Recovery of function following hip resurfacing arthroplasty: a randomized controlled trial comparing an accelerated versus standard physiotherapy rehabilitation programme

Abstract

Objective:

To identify if a tailored rehabilitation programme is more effective than standard practice at improving function in patients undergoing metal-on-metal hip resurfacing arthroplasty.

Design:

Randomized controlled trial.

Setting:

Specialist orthopaedic hospital.

Subjects:

80 men with a median age of 56 years.

Interventions:

Tailored post-operative physiotherapy programme compared with standard physiotherapy.

Main Outcomes:

Primary outcome – Oxford Hip Score (OHS), Secondary outcomes: Hip disability and Osteoarthritis Outcome Score (HOOS), EuroQol (EQ-5D-3L) and UCLA activity score. Hip range of motion, hip muscle strength and patient selected goals were also assessed.

Results:

At one year the mean (SD) Oxford Hip Score of the intervention group was higher, 45.1 (5.3), than the control group, 39.6 (8.8). This was supported by a linear regression model, which detected a 5.8 unit change in Oxford Hip Score (p < 0.001), effect size 0.76. There was a statistically significant increase in Hip disability and Osteoarthritis Outcome Score of 12.4% (p < 0.0005), effect size 0.76; UCLA activity score differed by 0.66 points (p < 0.019), effect size 0.43; EQ 5D showed an improvement of 0.85 (p < 0.0005), effect size 0.76. A total of 80% (32 of 40) of the intervention group fully met their self-selected goal compared with 55% (22 of 40) of the control group. Hip range of motion increased significantly; hip flexion by a mean difference 17.9 degrees (p < 0.0005), hip extension by 5.7 degrees (p < 0.004) and abduction by 4 degrees (p < 0.05). Muscle strength improved more in the intervention group but was not statistically significant.

Conclusions:

A tailored physiotherapy programme improved self-reported functional outcomes and hip range of motion in patients undergoing hip resurfacing.

Keywords

Arthroplasty range of motion physiotherapy randomized controlled trial

Get full access to this article

View all access options for this article.

References

Treacy

RBC

McBryde

Pynsent

. Birmingham hip resurfacing arthroplasty – a minimum follow-up of five years. J Bone Joint Surg Br 2005; 87-B: 167–170.

Hungerford

. Metal-on-metal resurfacing arthroplasty – no way under the sun in the affirmative. J Arthro 2005; 20(Suppl 2): 68–69.

MacDonald

. Metal-on-metal total hip arthroplasty – the concerns. Clin Orthop Rel Res 2004; 429: 86–93.

Johnson

Zywiel

Hooper

Mont

. Narrowed indications improve outcomes for hip resurfacing arthroplasty. Bull NYU Hosp for Joint Diseases 2011; 69: S27–29.

Smolders

JMH

Hol

Rijnberg

van Susante

JLC

. Metal ion levels and functional results after either resurfacing hip arthroplasty or conventional metal-on-metal hip arthroplasty. Acta Orthop 2011; 82: 559–566.

Murray

Grammatopoulos

Pandit

Gundle

Gill

McLardy-Smith

. The ten-year survival of the Birmingham hip resurfacing: an independent series. J Bone Joint Surg Br 2012; 94: 1180–1186.

Daniel

Pynsent

McMinn

. Resurfacing of the hip under the age of 55 years with osteoarthritis. J Bone Joint Surg Br 2004; 86-B: 177–184.

Schmalzried

Silva

Rosa

Choi

Fowble

. Optimizing patient selection and outcomes with total hip resurfacing. Clin Orthop Rel Res 2005; 441: 200–204.

Costa

Johnson

Naziri

Mont

. The outcomes of Cormet^TM resurfacing compared to standard primary total hip arthroplasty. Bull NYU Hosp for Joint Diseases 2011; 69: S12–15.

10.

Baker

Pollard

TCB

Eastaugh-Waring

Bannister

. A medium-term comparison of hybrid hip replacement and Birmingham hip resurfacing in active young patients. J Bone Joint Surg Br 2011; 93-B: 158–163.

11.

Hall

Srikantharajah

Anakwe

Gaston

Howie

. Patient reported outcome following metal-on-metal resurfacing of the hip and total hip replacement. Hip Int 2009; 19: 245–250.

12.

Killampalli

Kundra

Choudray

Chowdray

Fisher

Reading

. Resurfacing and uncemented arthroplasty for young hip arthritis: functional outcomes at 5 years. Hip Int 2009; 19: 234–238.

13.

Enloe

Shields

Smith

Leo

Miller

. Total hip and knee replacement treatment programs: a report using consensus. J Orthop Sports Phys Ther 1996; 23: 3–11.

14.

Sicard-Rosenbaum

Light

Berhman

. Gait, lower extremity strength and self assessed mobility after hip arthroplasty. J Gerontol A Biol Sci Med Sci 2002, 57: 47–51.

15.

