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INTRODUCTION: This paper aims to determine whether physiotherapy succeeds in improving the functional results (expressed by the Harris hip score) and the quality of life after primary total hip arthroplasty, especially in very elderly persons. MATERIAL AND METHOD: A prospective study has followed up 100 patients with coxarthrosis, who underwent a primary total hip arthroplasty and who were subject to an early initiation of a recovery treatment, adapted to each individual, focused on regaining functionality and independence and continued at home after discharge from hospital. After 3 months, the Harris hip score was compared with the preoperative one and the quality of life was assessed according to a simplified questionnaire derived from SF-36. RESULTS: The average preoperative Harris hip score was significantly lower in patients aged over 75 years, as compared to the other 3 age groups (under 40 years, between 41 and 60 years and between 61 and 75 years). After 3 months, the average Harris hip score was significantly improved, in comparison to the preoperative one (85.89 as compared to 40.06) and there were no statistically significant differences between the average Harris hip score in all 4 age groups. The quality of life was regarded by patients as being good on average, in all 4 age groups. CONCLUSION: Very elderly people benefit equally with the other age groups from a functional recovery after primary total hip arthroplasty, even if this recovery is initially more difficult and more cautious.
RESUMO
AIM: The present paper aims to decipher the multiple factors occurring in patients on the recovery program, in order to obtain an optimal functional outcome after the implantation of a primary total hip prosthesis. MATERIAL AND METHOD: One hundred patients operated with primary total hip prosthesis, consecutively included in this study, underwent an immediate postoperative recovery program, with an integrative aspect, over the entire duration of hospitalization. The program was individualized according to the specific features of the patients, such as gender, age, Body Mass Index (BMI), type of diagnosis that required the prosthesis implantation, type of prosthesis implanted and functional status of the opposite hip, and it was continued at home. At 3 months postoperatively, the Harris hip score (in comparison with the preoperative one) and the quality of life were calculated. RESULTS: At 3 months post-surgery and post-recovery, the average Harris hip score was more than double in comparison with the preoperative one (85.89 as compared to 40.06), and on average the patients considered the quality of life as good. The preoperative Harris hip score had no statistically significant differences in different patient groups, except for the ones aged over 75, for whom it was statistically significantly lower than the score of other age groups. Three months after surgery, the statistically significant differences between different groups of patients disappeared. At 3 months postoperatively, the average perceived quality of life was good. There were statistically significant differences only in obese patients, who considered it to be very good. DISCUSSION: Correlations are sought between different categories of patients and the obtained results, to be compared with the data in specialized literature. CONCLUSIONS: The factors contributing to a good functional outcome after primary total hip arthroplasty are the following: rehabilitation program beginning immediately after surgery, its performance gradually reaching exercises against resistance and its integrative aspect being mainly oriented towards obtaining movement independence and walking recovery, careful adaptation to the specific features of the patient, related to age, weight condition, opposite hip condition and, within each group, related to the physical possibilities of the person submitted to surgery, as well as the continuation of the rehabilitation program at home. Factors such as gender, old age, the cause requiring prosthesis implantation, obesity or unoperated hip with functional impairment are not limitative and do not prevent obtaining satisfactory results.