The role of pre-operative physiotherapy in Hip Osteoarthritis / Hip Arthroplasty
One of the most widely performed surgical interventions for advanced arthritis of the hip joint is total hip arthroplasty. Osteoarthritis (OA) is the underlying pathology that accounts for most total hip procedures and is one of the most common diseases of the hip joint.
The potential causes of hip OA vary from: joint trauma, repetitive abnormal stresses, disease and ageing process. The degenerative changes include articular cartilage breakdown and loss, capsular fibrosis, and osteophyte formation at the joint margins (1).
Clinical presentation of Hip Osteoarthritis:
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pain experienced in the groin and referred to anterior thigh and/or knee.
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morning stiffness/ stiffness after rest
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limited hip range of motion, first seen as loss of IR progressing to global loss
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antalgic gait pattern - commonly seen as Trendelenburg sign
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impaired balance
A study by Czyżewska et al showed that patients who received preoperative physiotherapy before a total hip replacement (THR) had significant improvements in pain, function, psychological health, social life, and internal rotation ROM(2). This study provides evidence of the benefit of exercise in the management of hip OA and pre-op surgical patients.
An appropriate exercise program can have positive effects on pain and hip function, which are important mediators of disability. A good exercise and pre-op program will not only improve the quality of life of people awaiting surgery but will set them up for a positive post-operative rehabilitative experience.
References:
Kisner C & Colby LA. Therapeutic Exercise: foundations and techniques 5th ed. Phiadelphia: F.A. Davis Company; 2007.
Czyżewska A et al Effects of preoperative physiotherapy in hip osteoarthritis patients awaiting total hip replacement. Arch Med Sci. 2014 Oct 27;10(5):985-91