Rothman Study: Formal PT Unnecessary After THA

Matthew S. Austin, M.D. is director of Joint Replacement Services at Rothman Institute in Philadelphia, and a co-author on a new study indicating that patients don’t absolutely have to undergo formal physical therapy (PT) after total hip arthroplasty (THA).

Their work, “Formal Physical Therapy After Total Hip Arthroplasty Is Not Required: A Randomized Controlled Trial,” was published in the April 19, 2017 edition of The Journal of Bone and Joint Surgery.

Dr. Austin told OTW, “We were seeing patients in follow-up who were telling us that they did not feel that formal physical therapy (formal=with a physical therapist) was beneficial after total hip arthroplasty.”

“We began informally questioning patients on their thoughts regarding the role that formal physical therapy played in their recovery after total hip arthroplasty and many patients felt that the exercises were ones that they could simply do at home after they were discharged from the hospital. After reviewing the existing literature, we decided to conduct this study to investigate the effects of formal physical therapy on recovery after total hip arthroplasty.”

The authors wrote, “We conducted a single-center, randomized trial of 120 patients undergoing primary, unilateral total hip arthroplasty who were eligible for direct home discharge. The experimental group followed a self-directed home exercise program for 10 weeks. The control group received the standard protocol for physical therapy that included in-home visits with a physical therapist for the first 2 weeks followed by formal outpatient physical therapy for 8 weeks.”

Dr. Austin commented to OTW, “Our most important finding was that formal physical therapy may not be necessary for the majority of patients who undergo total hip arthroplasty.”

“We believe that most patients benefit from a self-directed program that guides them through the recovery process. It is very important to note that many patients may still benefit from formal physical therapy after total hip arthroplasty (patients who are deconditioned prior to surgery, those who are not progressing as well as expected after surgery, etc.). The surgeon and the patient, after shared-decision making, should still be in control of deciding whether or not formal physical therapy is necessary after total hip arthroplasty.”

“We hope that this study will encourage other centers to investigate the the role of post-acute care discharge services, such as physical therapy, after total joint arthroplasty and to better define which patients may benefit from such services.”