Does reduced movement restrictions and use of assistive devices affect rehabilitation outcome after total hip replacement? A non-randomized, controlled study.
BACKGROUND
Improvements in surgical techniques and increase of femoral head size might have changed the rationale for movement restrictions after total hip replacement (THR).


OBJECTIVE
To evaluate the influence of movement restrictions and assistive devices on rehabilitation after fast track THR.


METHODS
Non-randomized, controlled study.


METHODS
Inpatient.


METHODS
365 consecutively included THR patients.


METHODS
Patients included the 3 initial month of the study underwent rehabilitation with restrictions in hip movement and a standard package of assistive devices (restricted group). This group was compared to patients included the following 3 months with less restricted hip movement and use of assistive devices according to individual needs (unrestricted group). Questionnaires on function, pain, quality of life (HOOS), anxiety (HADS), working status and patient satisfaction were completed before THR, 3 and 6 weeks after.


RESULTS
The HOOS function score at the 3 measurement times was (mean ± SD); unrestricted group: 46 ± 17 - 76 ± 9 - 83 ± 14 compared to restricted group: 43 ± 16 - 81 ± 14 - 83 ± 13. Changes over time was significantly higher in the restricted group (P=0.004). Return to work 6 weeks after THR for the unrestricted group compared to restricted group was: 53% versus 32% (P=0.045). No significant differences between groups in pain, symptoms, quality of life, anxiety/depression, hip dislocations and patient satisfaction.


CONCLUSIONS
This study showed slightly slower recovery in patient-reported function after reduction in movement restrictions and use of assistive devices, but the difference was eliminated after 6 weeks. Reduced movement restrictions did not affect the other patient-reported outcomes and led to earlier return to work.


CONCLUSIONS
It is possible to reduce movement restrictions and use of assistive devices considerably. More research on safety issues is needed to elucidate the effect of unrestricted rehabilitation on hip dislocation.
Elective Surgery Centre, Silkeborg Regional Hospital Silkeborg, Denmark - lonemike@rm.dk.
L R
LR
Mikkelsen
M K
MK
Petersen
K
K
Søballe
S
S
Mikkelsen
I
I
Mechlenburg
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D007297:Inpatients; D008297:Male; D017060:Patient Satisfaction; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D012656:Self-Help Devices; D011795:Surveys and Questionnaires; D016896:Treatment Outcome