A physiotherapy-led exercise programme after total hip replacement

Posted on February 13, 2017

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This blog is a critical appraisal of the following study, published in 2016: Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement


In 2014, 98,279 Total Hip Replacements (THR) were carried out in the UK alone (National Joint Registry, NJR 2015). A THR is a surgical procedure in which diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. THR can provide improved quality of life, improved function and pain relief (Agostini et al 2014, Anakwe et al 2011). Physiotherapy is a routine part of rehabilitation for patients after THR. However, a number of systematic reviews have been unable to establish evidence to support the effectiveness of physiotherapy (Monaghan and Cussack 2014, Minns Lowe et al. 2009).


This study aimed to evaluate the effectiveness of a 6 week outpatient physiotherapy-led functional exercise programme from 12-18 weeks post THR. Starting from 12 weeks post-operation (baseline), the intervention group received usual care and a 6 week exercise programme which consisted of two 35 minute exercise classes per week. The control group received usual care.

72 patients were eligible for the study, with 63 completing it. There were 32 patients in the intervention group and 31 in the control group. The 63 patients were allocated to a group post-op using a computer-generated random number table.

All outcome measurements were recorded 12 weeks after surgery (baseline) and 18 weeks after surgery. These were recorded by the principal investigator, who was blinded to group allocation.

The primary outcome measurement tool was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. This measures pain, stiffness and physical function. Secondary outcome measures included the Visual Analogue Pain Scale (VAS), the 6 Minute Walk Test (measuring walking speed) and Short Form 12 (SF12) self-reported physical and mental health scores.

ResultsImage of a hip

At 12 weeks post-op (i.e. baseline) there were no statistical differences between groups. At 18 weeks post-op, the intervention group showed a statistically significant improvement in WOMAC function and walking speed in comparison to the control group. There was no statistical difference between any other the other outcomes

Strengths and Weaknesses

In order to critically appraise this article, the Critical Appraisal Skills Programme (CASP) assessment tool has been used as a guide. 


Overall, this study is of high quality, adhering to the principles of good practice when undertaking research. The study found that patients may benefit functionally from a physiotherapy-led 6 week exercise programme at 12-18 weeks after a total hip replacement. However, further research is needed to verify whether these beneficial outcomes are sustained long-term, particularly given the inconclusiveness of prior systematic reviews.



AGOSTINI, V., GANIO, D., FACCHIN, K., CANE, L., MOREIRA CARNEIRO, S. and KNAFLITZ, M., 2014. Gait parameters and muscle activation patterns at 3, 6 and 12 months after total hip Arthroplasty. The Journal of Arthroplasty. June, vol. 29, no. 6, pp. 1265–1272.
ANAKWE, R. E., JENKINS, P. J. and MORAN, M., 2011. Predicting dissatisfaction after total hip Arthroplasty: A study of 850 patients. The Journal of Arthroplasty. February, vol. 26, no. 2, pp. 209–213.
MINNS LOWE, C., BARKER, K. L., DEWEY, M. E. and SACKLEY, C. M., 2009. Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: A systematic review of clinical trials. BMC Musculoskeletal Disorders. vol. 10, no. 1, p. 98.
MONAGHAN, B., CUNNINGHAM, P., HARRINGTON, P., HING, W., BLAKE, C., O’ DOHERTYA, D. and CUSACK, T., 2016. Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement. Physiotherapy.
MONAGHAN, B. and CUSACK, T., 2013. Effectiveness of delayed rehabilitation programmes in patients following total hip replacement. Physical Therapy Reviews. December, vol. 19, no. 2, pp. 94–104.
MR, A., GOLDBERG, J., REES, LUDLEY, J., THORNTON, J., YOUNG, E., MCCORMACK, V., MISTRY, A., NEWELL, C., PICKFORD, M., ROYALL, M., SWANSON, M., BEN, Y., PROFESSOR, S., BLOM, A., CLARK, E., DEERE, K., GREGSON, C., HUNT, L., JUDGE, A., PROFESSOR, K., PRICE, A., MR, S. and WHITEHOUSE, M., 2016. National joint registry for England, wales, Northern Ireland and the isle of man.

Andrew Ward

A physiotherapy student from Queen Margaret University, Edinburgh.

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A physiotherapy-led exercise programme after total hip replacement by Andrew Ward is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Unless otherwise stated, all images used within the blog are not available for reuse or republication as they are purchased for Students 4 Best Evidence from shutterstock.com.

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