The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial

Objective: To investigate the effects of preoperative physical therapy for patients undergoing total hip replacement. Design: Prospective randomized controlled study. Setting: Department of Orthopaedics and Traumatology in a university hospital. Subjects: Sixty patients with osteoarthritis of the hip scheduled to receive total hip replacement were randomly assigned into two groups. Interventions: Subjects in the study group received preoperative physiotherapy designed to strengthen the muscles of the upper and lower limbs and to improve range of motion of the hip, beginning from eight weeks before the operation. These patients also received an educational programme about living with a prosthesis. The control group received no preoperative physiotherapy or educational programme. Main outcome measures: Patients were evaluated at baseline (study group only, eight weeks prior to operation), before surgery, at discharge, three months and two years postoperatively using Harris Hip Score, visual analogue scale and range at hip abduction. Results: Although patients in the study group performed transfer activities earlier than the control group, there were no significant differences between the groups at discharge with regard to the improvement in Harris Hip Score (p < 0.48) and hip adduction (p < 0.97) and visual analogue scale at rest (p < 0.54) and activity (p < 0.89). At the latest follow-up (two years postoperatively) both groups had improved in Harris Hip Score, but rate of improvement between the groups was similar (p < 0.05). Conclusions: We conclude that the routine use of preoperative physiotherapy and education programme is not useful in total hip replacement surgery.