The effects of exercise on function and pain following total hip arthroplasty: a systematic literature review and meta-analysis

Abstract

Background

Previous reviews have reported the efficacy of exercise interventions following total hip arthroplasty (THA), but poor inter-study comparability of low-quality studies, and outcome measure heterogeneity predominate. Conclusions regarding exercise intervention efficacy following THA are lacking.

Objectives

Conduct a systematic literature review with meta-analysis to report the effects of exercise following THA, using self-reported outcome measures of function and pain, and clinical tests for gait capacity.

Methods

An electronic database search of CINAHL, Informit, Medline, Physiotherapy Evidence Database, Scopus, and SportDiscus was conducted. Included studies (1) reported exercise interventions in adult populations following THA; (2) reported outcomes either of physical function, pain intensity, or clinical gait capacity; (3) were randomised controlled trials published in English. Study appraisal was conducted using PEDro scale. A meta-analysis was conducted to report intervention effect size and statistical significance between experimental and control groups.

Results

Searches yielded 5,997 studies. Twenty-four studies underwent systematic review. Twelve were eligible for meta-analysis. Study quality ranged from fair to excellent (median = 7, range = 5–9/10). Exercise interventions included hydrotherapy, and progressive resistance, gait, task-based, upper-limb, and sports therapy training. Significant between-group differences in self-reported function, pain, and gait velocity were observed at short-term follow-up, favouring exercise intervention groups. At long-term follow-up, these improvements were not significant.

Conclusions

This review identified that exercise interventions significantly improved self-reported physical function, pain intensity and gait velocity following THA in the short term. Further research is required to clarify long-term exercise effects, and the most effective exercise intervention, in studies which detail the interventions explicitly.

Keywords:

• Physiotherapy
• arthroplasty
• hip
• replacement
• review
• meta-analysis Declarations of interest

Data availability statement

The data that support the findings of this study are available from the corresponding author, [CAF], upon reasonable request.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Additional information

Notes on contributors

Wilson Tang

Wilson Tang completed a Bachelor of Physiotherapy with Honours in 2019 and was awarded for Excellence in Musculoskeletal Physiotherapy at James Cook University, Townsville, Queensland, Australia. Wilson currently provides primary health care to regional and remote communities in the Whitsunday region and islands. Wilson’s interests include pre- and post-operative rehabilitation, health promotion throughout the lifespan, and sporting injuries in runners and triathletes.

Carol Ann Flavell

Carol Ann Flavell received membership to the Chartered Society of Physiotherapy in 1985, from Wolverhampton School of Physiotherapy, UK, a MSc from the University of the Sunshine Coast, Queensland, in 2010, and a PhD from James Cook University, Townsville in 2018. Carol practiced clinically for almost three decades in the UK, New Zealand, Australia, and Northern Vanuatu. She has experience at all levels of public and private health service delivery (primary and secondary care) and rehabilitation, including management in a regional hospital, and principal/owner of an accredited physiotherapy practice in New Zealand. Since 2010, Carol’s appointments include lecturer in human and functional anatomy, University of the Sunshine Coast, Maroochydore, senior lecturer in musculoskeletal physiotherapy, James Cook University, and post-doctoral research associate, King’s College London, UK. Research interests include reliability of muscle measurement using real time ultrasound, chronic disease (low back pain & HIV rehabilitation), biomechanical movement analysis, measurement tools and new technologies in physiotherapy practice, and interventions for balance, falls and vestibular dysfunction. Carol is a member of the Canada-International Research Collaborative for HIV Rehabilitation, the Australia & New Zealand Musculoskeletal Clinical Trials Network (osteoarthritis group), and the Collaborative Australian Physiotherapy Research Initiative.

Andrea Grant

Andrea Grant completed a Bachelor of Sports and Exercise Science in 2003, at James Cook University. She obtained membership to Exercise Sports Science Australia (ESSA) as a qualified Exercise Physiologist and in 2004 and co-founded an Exercise Physiology practice in Townsville the same year. Andrea received an opportunity to coordinate Chronic Disease Management Programs across North Queensland representing a multinational pharmaceutical company. After working in pharmaceuticals for five years, Andrea began work in Orthopaedic Medical Devices as a product specialist. In 2013, she joined the not-for-profit Orthopaedic Research Institute of Queensland (ORIQL) as Research Coordinator. Andrea has contributed to the growth and success of ORIQL by supporting surgeons, Interns, medical students and surgical fellows meet their research goals, and she has contributed to the completion of over 30 clinical research projects.

Kenji Doma

Kenji Doma completed a Bachelor of Sport and Exercise Science with Honours, in 2008, and a PhD from James Cook University in 2013. Kenji focuses his research on understanding the effects of various exercise modalities in a variety of populations, both athletic and clinical. He is an accredited exercise physiologist with ESSA, and a certified strength and conditioning specialist through the National Strength and Conditioning Association. He is a senior lecturer at James Cook University, primarily teaching into sports rehabilitation, exercise prescription for individuals with chronic conditions, and strength and conditioning for athletes.