OPTIMIZATION OF REHABILITATION PROTOCOLS AFTER ELECTIVE HIP REPLACEMENT IN LIGHT OF CURRENT SCIENTIFIC EVIDENCE
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.5840Keywords:
Total Hip Arthroplasty; Rehabilitation Protocols; Early Mobilization; Strength Training; Functional Outcomes; Pain; Enhanced Recovery After Surgery (ERAS)Abstract
Introduction: Hip replacement is one of the most effective treatments for advanced degenerative disease, but the optimal postoperative rehabilitation model remains a matter of debate.
Objective: The aim of this study was to evaluate current rehabilitation protocols used after elective hip replacement and identify their most important and best-documented elements.
Methods: A narrative literature review was conducted, encompassing 34 publications from 2015–2025, including randomized controlled trials, systematic reviews, meta-analyses, clinical guidelines, and epidemiological data. PubMed and Google Scholar databases were searched using predefined inclusion and exclusion criteria. The timing of rehabilitation initiation, type of intervention, therapy organization, and their impact on pain and functional outcomes were analyzed.
Main Findings: Available evidence confirms that rehabilitation after elective hip replacement promotes improved function, independence, and pain reduction. Promising results have been reported for early mobilization, resistance exercises, functional training, and multicomponent approaches, including patient education and gait retraining. Early mobilization, often on the day of surgery, can shorten hospitalization, while training programs improve functional outcomes, as assessed by the Harris Hip Score, among other measures. However, no clear advantage of one universal rehabilitation model over others has been demonstrated.
Conclusions: Rehabilitation is a key element of treatment after elective hip replacement, significantly improving function and reducing pain. Current evidence supports early, individually tailored, and comprehensive therapy, including mobilization and targeted strength training. Further high-quality methodological research aimed at standardizing treatment is necessary.
References
Beck, H., Beyer, F., Gering, F., Günther, K. P., Lützner, C., & Walther, A. (2019). Sports therapy interventions following total hip replacement. Deutsches Ärzteblatt International, 116(1–2), 1–8. https://doi.org/10.3238/arztebl.2019.0001
Brandes, M., Wirsik, N., Niehoff, H., Heimsoth, J., & Möhring, B. (2018). Impact of a tailored activity counselling intervention during inpatient rehabilitation after knee and hip arthroplasty: An explorative RCT. BMC Musculoskeletal Disorders, 19, 209. https://doi.org/10.1186/s12891-018-2130-7
Brigham and Women’s Hospital. (2022). Total hip arthroplasty/hemiarthroplasty protocol. https://www.brighamandwomens.org/
Chen, G., Yu, D., Wang, Y., Ma, Z., Bi, M., Lu, L., Zhang, X., Li, Y., & Sun, W. (2024). A prospective randomized controlled trial assessing the impact of preoperative combined with postoperative progressive resistance training on muscle strength, gait, balance and function in patients undergoing total hip arthroplasty. Clinical Interventions in Aging, 19, 745–760. https://doi.org/10.2147/CIA.S453117
Christofides, I., Vavliakis, I., De Klerk, H. H., Broekman, M., Verheyen, C. C., & Doornberg, J. N. (2026). Prevalence of hip and knee osteoarthritis in Europe: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 27(1), 155. https://doi.org/10.1186/s12891-026-09493-7
Colibazzi, V., Coladonato, A., Zanazzo, M., & Romanini, E. (2020). Evidence-based rehabilitation after hip arthroplasty. HIP International, 30(Suppl. 2), 20–29. https://doi.org/10.1177/1120700020971314
