Early Rehabilitation After Total Hip Arthroplasty

Effect of Early Rehabilitation on Functional Recovery After Total Hip Arthroplasty: A Randomized Controlled Trial

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.

Study Overview

• Status: Recruiting
• Conditions: Total Hip Arthroplasty (THA)
• Intervention / Treatment: Other: Early Postoperative Physiotherapy; Device: Neuromuscular Electrical Stimulation (NMES); Other: Telerehabilitation; Other: Standard Postoperative Care

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.

• Study Type: Interventional
• Enrollment (Estimated): 52
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Cansu Dal, Specialist Physiotherapist; Phone Number: +905379773071; Email: ptcansudal@gmail.com

Study Locations

• Turkey (Türkiye)
  • Merkez
    • Niğde, Merkez, Turkey (Türkiye), 51200
      • Recruiting
      • Niğde Ömer Halisdemir University, Education and Research Hospital
      • Contact: Emin Kürşat Bulut, Asst Prof Orthopedic Surgeon; Phone Number: +905536155737; Email: eminkursatbulut@ohu.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental Group (Early Physiotherapy + NMES + Telerehabilitation); Participants will receive a structured physiotherapy program initiated on the first postoperative day, including exercise and neuromuscular electrical stimulation (NMES) targeting the gluteus medius during hospitalization (5 days). After discharge, the intervention will continue with a 3-week home-based exercise program supported by synchronous telerehabilitation sessions conducted three times per week.	Other: Early Postoperative Physiotherapy; A structured physiotherapy program including mobilization and therapeutic exercises initiated on postoperative day 1 and continued daily until discharge (5 days).; Device: Neuromuscular 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.; Other: Telerehabilitation; A 3-week home-based exercise program supported by synchronous video-based telerehabilitation sessions conducted three times per week after discharge.
Active Comparator: Control Group (Standard Care); Participants will receive the hospital's standard postoperative care during hospitalization, including routine monitoring and wound care without a structured physiotherapy program. At discharge, they will be provided with a home exercise brochure with instructions but will not receive supervised telerehabilitation.	Other: Standard Postoperative Care; 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Timed Up and Go (TUG) Test	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.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4.
10-Meter Walk Test (10MWT)	Gait speed will be assessed using the 10-Meter Walk Test. Walking speed will be recorded in meters per second (m/s).	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4
Stair Climb Test	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.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
6-Minute Walk Test (6MWT)	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.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4
Hip Muscle Strength (Manual Muscle Testing)	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.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4
Range of Motion (ROM)	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.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4
Pain Intensity (Visual Analog Scale - VAS)	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.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4
Hip Function and Quality of Life (International Hip Outcome Tool-12)	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.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4
Gluteus Medius Muscle Sarcopenia (CT-Based Assessment)	Gluteus medius muscle sarcopenia will be assessed using computed tomography (CT) imaging. Muscle cross-sectional area and composition will be analyzed.	Preoperative (within 3 days before surgery) and postoperative week 4
Step Length	Step length will be assessed using gait analysis methods and recorded in meters. Higher values indicate better gait performance.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4
Cadence	Cadence will be assessed using gait analysis methods and recorded as steps per minute. Higher values indicate better gait performance.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4
Walking Speed	Walking speed will be assessed using gait analysis methods and recorded in meters per second (m/s). Higher values indicate better gait performance.	Preoperative (within 3 days before surgery), postoperative day 6 (at discharge), and postoperative week 4

Collaborators and Investigators

• Sponsor: Muğla Sıtkı Koçman University

Publications and helpful links

General Publications

• Monaghan B, Grant T, Hing W, Cusack T. Functional exercise after total hip replacement (FEATHER): a randomised control trial. BMC Musculoskelet Disord. 2012 Nov 28;13:237. doi: 10.1186/1471-2474-13-237.
• Baldwin EB, et al. Wide-pulse-width, high-frequency neuromuscular stimulation: implications for functional electrical stimulation. J Appl Physiol. 2006;101(1):228-240.
• Marchisio AE, et al. Accelerated rehabilitation versus conventional rehabilitation in total hip arthroplasty: A randomized double blinded clinical trial. Rev Col Bras Cir. 2020;47:e20202548.
• Madara KC, et al. Progressive rehabilitation after total hip arthroplasty: A pilot and feasibility study. Int J Sports Phys Ther. 2019;14(4):564-581.

Study record dates

Study Major Dates

• Study Start (Estimated): April 1, 2026
• Primary Completion (Estimated): July 1, 2027
• Study Completion (Estimated): October 1, 2027

Study Registration Dates

• First Submitted: March 30, 2026
• First Submitted That Met QC Criteria: April 19, 2026
• First Posted (Actual): April 24, 2026

Study Record Updates

• Last Update Posted (Actual): April 24, 2026
• Last Update Submitted That Met QC Criteria: April 19, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Rehabilitation; Total Hip Arthtoplasty
• Additional Relevant MeSH Terms: Health Services Administration; Delivery of Health Care; Therapeutics; Patient Care; Health Services; Health Care Facilities Workforce and Services; Rehabilitation; Aftercare; Continuity of Patient Care; Telemedicine; Patient Care Management; Telerehabilitation
• Other Study ID Numbers: CD2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: At this stage, the plan for sharing individual participant data has not yet been determined.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No