Rehabilitation in Patients with Total Hip Arthroplasty During the Covid-19 Pandemic. Functional Outcomes
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Published:
Jun 17, 2024
Keywords:
Total hip replacement, rehabilitation, functional outcomes, Forgotten Joint Score, Harris Hip Score, Covid-19
Main Article Content
Abstract
Introduction: The COVID-19 pandemic had a significant impact on many parts of people’s lives, including those who needed rehabilitation after primary hip arthroplasty.
Objective: To determine if there is a difference in functional outcomes between supervised and self-administered rehabilitation after THA.
Materials and Methods: Data were collected from two groups of patients: those who were operated on for unilateral THA and received supervised rehabilitation, and those who were operated on during the pandemic and experienced unsupervised, self-directed rehabilitation. The functional outcomes of both groups were compared three months and one year following surgery using the modified Harris Hip Score (mHHS) and the Forgotten Joint Score (FJS).
Results: No significant differences were found in HHS between the two groups at 3 and 12 months (p 0.18). On the contrary, a statistically significant difference (p <0.001) was observed in the FJS, which was superior for unsupervised THA, both at 3 months and at 1 year. After 12 months, both scores showed significant improvement in the two groups (p < 0.001).
Conclusion: After a THA, both supervised and unsupervised rehabilitation options should be considered. Our findings indicate that supervision does not result in faster or more successful rehabilitation, therefore enabling unsupervised rehabilitation for patients who require it.
Objective: To determine if there is a difference in functional outcomes between supervised and self-administered rehabilitation after THA.
Materials and Methods: Data were collected from two groups of patients: those who were operated on for unilateral THA and received supervised rehabilitation, and those who were operated on during the pandemic and experienced unsupervised, self-directed rehabilitation. The functional outcomes of both groups were compared three months and one year following surgery using the modified Harris Hip Score (mHHS) and the Forgotten Joint Score (FJS).
Results: No significant differences were found in HHS between the two groups at 3 and 12 months (p 0.18). On the contrary, a statistically significant difference (p <0.001) was observed in the FJS, which was superior for unsupervised THA, both at 3 months and at 1 year. After 12 months, both scores showed significant improvement in the two groups (p < 0.001).
Conclusion: After a THA, both supervised and unsupervised rehabilitation options should be considered. Our findings indicate that supervision does not result in faster or more successful rehabilitation, therefore enabling unsupervised rehabilitation for patients who require it.
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How to Cite
Otero, M., Posse, R. A., Pérez Lloveras, G. O., Casserá, F., Rognoni, T. M., Laboranti, A., Lazzari, M., Casen Infante, F. G., Arjona Angarita, D., & R. Tanus, J. (2024). Rehabilitation in Patients with Total Hip Arthroplasty During the Covid-19 Pandemic. Functional Outcomes. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(3), 314-321. https://doi.org/10.15417/issn.1852-7434.2024.89.3.1867
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Section
Rehabilitación
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References
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Rehabil Res Dev 2014;51(10):1567-78. https://doi.org/10.1682/jrrd.2014.05.0132
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to improve function for patients with total knee arthroplasty: a randomized clinical trial. Phys Ther 2010;90(6):880-94. https://doi.org/10.2522/ptj.20090150
6. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 2005;35(7):424-36. https://doi.org/10.2519/jospt.2005.35.7.424
7. Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, et al. Effect of preoperative exercise on
measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum
2006;55(5):700-8. https://doi.org/10.1002/art.22223
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https://doi.org/10.7759/cureus.29322
9. Beaupre LA, Masson EC, Luckhurst BJ, Arafah O, O’Connor GJ. A randomized pilot study of a comprehensive
postoperative exercise program compared with usual care following primary total hip arthroplasty in subjects les
than 65 years of age: Feasibility, selection of outcome measures and timing of assessment. BMC Musculoskelet
Disord 2014;15(1):192. https://doi.org/10.1186/1471-2474-15-192
10. Monaghan B, Cunningham P, Harrington P, Hing W, Blake C, O’ Dohertya D, et al. Randomised controlled
trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement. Physiotherapy
2017;103(3):283-8. https://doi.org/10.1016/j.physio.2016.01.003
11. Galea MP, Levinger P, Lythgo N, Cimoli C, Weller R, Tully E, et al. A targeted home- and center-based
exercise program for people after total hip replacement: A randomized clinical trial. Arch Phys Med Rehabil
2008;89(8):1442-7. https://doi.org/10.1016/j.apmr.2007.11.058
12. Coulter C, Perriman DM, Neeman TM, Smith PN, Scarvell JM. Supervised or unsupervised rehabilitation after total hip replacement provides similar improvements for patients: a randomised controlled trial. Arch Phys Med Rehabil 2017;98(11):2253-64. https://doi.org/10.1016/j.apmr.2017.03.032
13. Saueressig T, Owen PJ, Zebisch J, Herbst M, Belavy DL, et al. Evaluation of exercise interventions and outcomes after hip arthroplasty. JAMA Netw Open 2021;4(2):e210254. https://doi.org/10.1001/jamanetworkopen.2021.0254
14. Fatoye F, Wright JM, Yeowell G, Gebrye T. Clinical and cost-effectiveness of physiotherapy interventions following total hip replacement: A systematic review and meta-analysis. Rheumatol Int 2020;40(9):1385-98.
