Effect of pre-operative physiotherapy in patients with end-stage osteoarthritis undergoing hip arthroplasty

Objective: To examine the effect of pre-operative physiotherapy before hip arthroplasty in patients with end-stage hip osteoarthritis. Design: A prospective randomized controlled study. Setting: Physical medicine and rehabilitation and orthopaedic departments of Policlinico Gemelli of Rome. Subjects: Twenty-three patients randomized in study and control groups. Intervention: The study group took part in an educational and physiotherapy programme one month before surgery. Both groups took part in the same inpatient rehabilitation programme after surgery. Main outcome measures: Both groups were evaluated one month (T0) and the day before arthroplasty (T1), after 15 days (T2), four weeks (T3) and three months (T4) post surgery, using the Barthel Index, the Short Form-36 (SF-36), the Western Ontario and McMaster Osteoarthritis Index (WOMAC), the Hip Harris Score (HHS), visual analogue scale (VAS), the British Medical Research Council (BMRC) measures of hip abductor and quadriceps strength and range of hip abduction and external rotation. Results: There were no significant differences between groups with regard to the Barthel Index, SF-36, WOMAC and HHS at T4. The study group presented significant improvements of the SF-36 physical composite score at T1. The hip external rotation was significantly higher in the study group at each evaluation and the visual analogue scale values were lower at T1, T3 and T4. Conclusion: Pre-operative physiotherapy in patients undergoing hip arthroplasty does not improve impairment and health-related quality of life after intervention. Physiotherapy and educational therapy may be useful for end-stage osteoarthritis.