Costa, L. dos S. M., Lima, V. G., Barros, F. D. da S. F., Pereira, P. A., Lima, R. M. A., & Silva, A. K. A. da. (2021). Hip arthroplasty: Effective rehabilitation protocols. Research, Society and Development, 10(4), e45510414370. https://doi.org/10.33448/rsd-v10i4.14370
Frydendal, T., Christensen, R., Mechlenburg, I., Mikkelsen, L. R., Varnum, C., & Graversen, A. E. (2024). Total hip replacement or resistance training for severe hip osteoarthritis. New England Journal of Medicine, 391(17), 1610–1620. https://doi.org/10.1056/NEJMoa2400141
Götz, J., Maderbacher, G., Leiss, F., Zeman, F., Meyer, M., & Reinhard, J. (2024). Better early outcome with enhanced recovery total hip arthroplasty versus conventional setup: A randomized clinical trial. Archives of Orthopaedic and Trauma Surgery, 144(1), 439–450. https://doi.org/10.1007/s00402-023-05002-w
Huang, L., Han, W., Qi, W., Zhang, X., Lv, Z., & Lu, Y. (2023). Early unrestricted vs. partial weight bearing after uncemented total hip arthroplasty: A systematic review and meta-analysis. Frontiers in Surgery, 10, 1225649. https://doi.org/10.3389/fsurg.2023.1225649
Judd, D. L., Cheuy, V., Peters, A., Graber, J., Hinrichs-Kinney, L., & Forster, J. E. (2024). Incorporating functional strength integration techniques during total hip arthroplasty rehabilitation: A randomized controlled trial. Physical Therapy, 104(3), pzad168. https://doi.org/10.1093/ptj/pzad168
Konnyu, K. J., Thoma, L. M., Cao, W., Aaron, R. K., Panagiotou, O. A., & Bhuma, M. R. (2023a). Prehabilitation for total knee or total hip arthroplasty: A systematic review. American Journal of Physical Medicine & Rehabilitation, 102(1), 1–10. https://doi.org/10.1097/PHM.0000000000002006
Konnyu, K. J., Pinto, D., Cao, W., Aaron, R. K., Panagiotou, O. A., & Bhuma, M. R. (2023b). Rehabilitation for total hip arthroplasty: A systematic review. American Journal of Physical Medicine & Rehabilitation, 102(1), 11–18. https://doi.org/10.1097/PHM.0000000000002007
Lützner, C., Deckert, S., Günther, K. P., Postler, A. E., Lützner, J., & Schmitt, J. (2022). Indication criteria for total hip arthroplasty in patients with hip osteoarthritis—Recommendations from a German consensus initiative. Medicina, 58(5), 574. https://doi.org/10.3390/medicina58050574
Mark-Christensen, T., Thorborg, K., Kallemose, T., & Bandholm, T. (2024). Clinical benefit of physical rehabilitation after total hip and knee arthroplasty: A pragmatic randomized controlled trial (The DRAW1 trial). Osteoarthritis and Cartilage Open, 6(4), 100530. https://doi.org/10.1016/j.ocarto.2024.100530
Massachusetts General Brigham Sports Medicine. (2025). Rehabilitation protocol for total hip arthroplasty (THA). https://www.massgeneral.org/assets/mgh/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-total-hip-arthroplasty.pdf
Meng, Y., Deng, B., Liang, X., Li, J., Li, L., & Ou, J. (2022). Effectiveness of self-efficacy-enhancing interventions on rehabilitation following total hip replacement: A randomized controlled trial. Journal of Orthopaedic Surgery and Research, 17(1), 225. https://doi.org/10.1186/s13018-022-03116-2
Mohanan, C., Aseer, A. L., Jeldi, A. J., Sameer, M. M., & Kannan, S. (2025). The effect of exercises on the quality of life in individuals undergoing hip arthroplasty following hip fractures: A systematic review and meta-analysis. European Journal of Clinical and Experimental Medicine, 23(3), 791–799. https://doi.org/10.15584/ejcem.2025.3.20
Monaghan, B., Cunningham, P., Harrington, P., Hing, W., Blake, C., & O’Doherty, D. (2017). Randomised controlled trial to evaluate a physiotherapy-led functional exercise programme after total hip replacement. Physiotherapy, 103(3), 283–288. https://doi.org/10.1016/j.physio.2016.01.003
