As advances have been made in anesthetic and surgical techniques, patient outcomes following hip arthroplasties (hip replacements) have greatly improved. With these developments, formal physical therapy may no longer be necessary for patients, and self-directed therapy may be sufficient.
Total hip arthroplasty (total hip replacement) has undergone drastic advancements over the years that may have adjusted optimal postoperative therapy. Formerly, hip replacements required strict outpatient physical therapy to ensure optimal recovery and return to function. However, with new developments in surgical and anesthetic techniques, postoperative routines may be less strict and rigorous. Prior studies have suggested that independent, self-directed therapy may be sufficient to support surgical intervention in preventing degenerative disease.
Determining whether physical therapy is indeed needed following hip arthroplasty is important for a number of reasons related to physical therapy traffic. If physical therapy were not needed, it would save patients the burden of finding a physical therapist and meeting with them for weeks, if not months. It would also improve the availability of physical therapists for those who require urgent treatment. Finally, reducing the number of hip replacement patients that seek physical therapy would reduce the financial burden put on public health insurance providers such as U.S. Medicare, which administered $180.4 million dollars’ worth of physical therapy for postoperative hip arthroplasty patients alone in 2009.
In this study published in The Journal of Bone and Joint Surgery, Austin and colleagues set out to evaluate whether self-directed therapy was efficacious following total hip arthroplasty. The study included patients 18 to 80 years of age who were undergoing hip arthroplasty for the first time and did not suffer from arthritis. Of 120 enrolled patients, 60 received outpatient physical therapy and 60 underwent self-directed home exercise. The physical therapy group received 2 weeks of in-home physical therapy followed by 8 weeks of formal outpatient therapy. The self-directed group received a 10-week exercise program and were taught exercises prior to leaving the hospital. They received follow up visits 2 weeks post-operation to see how successful the informal therapy was and if they wished, they could switch to formal physical therapy. Patients were evaluated for pain, function and range of motion.
Modern techniques for hip arthroplasty have made it one of the most successful operations restoring patient function and relieving pain. This was supported by the findings of the study, which suggest that formal physical therapy may be unnecessary following hip replacement. Patients showed substantial improvement in all patient outcomes regardless of treatment, and no clinically or statistically significant differences were found between the 2 groups. One issue with the study is that patients who saw themselves as less likely to recover may have been less likely to join the study, inflating the improvements of the study population. Despite this, the study demonstrates that self-directed physical therapy may be sufficient following total hip arthroplasty; however, it should be noted that some at-risk subsets of the population may still require formal physical therapy for a full recovery.
Written By: Wesley Tin, BMSc