Rehabilitation in Patients with Total Hip Arthroplasty During the Covid-19 Pandemic. Functional Outcomes
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.Downloads
References
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the
United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
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
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
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
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
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
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
;55(5):700-8. https://doi.org/10.1002/art.22223
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
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
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
;103(3):283-8. https://doi.org/10.1016/j.physio.2016.01.003
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
;89(8):1442-7. https://doi.org/10.1016/j.apmr.2007.11.058
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
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
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
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
Scott CEH, MacDonald DJ, Howie CR. ‘Worse than death’ and waiting for a joint arthroplasty. Bone Joint J
;101-B(8):941-50. https://doi.org/10.1302/0301-620X.101B8.BJJ-2019-0116.R1
Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.
In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.
It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.
The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.


