Postop Outpatient Physical Therapy and THA Outcomes

HealthDay News –  No differences in postoperative outcomes were found between those patients who received formal outpatient physical therapy (OPT) after total hip arthroplasty (THA) and those who did not, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 1 to 5 in Orlando, Fla.¹

Brian Urbani, MS, from the Rothman Institute in Philadelphia, and colleagues randomized 77 patients who underwent THA to receive two months of formal OPT (39 patients), with two to three sessions per week, or no formal OPT (38 patients), with patients following a prescribed exercise program on their own. Before surgery and at one and six months postoperatively, functional scores were recorded.

The researchers observed no significant between-group differences in any measured outcomes at one or six months postoperatively. The Harris Hip Score was 67.67 ± 3.0 and 80.19 ± 4.33 for the formal OPT group, compared with 71.26 ± 3.24 and 84.68 ± 3.32 for the no OPT group at one month and six months, respectively. There were no significant differences between the groups in the Western Ontario and McMaster Universities Arthritis Index or in the Short Form-36 scores at either postoperative interval.

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Summary and Clinical Applicability

In this study, patients were evaluated at 1 and 6 months after THA, and no differences in postoperative outcomes were found between those patients who received OPT and those who did not. 

“These findings suggest that formal OPT is not superior to prescribed, patient-directed home exercises,” the authors of this study write. “Based on the findings of this study, we have moved away from routinely prescribing formal OPT for all patients after THA”.¹

Notably, for certain surgeries in subsets of patients, researchers have found that unsupervised physical therapy provides results comparable with therapist-managed physical therapy.²  However, the decision to prescribe formal physical therapy should be individualized to the needs of the patients, specific operative pathology and pre/post-op physical condition. Some patients may still benefit from a formal OPT training, especially if they are not able to effectively complete prescribed exercises at home, or at higher risk for falls or injuries. 

Summary and Clinical Applicability Statement by Corinna Panlilio Sison, MD

Reference

1. Urbani B, Purtill J, Hozack W, et al. Formal Physical Therapy After Primary Total Hip Arthroplasty May Not Be Necessary.  Abstract presented at the American Academy of Orthopedic Surgeons 2016 Annual Meeting, Orlando, FL, March 2016. 

2. Russell TG, Buttrum P, Wootton R, Jull GA. Internet-based outpatient telerehabilitation for patients following total knee arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2011;93(2):113-20.