Methods for Optimising Patient Function After Total Hip Arthroplasty

Symptomatic hip osteoarthritis occurs in 3% of the elderly (Felson 2004) and is associated with poor general health status (Dawson et al. 2004). Treatment strategies for hip pain have traditionally involved conservative measures (analgesia, exercise, education, weight reduction) and surgical intervention (joint replacement) is the most effective treatment for end stage disease (Birrell et al. 2000, Di Domenica et al. 2005). According to the National joint registry, the number of primary total hip replacements (THR) in England and Wales in 2008/2009 totalled 77608, which is a steady rise from the amount reported in 2007/2008 (73632) and 2006/2007 (51981) (National Joint Registry for England and Wales 2010). The average age of patients undergoing a primary total hip replacement is 66.7 years (SD 13.1) with females slightly older than males (average 68.4 years (SD12.4) vs. 65.8 years (SD 12.24) respectively) (National Joint Registry for England and Wales 2010). As technology and surgical techniques for total hip replacement (THR) improve, patient expectations have also increased, including for an early return to normal physical function and activities (Wang, Gilbey & Ackland 2002). A reduced time between surgery and mobilisation has been found to have an influence in reducing length of stay and increasing patient satisfaction (Husted et al. 2008). This is particularly important due to the introduction of initiatives such as integrated care pathways, which have rapidly reduced the length of hospital stay following joint replacement with inpatient physiotherapy time also reduced (National Audit Office 2003). The median length of stay for THR patients according to data collated from a total of 125 acute trusts in England (2004-2005) was 7 days (interquartile range IQR 5-10) (Wilson et al. 2008). Whilst THR generally resolves pain, function usually remains substantially sub-optimal. At 24 months following total joint arthroplasty, patients with low pre-operative function are five times more likely to require assistance from another person for their activities of daily living compared to those with high preoperative function (relative risk 5.2, 95% CI 1.9-14.6; (Fortin et al. 2002)). This protracted disability has detrimental economic, social and health consequences. Optimising function after surgery is therefore an important component of rehabilitation.