Factors Influencing Early Rehabilitation After THA: A Systematic Review

A wide variation exists in rehabilitation after total hip arthroplasty (THA) in part due to a paucity of evidence-based literature. We asked whether a minimally invasive surgical approach, a multimodal approach to pain control with revised anesthesia protocols, hip restrictions, or preoperative phys...

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Bibliographic Details
Published in:Clinical orthopaedics and related research 2009-06, Vol.467 (6), p.1400-1411
Main Authors: Sharma, Vivek, Morgan, Patrick M., Cheng, Edward Y.
Format: Article
Language:English
Subjects:
Anesthesia - methods
Arthroplasty, Replacement, Hip - rehabilitation
Conservative Orthopedics
Humans
Medicine
Medicine & Public Health
Orthopedics
Pain, Postoperative - rehabilitation
Physical Therapy Modalities
Recovery of Function
Sports Medicine
Surgery
Surgical Orthopedics
Symposium: Advanced Techniques for Rehabilitation after Total Hip and Knee Arthroplasty
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Summary:A wide variation exists in rehabilitation after total hip arthroplasty (THA) in part due to a paucity of evidence-based literature. We asked whether a minimally invasive surgical approach, a multimodal approach to pain control with revised anesthesia protocols, hip restrictions, or preoperative physiotherapy achieved a faster rehabilitation and improved immediate short-term outcome. We conducted a systematic review of 16 level I and II studies after a strategy-based search of English literature on OVID Medline, PubMed, CINAHL, Cochrane, and EMBASE databases. We defined the endpoint of assessment as independent ambulation and ability to perform activities of daily living. Literature supports the use of a multimodal pain control to improve patient compliance in accelerated rehabilitation. Multimodal pain control with revised anesthesia protocols and accelerated rehabilitation speeds recovery after minimally invasive THA compared to the standard approach THA, but a smaller incision length or minimally invasive approach does not demonstrably improve the short-term outcome. Available studies justify no hip restrictions following an anterolateral approach but none have examined the question for a posterior approach. Preoperative physiotherapy may facilitate faster postoperative functional recovery but multicenter and well-designed prospective randomized studies with outcome measures are necessary to confirm its efficacy. Level of Evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
ISSN:0009-921X
1528-1132
DOI:10.1007/s11999-009-0750-9