Hakkinen

Borg

Kautiainen

, et al. Muscle strength and range of movement deficits 1 year after hip resurfacing surgery using posterior approach. Disab Rehab 2010; 32: 483–491.

16.

Newman

Barker

Pandit

Murray

. Outcomes after metal-on-metal hip resurfacing – could we achieve better function? Arch Phys Med Rehabil 2008; 89: 660–666.

17.

Trudelle-Jackson

Emerson

Smith

. Outcomes of total hip arthroplasty: a study of patients one year post surgery. J Orthop Sports Phys Ther 2002; 32: 260–267.

18.

Campbell

Fitzpatrick

Haines

, et al. Framework for design and evaluation of complex interventions to improve health. BMJ 2000, 321: 694–696.

19.

MRC. A framework for development and evaluation of RCTs for complex interventions to improve health. [19 screens]. Available from http://www.mrc.ac.uk/utilities/Documentrecord/index.htm?d=MRC003372, 2000 April.

20.

Trudelle-Jackson

Smith

. Effects of a late-phase exercise program after total hip arthroplasty: a randomised controlled trial. Arch Phys Med Rehab 2004; 85: 1056–1062.

21.

Murray

Fitzpatrick

Rogers

, et al. The use of Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89(8): 1010–1014.

22.

Nilsdotter

Lohmander

Klassbo

Roos

. Hip disability and osteoarthritis outcome score (HOOS) – validity and responsiveness in total hip replacement. BMC Musculoskel Disord 2003; 4: 10. Epub ahead of print 30 May 2003.

23.

Zahiri

Schmalzried

Szuszczewicz

Amstutz

. Assessing activity in joint replacement patients. J Arthroplasty 1998; 13: 890–895.

24.

Dolan

Guidex

Kind

Williams

. University of York. Centre for Health Economics. Social tariff for EuroQol: results from a UK general population survey. York, UK: Centre for Health Economics University of York, 1995.

25.

Altman

. Practical statistics for medical research. Chapman & Hall, London, 1991, p.456.

26.

Cohen

. A power primer. Psychological Bull 1992; 112: 155–159.

27.

Shimmin

Back

. Femoral neck fractures following hip resurfacing. A national review of 50 cases. J Bone Joint Surg Br 2007; 87-B: 463–464.

28.

Rama

Vendittoli

Ganapathi

Bergmann

Raj

Lavigne

. Heterotrophic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study. J Arthroplasty 2009; 24: 256–262.

29.

Murray

Grammatopoulos

Gundle

, et al. Hip resurfacing and pseudotumour. Hip Int 2011; 21: 279–283.

30.

Long

Dorr

Healy

Perry

. Functional recovery of non-cemented total hip arthroplasty. Clin Orthop Rel Res 1993; 288: 73–77.

31.

Johnston

Smidt

. Hip motion measurements for selected activities of daily living. Clin Orthop Rel Res 1970; 72: 205–215.

32.

Asmutz

Graff-Radford

Mai

Thomas

. Surface replacement of the hip with the Tharies system. Two to five year results. J Bone Joint Surg Am 1981; 63-Am: 1069–1077.

33.

Wagner

. Surface replacement arthroplasty of the hip. Clin Orthop Relat Res 1978; 134: 102–130.

34.

dela Rosa

Silva

Heisel

Reich

Schmalzried

. Range of motion after total hip resurfacing. Orthop 2007; 30: 352–357.

35.

Svenningsen

Terjesen

Auflem

Berg

. Hip motion related to age and sex. Acta Orthop Scand 1989; 60: 97–100.

36.

Fisher

Killampalli

Kundra

Jagodzinski

Mathur

Reading

. Sporting and physical activity following hip resurfacing. Int Orthop 2011; 35: 977–980.

37.

Davis

Perruccio

Ibrahim

, et al. The trajectory of recovery and the inter-relationships of symptoms, activity and participation in the first year following total hip and knee replacement. Osteoarthritis Cartilage 2011, 19: 1413–1421.

38.

Gignac

Backman

Davis

, et al. Understanding social role participation: what matters to people with arthritis? J Rheumatol 2008; 35: 1655–1663.

39.

Medicines and Healthcare Products Regulatory Agency. Medical device alert: All metal-on-metal (MoM) hip replacements. MDA/2010/033, http://www.mhra.gov.uk/Publications/Safetywarnings/MedicalDeviceAlerts/CON079157 (2010).

40.

Dohnke

Knauper

Muller-Fahmow

. Perceived self-efficacy gained from, and health effects of, a rehabilitation program after hip replacement. Arthritis Rheum 2005; 53: 585–592.

41.

Marker

Seyler

Bhave

Zywiel

Mont

. Does commitment to rehabilitation influence clinical outcome of total hip resurfacing arthroplasty? J Orthop Surg Res 2010; 5: 20.

42.

Crow

Gelfand

. Use of joint mobilisation in a patient with severely restricted hip motion following bilateral hip resurfacing arthroplasty. Phys Ther 2008; 12: 159–160.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.15 MB