https://doi.org/10.1007/s00296-020-04597-2
15. Peter WF, Nelissen RG, Vliet Vlieland TP. Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: Are they used in daily clinical practice? Musculoskeletal Care 2014;12(3):125-31. https://doi.org/10.1002/msc.1067
16. Scott CEH, MacDonald DJ, Howie CR. ‘Worse than death’ and waiting for a joint arthroplasty. Bone Joint J
2019;101-B(8):941-50. https://doi.org/10.1302/0301-620X.101B8.BJJ-2019-0116.R1
United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
2. Estado de situación de la cobertura de casos por covid-19 [Internet]. Argentina.gob.ar. 2022. Disponible en:
https://www.argentina.gob.ar/noticias/estado-de-situacion-de-la-cobertura-de-casos-por-covid-19
3. Wainwright TW, Memtsoudis SG, Kehlet H. Fast-track hip and knee arthroplasty. how fast? Br J Anaesth 2021;126(2):348-9. https://doi.org/10.1016/j.bja.2020.09.038
4. Umpierres CS, Aguiar Ribeiro T, Marchisio AE, Galvão L, Krás Borges IN, de Souza Macedo CA, et al. Rehabilitation following total hip arthroplasty evaluation over short follow-up time: Randomized clinical trial. J
Rehabil Res Dev 2014;51(10):1567-78. https://doi.org/10.1682/jrrd.2014.05.0132
5. Piva SR, Gil AB, Almeida GJM, DiGioia AM 3rd, Levison TJ, Fitzgerald GK. A balance exercise program appears
to improve function for patients with total knee arthroplasty: a randomized clinical trial. Phys Ther 2010;90(6):880-94. https://doi.org/10.2522/ptj.20090150
6. Mizner RL, Petterson SC, Snyder-Mackler L. Quadriceps strength and the time course of functional recovery after total knee arthroplasty. J Orthop Sports Phys Ther 2005;35(7):424-36. https://doi.org/10.2519/jospt.2005.35.7.424
7. Rooks DS, Huang J, Bierbaum BE, Bolus SA, Rubano J, Connolly CE, et al. Effect of preoperative exercise on
measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Rheum
2006;55(5):700-8. https://doi.org/10.1002/art.22223
8. Chaudhry YP, Hayes H, Wells Z, Papadelis E, Arevalo A, Horan T, et al. Unsupervised home exercises versus formal physical therapy after primary total HIP arthroplasty: A systematic review. Cureus 2022;14(9):e29322.
https://doi.org/10.7759/cureus.29322
9. Beaupre LA, Masson EC, Luckhurst BJ, Arafah O, O’Connor GJ. A randomized pilot study of a comprehensive
postoperative exercise program compared with usual care following primary total hip arthroplasty in subjects les
than 65 years of age: Feasibility, selection of outcome measures and timing of assessment. BMC Musculoskelet
Disord 2014;15(1):192. https://doi.org/10.1186/1471-2474-15-192
10. Monaghan B, Cunningham P, Harrington P, Hing W, Blake C, O’ Dohertya D, et al. Randomised controlled
trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement. Physiotherapy
2017;103(3):283-8. https://doi.org/10.1016/j.physio.2016.01.003
11. Galea MP, Levinger P, Lythgo N, Cimoli C, Weller R, Tully E, et al. A targeted home- and center-based
exercise program for people after total hip replacement: A randomized clinical trial. Arch Phys Med Rehabil
2008;89(8):1442-7. https://doi.org/10.1016/j.apmr.2007.11.058
12. Coulter C, Perriman DM, Neeman TM, Smith PN, Scarvell JM. Supervised or unsupervised rehabilitation after total hip replacement provides similar improvements for patients: a randomised controlled trial. Arch Phys Med Rehabil 2017;98(11):2253-64. https://doi.org/10.1016/j.apmr.2017.03.032
13. Saueressig T, Owen PJ, Zebisch J, Herbst M, Belavy DL, et al. Evaluation of exercise interventions and outcomes after hip arthroplasty. JAMA Netw Open 2021;4(2):e210254. https://doi.org/10.1001/jamanetworkopen.2021.0254
14. Fatoye F, Wright JM, Yeowell G, Gebrye T. Clinical and cost-effectiveness of physiotherapy interventions following total hip replacement: A systematic review and meta-analysis. Rheumatol Int 2020;40(9):1385-98.
https://doi.org/10.1007/s00296-020-04597-2
15. Peter WF, Nelissen RG, Vliet Vlieland TP. Guideline recommendations for post-acute postoperative physiotherapy in total hip and knee arthroplasty: Are they used in daily clinical practice? Musculoskeletal Care 2014;12(3):125-31. https://doi.org/10.1002/msc.1067
16. Scott CEH, MacDonald DJ, Howie CR. ‘Worse than death’ and waiting for a joint arthroplasty. Bone Joint J
2019;101-B(8):941-50. https://doi.org/10.1302/0301-620X.101B8.BJJ-2019-0116.R1