, D.S., Huang, J., Bierbaum, B.E., i dr. (2006) Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis and Rheumatism, 55(5): 700
Sashika, H., Matsuba, Y., Watanabe, Y. (1996) Home program of physical therapy: Effect on disabilities of patients with total hip arthroplasty. Arch Phys Med Rehabil, 77(3): 273-7
Siggeirsdottir, K., Olafsson, O., Jonsson, H., Iwarsson, S., Gudnason, V., Jonsson, B.Y. (2005) Short hospital stay augmented with education and home-based rehabilitation improves function and quality of life after hip replacement: Randomized study of 50 patients with 6 months of follow-up. Acta Orthop, 76(4): 555-62
Spalding, N.J. (2003) Reducing anxiety by pre-operative education: Make the future familiar. Occup Ther Int, 10(4): 278-93
Wang, A.W., Gilbey, H.J., Ackland, T.R. (2002) Perioperative exercise programs improve early return of ambulatory function after total hip arthroplasty: A randomized, controlled trial. Am J Phys Med Rehabil, 81(11): 801-6
Weingarten, S., Riedinger, M.S., Sandhu, M., Bowers, C., Ellrodt, A.G., Nunn, C., Hobson, P., Greengold, N. (1998) Can practice guidelines safely reduce hospital length of stay?: Results from a multicenter interventional study. Am J Med, 105(1): 33-40
Wijgman, A.J., Dekkers, G.H., Waltje, E., Krekels, T., Arens, H.J. (1994) No positive effect of preoperative exercise therapy and teaching in patients to be subjected to hip arthroplasty. Ned Tijdschr Geneeskd, 138(19): 949-52