Total Hip Arthroplasty (THA)
Conditions
Keywords
Rehabilitation, Total Hip Arthtoplasty
Brief summary
This study aims to investigate the effects of an early postoperative rehabilitation program combined with neuromuscular electrical stimulation (NMES) and telerehabilitation on functional recovery in patients undergoing total hip arthroplasty (THA). In the early postoperative period, patients commonly experience muscle weakness, impaired gait, and functional limitations that may delay recovery. Early rehabilitation has been shown to improve functional outcomes, while NMES may enhance muscle activation, particularly in hip abductor muscles. Additionally, telerehabilitation may support continuity of care following discharge by enabling supervised home-based exercise. In this prospective study, participants will be assigned to either an intervention group receiving early physiotherapy combined with NMES and telerehabilitation, or a control group receiving standard postoperative care. Functional outcomes, gait parameters, quality of life, and muscle-related changes will be evaluated at predefined time points.
Detailed description
This study is designed as a prospective, randomized controlled clinical trial to evaluate the effectiveness of an early postoperative rehabilitation program combined with neuromuscular electrical stimulation (NMES) and telerehabilitation in patients undergoing total hip arthroplasty (THA). Following THA, patients frequently experience muscle weakness, gait asymmetries, and reduced functional capacity, which may prolong recovery. Although early mobilization and rehabilitation are widely recommended, the combined effects of NMES and telerehabilitation within a structured early-phase rehabilitation program have not been sufficiently investigated. Participants will be randomly allocated into intervention and control groups using a simple randomization method. The intervention group will receive a structured physiotherapy program initiated on the first postoperative day and continued daily during hospitalization. This program will be combined with NMES targeting the gluteus medius muscle, applied using surface electrodes placed over the motor point with stimulation parameters adjusted according to patient tolerance. After discharge, participants in the intervention group will continue a structured home-based exercise program supported by synchronous telerehabilitation sessions conducted three times per week. These sessions will enable real-time supervision, feedback on exercise performance, and progression based on standardized tolerance criteria. The control group will receive the standard postoperative care protocol routinely applied in the clinic, without additional NMES or telerehabilitation support. All participants will be evaluated at predefined time points: preoperatively (within 3 days before surgery), at discharge (postoperative day 6), and at postoperative week 4. Outcome assessments will be performed by an experienced physiotherapist blinded to group allocation, and intervention delivery and outcome assessment will be conducted by different physiotherapists. The primary objective of the study is to determine whether the addition of NMES and telerehabilitation to early rehabilitation improves functional recovery following THA. Secondary objectives include evaluating changes in muscle strength, joint mobility, pain levels, gait characteristics, and muscle morphology.
Interventions
OTHEREarly Postoperative Physiotherapy
A structured physiotherapy program including mobilization and therapeutic exercises initiated on postoperative day 1 and continued daily until discharge (5 days).
DEVICENeuromuscular Electrical Stimulation (NMES)
NMES applied to the gluteus medius muscle starting on postoperative day 1, administered daily for 5 days using standard stimulation parameters to enhance muscle activation.
OTHERTelerehabilitation
A 3-week home-based exercise program supported by synchronous video-based telerehabilitation sessions conducted three times per week after discharge.
Routine postoperative care including wound monitoring and general medical follow-up during hospitalization. At discharge, patients receive a home exercise brochure without supervised rehabilitation or telerehabilitation.
Sponsors
Muğla Sıtkı Koçman University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The study was designed as a single-blind randomized controlled trial in which outcome assessments were performed by an independent and experienced physiotherapist blinded to group allocation.
Intervention model description
2 groups with two different applications
Eligibility
Sex/Gender
ALL
Age
50 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients scheduled for unilateral total hip arthroplasty due to osteoarthritis or developmental dysplasia of the hip (DDH) * Aged between 50 and 75 years * Willing and able to participate in all follow-up assessments * Able to comply with assessment procedures * Able to meet the requirements of telerehabilitation * Undergoing surgery with a standardized surgical protocol
Exclusion criteria
* Previous history of total hip arthroplasty on either side * Planned revision total hip arthroplasty * Severe osteoarthritis in the contralateral hip * Presence of severe acute metabolic, neuromuscular, or cardiovascular disease * History of active malignancy * Presence of respiratory infection * Concomitant orthopedic conditions (e.g., lower extremity fractures, severe hip/knee deformities, lumbar or sacroiliac dysfunction) * Body mass index \>35 * Occurrence of postoperative complications (e.g., prosthetic infection, thromboembolic events, or conditions requiring reoperation)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Timed Up and Go (TUG) Test | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4. | Functional mobility will be assessed using the Timed Up and Go (TUG) test. The time required to stand up from a chair, walk 3 meters, turn, return, and sit down will be recorded in seconds. |
| 10-Meter Walk Test (10MWT) | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Gait speed will be assessed using the 10-Meter Walk Test. Walking speed will be recorded in meters per second (m/s). |
| Stair Climb Test | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Functional lower extremity performance will be assessed using the Stair Climb Test. The time required to ascend and descend a standardized flight of stairs will be recorded in seconds. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 6-Minute Walk Test (6MWT) | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Functional exercise capacity will be assessed using the 6-Minute Walk Test. The total walking distance covered in 6 minutes will be recorded in meters. |
| Hip Muscle Strength (Manual Muscle Testing) | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Hip muscle strength (flexion, extension, and abduction) will be evaluated using Manual Muscle Testing, graded on a scale from 0 to 5, where 0 indicates no muscle contraction and 5 indicates normal muscle strength. Higher scores indicate better muscle strength. |
| Range of Motion (ROM) | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Hip joint range of motion (flexion, extension, and abduction) will be measured using a goniometer and recorded in degrees. Higher values indicate greater joint mobility. |
| Pain Intensity (Visual Analog Scale - VAS) | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Pain intensity during movement will be assessed using the Visual Analog Scale (VAS), a 10-centimeter scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate worse pain. |
| Hip Function and Quality of Life (International Hip Outcome Tool-12) | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Hip-related function and quality of life will be assessed using the International Hip Outcome Tool-12 (IHOT-12). Scores range from 0 to 100, with higher scores indicating better hip function and quality of life. |
| Gluteus Medius Muscle Sarcopenia (CT-Based Assessment) | Preoperative (within 3 days before surgery) and postoperative week 4 | Gluteus medius muscle sarcopenia will be assessed using computed tomography (CT) imaging. Muscle cross-sectional area and composition will be analyzed. |
| Step Length | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Step length will be assessed using gait analysis methods and recorded in meters. Higher values indicate better gait performance. |
| Cadence | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Cadence will be assessed using gait analysis methods and recorded as steps per minute. Higher values indicate better gait performance. |
| Walking Speed | Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4 | Walking speed will be assessed using gait analysis methods and recorded in meters per second (m/s). Higher values indicate better gait performance. |
Countries
Turkey (Türkiye)
Contacts
CONTACTCansu Dal, Specialist Physiotherapist
Outcome results
None listed