Narodowy Fundusz Zdrowia. (2023). Wykonanie świadczeń endoprotezoplastyki stawowej w 2022 r. https://www.nfz.gov.pl/
National Institute for Health and Care Excellence. (2020). Joint replacement (primary): Hip, knee and shoulder (NG157). https://www.nice.org.uk/guidance/ng157
Najwyższa Izba Kontroli. (2019). Dostępność i finansowanie endoprotezoplastyki stawów. https://www.nik.gov.pl/
Naylor, J. M., Hart, A., Harris, I. A., & Lewin, A. M. (2019). Variation in rehabilitation setting after uncomplicated total knee or hip arthroplasty: A call for evidence-based guidelines. BMC Musculoskeletal Disorders, 20, 214. https://doi.org/10.1186/s12891-019-2570-8
Orczyk, P., Gąsior, Z., Dąbek, J., & Kusz, D. (2021). Analysis of factors predisposing to degenerative hip joint lesions based on orthopaedic ward patients. Annales Academiae Medicae Silesiensis, 75, 49–61. https://doi.org/10.18794/aams/133452
Park, S. J., & Kim, B. G. (2023). Effects of exercise therapy on the balance and gait after total hip arthroplasty: A systematic review and meta-analysis. Journal of Exercise Rehabilitation, 19(4), 190–197. https://doi.org/10.12965/jer.2346290.145
Perruccio, A. V., Young, J. J., Wilfong, J. M., Power, J. D., Canizares, M., & Badley, E. M. (2024). Osteoarthritis year in review 2023: Epidemiology & therapy. Osteoarthritis and Cartilage, 32(2), 159–165. https://doi.org/10.1016/j.joca.2023.11.012
Pop, T., Bejer, A., Baran, J., & Szymczyk, D. (2018). Factors affecting the maintenance of occupational activity over a 2–3-year period after total hip replacement. Medycyna Pracy, 69(2), 191–198. https://doi.org/10.13075/mp.5893.00628
Poulsen, A. G., Gravesen, J. D., Madsen, M. N., Mikkelsen, L. R., Bandholm, T., & Rossen, C. B. (2023). Patient perspectives on home-based rehabilitation exercise and general physical activity after total hip arthroplasty: A qualitative study (PHETHAS-2). F1000Research, 10, 382. https://doi.org/10.12688/f1000research.51684.5
Sowa, K., Kotwas, A., Antczak, K., Zdziarski, K., Knyszyńska, A., & Karakiewicz, B. (2019). Postępowanie rehabilitacyjne u pacjentów po endoprotezoplastyce stawu biodrowego w okresie szpitalnym jako profilaktyka przewlekłych deficytów funkcjonalnych. Pielęgniarstwo w Opiece Długoterminowej, 17–24. https://doi.org/10.19251/pwod/2019.1(2)
Su, R., Feng, W., Liu, X., Song, Y., Xu, Z., & Liu, J. (2021). Early rehabilitation and periprosthetic bone environment after primary total hip arthroplasty: A randomized controlled trial. Orthopaedic Surgery, 13(5), 1521–1531. https://doi.org/10.1111/os.12984
Temporiti, F., Draghici, I., Fusi, S., Traverso, F., Ruggeri, R., & Grappiolo, G. (2020). Does walking the day of total hip arthroplasty speed up functional independence? A non-randomized controlled study. Archives of Physiotherapy, 10, 1–7. https://doi.org/10.1186/s40945-020-00079-7
The Ohio State University Wexner Medical Center. (2022). Total hip arthroplasty post-operative clinical practice guideline. https://medicine.osu.edu/-/media/files/medicine/departments/sports-medicine/medical-professionals/hip/total-hip-arthroplasty-cpg-update-2022.pdf
Zhu, S., Qian, W., Jiang, C., Ye, C., & Chen, X. (2017). Enhanced recovery after surgery for hip and knee arthroplasty: A systematic review and meta-analysis. Postgraduate Medical Journal, 93(1106), 736–742. https://doi.org/10.1136/postgradmedj-2017-134991
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Copyright (c) 2026 Weronika Winiarska, Wiktoria Bełcikowska-Skowron, Aleksandra Siegmund, Marzena Chrapczyńska, Agnieszka Filarecka, Piotr Przybyszewski, Emilia Przybyszewska, Julia Gatniejewska, Paulina Prudzic, Martyna Sienicka
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