Despite the number of sources in the literature that emphasize the importance of rehabilitation programs or, more specifically, a postoperative exercise and ambulation program after THA, the impact of these postoperative interventions has not been clearly established. The NIH reported that there is currently insufficient evidence to determine what constitutes an appropriate level of physical therapy utilization after THA. The report went on to say that there does appear to be a role for these interventions but that the efficacy of these postoperative programs has not yet been determined. Studies have demonstrated that access to inpatient physical therapy services does and does not decrease a patient’s length of stay in an acute care facility after THA. The use of physical therapy services after THA also has been shown to increase the probability of discharge to the home setting rather than to another health-care facility.

Studies with control groups that have evaluated the impact of exercise on functional outcomes in patients who have undergone THA are few in number. Most of these studies have looked at the effect of exercise several months or even a year or two after surgery, not during the first 6 to 12 weeks. However, Wang and colleagues conducted a randomized, controlled investigation to determine if a customized exercise program initiated before scheduled THA had an efffect on the ambulatory abilities of patients after surgery. Gait velocity was measured by the 25-meter walk test, and walking endurance was measured by the 6-minute walk test. Participants in the exercise group (n = 15) took part in two facility-based and two home-based exercise sessions of stationary bicycling and resistance training two times per week for 8 weeks prior to surgery. At 3 weeks postoperatively, these patients resumed their individualized exercise regimens, modified to incorporate postoperative precautions, and continued until 12 weeks. Patients in the control goup (n = 13) underwent no preoperative intervention and received routine post-THA functional training. At 3 weeks postoperatively the exercise group demonstrated significantly greater gait velocity and stride length and at 12 weeks significantly greater 6-minute walking distance than the control group. The investigators concluded that a customized strength and endurance training program prior to and after THA improved the rate of recovery of ambulatory function.

In a nonrandomized study of the effectiveness of a 6-week home exercise program with patients who were 6 to 48 months post-THA, the two exercise groups (one performing ROM and isometric exercises of the hip and the other performing ROM, isometric, and eccentric exercises) increased their walking speed, whereas a control group (no exercise program) did not. Interestingly, strength improvements were noted in all three groups. The results of these two studies provide useful information, but a great deal more research needs to be done on the effects of exercise on function after THA.

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