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Titel på arbejdetEarly rehabilitation after fast-track total hip replacement
NavnLone Ramer Mikkelsen
Afdeling / StedCenter for Planlagt Kirurgi, Regionshospitalet Silkeborg
UniversitetAarhus Universitet
  • Hip and knee surgery
Abstract / Summary

Total hip replacement (THR) surgery results in substantial pain relief and functional
gains. However, deficits in muscle strength and physical function after THR persist.
Progressive resistance training (PRT) commenced early after THR can potentially
reduce these deficits and thereby enhance recovery. Traditionally, rehabilitation after
THR has included movement restrictions to prevent hip dislocations. Improvements
in surgical techniques and increase of femoral head size may have changed the
rationale for these restrictions.
The objectives of this thesis were I) to evaluate the influence of movement restrictions
and assistive devices on rehabilitation after fast-track THR, II) to assess the inter-rater
reliability of a test battery of functional performance, muscle strength and leg
extension power on THR patients and III) to examine whether two weekly sessions of
supervised PRT in combination with home-based exercise is more effective than
unsupervised home-based exercise alone in improving leg-extension power of the
operated leg 10 weeks after THR in patients with perceived functional limitations.
The thesis consists of three studies (I-III) including patients undergoing primary THR
due to hip osteoarthritis (OA) at Silkeborg Regional Hospital in the period September
2010 to November 2012. In Study I, 146 patients treated with movement restrictions
and a standard package of assistive devices (restricted group) was compared to 219
patients treated with less movement restrictions and use of assistive devices
according to individual needs (unrestricted group) in a non-randomised,
comparative study. Questionnaires on function, pain, quality of life (HOOS), anxiety,
depression (HADS), working status and patient satisfaction were completed before
THR, 3 and 6 weeks after. At the 3-week follow-up independency in four different
activities of daily living (ADL) tasks was evaluated. In Study II, two raters performed
test and re-test on two samples of 20 patients 3 months after THR. The test battery
included sit-to-stand performance, 20-metre maximum walking speed, stair climb
performance, isometric muscle strength (hip abduction/flexion), and leg extension
power. In Study III, patients were randomly assigned to a control group (n=30)
performing home-based exercises 7 days/week or an intervention group (n=32)
performing PRT 2 days/week and home-based exercises the remaining 5 days/week.
The PRT consisted of four lower extremity exercises performed with loads of 8-12
repetition maximum (RM) from week 1 to 10 after THR. Outcome was assessed
before THR and 10 and 26 weeks after by the test battery presented in Study II and
patient-reported outcome (HOOS). The primary outcome was change in leg
extension power from baseline to 10-week follow-up.
Study I showed slightly slower recovery in patient-reported function in the
unrestricted group compared to the restricted group, but the difference was
eliminated after 6 weeks and potentially biased by missing answers. The unrestricted
group was more independent in ADL after 3 weeks and returned earlier to work
compared to the restricted group, with no differences in the other patient-reported
outcomes. The reliability study (II) documented acceptable relative and absolute
inter-rater reliability of the test battery on a group level, but not on an individual
level. In Study III, the supervised PRT in addition to home-based exercise was not
superior to home-based exercise alone in improving leg extension power of the
operated leg after THR. A few secondary outcomes favoured PRT but seemed
clinically insignificant.

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